Polycystic ovary syndrome (PCOS)

Question 1

Pathophysiology of PCOS

Answer 1

• LH hypersecretion and potentiates the action of LH and IGF-1. Both LH and IGF-1 upregulate synthesis of ovarian and adrenal androgens causing production of testosterone and DHEA-S
• In the ovaries, hyperinsulinism, hyperandrogenism and disordered paracrine signalling cause arrest of follicular development, typically when the follicle acquires aromatase activity and is around 7 mm in size.
• Excessive ovarian androgens impair aromatase function, which is required for further follicular growth
• Overproduction AMH antagonises FSH action and reduces availability of estrogen, which is required for developing follicles
• Arrest of follicular development leads to menstrual disturbance, anovulation and subfertility

Question 2

Rotterdam criteria of PCOS

Answer 2

Two of the following three criteria to be met:
- Oligomenorrhoea or anovulation,
- Clinical and/or biochemical evidence of hyperandrogenism,
- Polycystic ovaries on ultrasonography: multiple
peripheral follicles with ovarian volume >10 ml.