Polycystic Ovary Syndrome Flashcards
What does PCOS comprise of?
Hyperandrogenism
oligomenorrheoa
polycystic ovaries on US
in the absence of other causes of polycystic ovaries
What is PCOS associated w
metabolic syndrome: HTN Dyslipidaemia insulin resistance visceral obesity increase in circulating insulin
what is a sign of hyperinsulinaemia
darkened skin on neck and skin flexures
What are the two most common hormone abnormalities seen?How do they lead to increased androgens?
XS LH - increased GnRH pulse frequency leads to more LH being produced by the ant pituitary stimulating ovarian production of androgens
Insulin resistance - resulting in high levels of insulin secretion which suppresses hepatic production of sex hormone binding globulin leading to higher levels of free circulating androgens
What is the typical presentation?
i. Oligomenorrhoea or amenorrhoea
ii. Hirsutism
iii. Acne
iv. Subfertility
Acanthosis nigricans
What is the diagnostic criteria? Explain it
Rotterdam criteria - 2 out of 3 must be present:
- Polycystic ovaries (12 or more follicles or ovarian volume >10cm3 on US)
- Oligo-ovulation or anovulation
- Clinical and/or biochemical signs of hyperandrogenism
What are other causes of irregular cycles which should be excluded
. thyroid dysfunction, hyperprolactinaemia, congenital adrenal hyperplasia, androgen secreting tumours and Cushing’s syndrome
What are the ix
Blood tests
- testosterone
- SHBG is low
- LH
- progesterone
What is the conservative management of PCOS?
→ Weight loss and exercise - mainstay of treatment to increase insulin sensitivity
→ Smoking cessation
→ Treat diabetes, HTN, dyslipidaemia and sleep apnoea
What is the pharmacological treatment? what are they used for?
- COCP - controls bleeding, reduces unopposed oestrogen
- Metformin - improves insulin sensitivity
- Clomifene - induces ovulation
- anti-androgen - hirsutism
- Spirinolactone - anti-androgenic
What is the surgical treatment of PCOS
ovarian drilling
