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Gynaecology > Polycystic Ovary Syndrome > Flashcards

Polycystic Ovary Syndrome Flashcards

1
Q

What are the features of PCOS?

A

Oligomenorrhoea
Subfertility
Hirtuism
Obesity
Mood swings and depression
Male pattern baldness
Acanthosis nigricans

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2
Q

What is the definition of oligomenorrhoea?

A

Infrequent, and irregular menstruation

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3
Q

What is the Rotterdam criteria?

A

2 of the 3 criteria are required for a diagnosis of PCOS:
- Polycystic ovaries - more than 12 cysts seen on imaging or ovarian volume > 10cm cubed
- Hyperandrogenism - hirtuism or acne
- Oligoovulation or anovulation (presenting as irregular or infrequent periods)

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4
Q

What are alternative causes of hirtuism?

A

Medications
Ovarian or adrenal tumours (that secrete androgens)
Cushing’s syndrome
Congenital adrenal hyperplasia

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5
Q

What investigations are used to help diagnose PCOS, and what are the corresponding results?

A

LH/FSH ratio (more than 2)
Raised LH
Total testosterone (raised)
Prolactin (mildly elevated)
17-hydroxyprogesterone (to exclude CAH)
Oral glucose tolerance test
TSH

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6
Q

What is the gold standard investigation for visualising the ovaries?

A

Transvaginal ultrasound

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7
Q

What is the initial management of PCOS?

A

Weight loss
Low glycaemic index, calorie controlled diet
Exercise
Smoking cessation

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8
Q

What are the complications of PCOS?

A

Endometrial hyperplasia and cancer
Type 2 diabetes
Infertility
Depression and anxiety
Obstructive sleep apnoea

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9
Q

What medications might patients be started on to reduce cardiovascular complications of PCOS?

A

Antihypertensives
Statins

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10
Q

What medication can be used to reduce hirtuism?

A

Co-cyprindol (combined oral contraceptive pill)

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11
Q

What medication can be used to regulate menstrual bleeding in PCOS?

A

Combined oral contraceptive pill

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12
Q

What medication can be started in PCOS to increase fertility?

A

Clomifene

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13
Q

What is the action of clomifene?

A

Increase ovulation

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14
Q

What is the second line management for increasing fertility in PCOS?

A

Laparoscopic ovarian drilling
- A laser is used to damage the hormone producing cells of the ovaries - this lowers the amount of testosterone made by the ovaries

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15
Q

What is the first line treatment for the management of acne in PCOS?

A

Combined oral contraceptive pill

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16
Q

What risks do women with PCOS have for endometrial cancer?

A

Amenorrhoea
Obesity
Diabetes
Insulin resistance

17
Q

How is endometrial cancer risk reduced in women with PCOS?

A

Mirena coil
Inducing a withdrawal bleed via:
- Combined oral contraceptive pill (with a withdrawal bleed at least once every 3 months)
- Cyclical progesterone only

Gynaecology (27 decks)

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