Polycystic Ovary Syndrome (PCOS)

Question 1

What does the Rotterdam criteria for the diagnosis of polycystic ovary syndrome include

Answer 1

2 out of the following:

1. Oligomenorrhoea/ amenorrhoea
2. Hyperandrogenism: clinical (acne, hirsutism, male-pattern hair loss) and / or biochemical (elevated serum androgen levels)
3. Polycystic ovaries on US

Question 2

What is PCOS associated with

Answer 2

obesity
insulin resistance and
dysplipidaemia

Question 3

PCOS is the most common cause of infertility in women. True or false

Answer 3

True

Question 4

What might influence the development of PCOS

Answer 4

environmental- diet and development of obesity
genetic variants - genes regulating gonadotrophin, insulin, androgen synthesis, secretion and action, weight and energy regulation

Question 5

What are some of the clinical presentations of PCOS

Answer 5

Menstrual abnormalities: infrequent or absent menses

Hyperandrogenism: acne, hirsutism and male pattern hair loss

Question 6

What is hirsutism

Answer 6

excess hair growing in a male distribution (upper lip, chin, midstream, periareolarly,linea alba

Question 7

What should be suspected in patients with progressive hirsutism, amenorrhoea and signs of virilisation such as clitoral enlargement, increased muscle mass and deepening of the voice

Answer 7

Androgen-secreting ovarian or adrenal tumour and ovarian hyperthecosis

Question 8

What investigations should be done for patients with potential PCOS

Answer 8

Pregnancy test
LH - high levels are often seen in PCOS
LH: FSH ratio is also often high
Fasting lipid profile

Question 9

Why should serum FSH levels be measured

Answer 9

to rule out premature ovarian failure

Question 10

What should be seen on US to diagnose PCOS

Answer 10

The presence of 12 or more follicles in each ovary measuring 2-9mm and or an increased ovarian volume of more than 10ml

Question 11

What is the treatment for Hirsutism

Answer 11

Oral contraceptive pills are the treatment of choice - oestrogen component increases serum SHBG which binds to and decreases serum free androgen

Question 12

What may be added if the patient is not satisfied with the clinical response after 4-6 months

Answer 12

spironolactone

Question 13

Why should anti androgens not be prescribed without reliable contraception

Answer 13

Potential teratogenic effects

Question 14

What is a side effect of spironolactone

Answer 14

Hyperkalaemia and GI discomfort

Question 15

Name some other anti androgens used in the treatment of hirsutism

Answer 15

Flutamide - may cause hepatotoxicity
Finasteride
Cyproterone acetate - increased risk of hepatotoxicity

Question 16

What is advised for patients desiring pregnancy

Answer 16

Weight loss

Question 17

What is ovarian hyperthecosis characterised by

Answer 17

The presence of islets of Luteinisedk theca cells in the ovarian stroma, resulting in an increased production of androgens

Question 18

Who can be affected by ovarian hyperthechosis

Answer 18

Postmenopausal women (unlike PCOS)

Question 19

How is the diagnosis of ovarian hyperthecosis made

Answer 19

histological examination of the ovaries following a wedge biopsy performed to rule out virilising ovarian tumours

Question 20

What does the treatment of hyperthecosis include

Answer 20

weight reduction
oral contraceptives
spironolactone

Question 21

What drug is superior to metformin in achieving live birth

Answer 21

Clomiphene

Question 22

What drug is a reasonable adjunct to diet and exercise in women with PCOS who are obese

Answer 22

Metformin