Polycystic Ovary Syndrome

Question 1

Define PCOS

Answer 1

Triad of increased androgens, oligo/anovulation and polycystic ovaries on USS

Question 2

What are the causes/risk factors of PCOS?

Answer 2

Insulin resistance -> compensatory hyperinsulinaemia -> ↑ ovarian androgen synthesis and
↓ hepatic SHBG synthesis -> increased free androgens
↑ GnRH pulses from hypothalamus -> ↑ LH -> ↑ ovarian androgen synthesis and polycystic
ovaries

Associated with obesity, insulin resistance (IGT/diabetes), dyslipidaemia
• Family history of PCOS
• Obesity

Question 3

What are the symptoms of PCOS?

Answer 3

• Oligo/amenorrhea
• Dysfunctional uterine bleeding
• Infertility
• Hirsutism
• Acne
• Oily skin
• Excessive sweating
• Male pattern baldness

Question 4

What are the signs of PCOS?

Answer 4

• Acanthosis nigricans

Question 5

What investigations are carried out for PCOS?

Answer 5

• Bloods
- Raised LH and LH:FSH ratio
- Elevated testosterone, DHEA-S
- Fasting lipid panel – elevated lipids
- Prolactin – exclude hyperprolactinaemia
- TFTs – exclude thyroid disease
- Glucose – look for IGT and diabetes
• Pelvic/transvaginal USS – 12 or more follicles in each ovary measuring 2-9mm