Polycystic Ovary Syndrome (PCOS) Flashcards
What does the Rotterdam criteria for the diagnosis of polycystic ovary syndrome include
2 out of the following:
- Oligomenorrhoea/ amenorrhoea
- Hyperandrogenism: clinical (acne, hirsutism, male-pattern hair loss) and / or biochemical (elevated serum androgen levels)
- Polycystic ovaries on US
What is PCOS associated with
obesity
insulin resistance and
dysplipidaemia
PCOS is the most common cause of infertility in women. True or false
True
What might influence the development of PCOS
environmental- diet and development of obesity
genetic variants - genes regulating gonadotrophin, insulin, androgen synthesis, secretion and action, weight and energy regulation
What are some of the clinical presentations of PCOS
Menstrual abnormalities: infrequent or absent menses
Hyperandrogenism: acne, hirsutism and male pattern hair loss
What is hirsutism
excess hair growing in a male distribution (upper lip, chin, midstream, periareolarly,linea alba
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
Androgen-secreting ovarian or adrenal tumour and ovarian hyperthecosis
What investigations should be done for patients with potential PCOS
Pregnancy test
LH - high levels are often seen in PCOS
LH: FSH ratio is also often high
Fasting lipid profile
Why should serum FSH levels be measured
to rule out premature ovarian failure
What should be seen on US to diagnose PCOS
The presence of 12 or more follicles in each ovary measuring 2-9mm and or an increased ovarian volume of more than 10ml
What is the treatment for Hirsutism
Oral contraceptive pills are the treatment of choice - oestrogen component increases serum SHBG which binds to and decreases serum free androgen
What may be added if the patient is not satisfied with the clinical response after 4-6 months
spironolactone
Why should anti androgens not be prescribed without reliable contraception
Potential teratogenic effects
What is a side effect of spironolactone
Hyperkalaemia and GI discomfort
Name some other anti androgens used in the treatment of hirsutism
Flutamide - may cause hepatotoxicity
Finasteride
Cyproterone acetate - increased risk of hepatotoxicity
What is advised for patients desiring pregnancy
Weight loss
What is ovarian hyperthecosis characterised by
The presence of islets of Luteinisedk theca cells in the ovarian stroma, resulting in an increased production of androgens
Who can be affected by ovarian hyperthechosis
Postmenopausal women (unlike PCOS)
How is the diagnosis of ovarian hyperthecosis made
histological examination of the ovaries following a wedge biopsy performed to rule out virilising ovarian tumours
What does the treatment of hyperthecosis include
weight reduction
oral contraceptives
spironolactone
What drug is superior to metformin in achieving live birth
Clomiphene
What drug is a reasonable adjunct to diet and exercise in women with PCOS who are obese
Metformin
