Sexual Health - Polycystic Ovarian Syndrome Flashcards
What is polycystic ovarian syndrome?
Common condition causing features of :
- Multiple ovarian cysts
- Infertility
- Oligomenorrhea
- Hyperandrogenism
- Insulin resistance
What do each of the following mean?
Anovulation
Oligoovulation
Amenorrhoea
Oligomenorrhoea
Androgens
Hyperandrogenism
Hirsutism
Insulin resistance
Anovulation - absence of ovulation
Oligoovulation - irregular, infrequent ovulation
Amenorrhoea - absence of menstrual periods
Oligomenorrhoea - irregular, infrequent menstrual periods
Hyperandrogenism - effects of high levels of androgens
Hirsutism - growth of thick dark hair
Insulin resistance - lack of response to insulin, high blood sugar levels
What is the Rotterdam criteria used for?
Used for making a diagnosis of PCOS, needs at least 2 of 3 features
- Oligoovulation or anovulation
- Hyperandrogenism
- Polycystic ovaries on USS
Many women have cysts on their ovaries so they must meet at least 2 criteria
How do women with PCOS present?
Oligomenorrhoea or amenorrhoea
Infertility
Obesity (70%)
Hirsutism
Acne
Hair loss in male pattern
What are some other features of PCOS?
Insulin resistance and diabetes
Acanthosis nigricans
CVD
OSA
Sexual problems
Endometrial hyperplasia and cancer
What causes Acanthosis nigricans?
Due to hyperglycaemia, this causes insulin insensitivity and hyperinsulinaemia
High insulin levels act on the IGF-1 receptors of melanocytes causing hyperpigmentation
What are some differential diagnoses of hirsutism?
Medications e.g. phenytoin, ciclosporin, corticosteroids
Ovarian or adrenal tumours
Cushing’s syndrome
Congenital adrenal hyperplasia
Why is insulin resistance a crucial part of PCOS?
Insulin resistance causes increased production by pancreas
Inslun promotes androgen release from ovaries and adrenal glands
Higher levels of insulin result in higher levels of androgens
Insulin suppresses sex hormone-binding globulin (SHBG) production by the liver
SHBG binds to androgens and suppresses function
Reduced SHBG promotes hyperandrogenism
High insulins contribute to lack of development of follices leading to anovulation and multiple partially developed follicles
What helps reduce insulin resistance?
Diet
Exercise
Weight loss
What investigations are used for PCOS?
Testosterone
SHBG
LH
FSH
PRL
TSH
What do hormonal blood tests typically show in PCOS?
Raised LH
Raised LH:FSH
Raised testosterone
Raised insulin
Normal or raised oestrogen levels
What is the gold standard imaging for diagnosing PCOS?
Transvaginal USS
Follicles arranged around periphery of ovary string of pearls appearance
Not reliable in adolescents
What are the diagnostic criteria for PCOS?
12 or more developing follicles in one ovary
Ovarian volume of more than 10cm3
What screening test is used for diabetes in patients with PCOS?
2 hour 75g oral glucose tolerance test
Impaired fasting glucose- 6.1-6.9mmol/L (before glucose drink)
Impaired glucose tolerance- plasma glucose at 2 hours of 7.8-11.1mmol/l
Diabetes- plasma glucose at 2 hours over 11.1mmol/l
What is the general management of PCOS?
Reduce risks associated with obesity, T2DM, hypercholesterolaemia and CVD
What is a significant part of PCOS management?
Weight loss
Can result in ovulation and restore fertility, improve insulin resistance and reduce hirsutism
What drug may be used to help weight loss in women with a BMI over 30?
Orlistat
Lipase inhibitor, stops absorption of fat in the intestines
Why are women with PCOS at higher risk of endometrial cancer?
Corpus luteum releases progesterone after ovulation
Infrequent ovulation means insufficient progesterone
Continuous production of oestrogen
Continuous endometrial lining proliferation without regular shedding
What investigation do women with extended gaps between periods need?
Pelvic USS
Assess endometrial thickness
What options are there for reducing risk of endometrial hyperplasia and endometrial cancer?
Mirena coil
Inducing a withdrawal bleed
- Cyclical progestogens
- COCP
How is infertility managed?
Weight loss initial step
Clomifene
Laparoscopic ovarian drilling
IVF
- Requires screening for gestational diabetes
How is hirsutism managed?
Weight loss
COCP
Topical eflornithine
Finasteride
How is acne managed?
COCP is first-line for acne in PCOS
- Topical adapelene
- Topical clindamycin with benzoyl peroxide
