Polycystic ovary syndrome Flashcards
What is the Rotterdam Criteria for PCOS?
2/3 + exclusion of other dx
1. Clinical evidence of Hyper-androgenism
2. Oligo/ anovulation
3. Polycystic ovarian morphology on USS.
What is the aetiology of PCOS? What are the risk factors for PCOS?
Unknown.
Environmental: Diet, exercise, obesity
Genetics: FH, Insulin resistance, hyperandrogenism
Summarise the epidemiology of PCOS.
6-10% of reproductive age
Describe the relationship between insulin and androgens
Androgens increase insulin resistance
Insulin increases androgen production
What are 8 signs and symptoms of PCOS?
Oligmenorrhoea
Subfertility
Hirsutism
Acne
Overweight or obesity
HTN
Acanthosis nigricans
Depression
Give other causes of secondary amenorrhoea and tests to exclude these
Pregnancy
POF: High FSH/LH
Hyperprolactinaemia
TFTs
FHA: SOL, anorexia, excess exercise, Sheehans
Pelvis USS: congenital abnormalities, Asherman’s
Karyotype: Turners
Endocrinopathies: Cushing’s, Acromegaly
What investigations should be performed for PCOS?
Raised LH:FSH ratio
Prolactin: N/ high
SHBG: low
Testosterone: high
TVUSS: 12+ cysts in both ovaries, or ovarian volume >10mL
OGTT: insulin resistance/ T2DM
Which hormones if raised may indicate adrenal cause rather than PCOS?
DHEAS
Androstenedione
?Congenital adrenal hyperplasia
What sign may be seen on USS in PCOS?
String of pearls sign
What is the management of PCOS?
Weight loss, Exercise: Obesity + Amenhorrea
COCP: Amenhorrea, Acne, Hirsutism
Clomifene citrate + Metformin: Fertility
Eflornithine hydrochloride: Hirtuitism.
Anti androgen e.g. Sprinolactone: Hirsuitism (Teratogenic)
What are complications associated with PCOS?
Infertility
Pregnancy complications
T2DM
Non-alcoholic fatty liver disease (NAFLD)
Cardiovascular disease (CVD)
Endometrial hyperplasia or cancer
Metabolic syndrome
Dyslipidaemia
Psychological complications
Obstructive sleep apnoea
What is the prognosis for PCOS?
PCOS is a chronic condition
No cure.
Mx options are targeted at alleviating the signs + Sx to reduce morbidity.
Why is it important to induce at least 3 bleeds per year in PCOS?
Anovulatory: effect of oestrogen is unopposed due to lower levels of progesterone.
Can cause endometrial hyperplasia, risk of becoming malignant.
What can be used to induce a bleed in PCOS if the COCP is contraindicated?
Dydrogesterone: a progesterone analogue
IUS
