Question 11: PCOS

Question 1

What criteria are used to diagnose PCOS?

Answer 1

Rotterdam Criteria (2 out of 3 required):

Oligo/anovulation (irregular cycles)
Hyperandrogenism (hirsutism, acne)
Polycystic ovaries on ultrasound

Question 2

What key clinical signs suggest PCOS?

Answer 2

Irregular menstrual cycles
Hirsutism (excessive hair growth)
Acne
Acanthosis nigricans (sign of insulin resistance)

Question 3

What blood tests help diagnose PCOS?

Answer 3

Total testosterone (mildly elevated)
LH/FSH ratio (High LH:FSH, 2:1)
Fasting glucose & insulin (for insulin resistance)
Lipid profile (for metabolic risk)
TSH & prolactin (to rule out other causes)

Question 4

What imaging is used for PCOS diagnosis?

Answer 4

Pelvic ultrasound

≥12 follicles per ovary or increased ovarian volume

Question 5

What is the first-line management for PCOS?

Answer 5

Lifestyle modifications:

Weight loss, healthy diet, exercise

Question 6

How is menstrual irregularity managed in PCOS?

Answer 6

Combined Oral Contraceptives (COCs) – first-line
Cyclic progesterone (if COCs are contraindicated)

Question 7

What medications help with hyperandrogenism in PCOS?

Answer 7

Antiandrogens (spironolactone)
COCs (for hirsutism & acne)

Question 8

What is the treatment for insulin resistance in PCOS?

Answer 8

Metformin

Question 9

How is infertility managed in PCOS?

Answer 9

First-line: Letrozole (ovulation induction)
Alternative: Clomiphene citrate

Question 10

What are the long-term complications of PCOS?

Answer 10

Metabolic: Type 2 diabetes, dyslipidemia, hypertension, cardiovascular disease

Reproductive: Infertility, endometrial hyperplasia/cancer

Psychological: Depression, anxiety