Polycystic Ovary Syndrome Flashcards Preview

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Flashcards in Polycystic Ovary Syndrome Deck (11)
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1
Q

What does PCOS comprise of?

A

Hyperandrogenism
oligomenorrheoa
polycystic ovaries on US
in the absence of other causes of polycystic ovaries

2
Q

What is PCOS associated w

A
metabolic syndrome:
HTN
Dyslipidaemia
insulin resistance 
visceral obesity
increase in circulating insulin
3
Q

what is a sign of hyperinsulinaemia

A

darkened skin on neck and skin flexures

4
Q

What are the two most common hormone abnormalities seen?How do they lead to increased androgens?

A

XS LH - increased GnRH pulse frequency leads to more LH being produced by the ant pituitary stimulating ovarian production of androgens
Insulin resistance - resulting in high levels of insulin secretion which suppresses hepatic production of sex hormone binding globulin leading to higher levels of free circulating androgens

5
Q

What is the typical presentation?

A

i. Oligomenorrhoea or amenorrhoea
ii. Hirsutism
iii. Acne
iv. Subfertility
Acanthosis nigricans

6
Q

What is the diagnostic criteria? Explain it

A

Rotterdam criteria - 2 out of 3 must be present:

  1. Polycystic ovaries (12 or more follicles or ovarian volume >10cm3 on US)
  2. Oligo-ovulation or anovulation
  3. Clinical and/or biochemical signs of hyperandrogenism
7
Q

What are other causes of irregular cycles which should be excluded

A

. thyroid dysfunction, hyperprolactinaemia, congenital adrenal hyperplasia, androgen secreting tumours and Cushing’s syndrome

8
Q

What are the ix

A

Blood tests

  1. testosterone
  2. SHBG is low
  3. LH
  4. progesterone
9
Q

What is the conservative management of PCOS?

A

→ Weight loss and exercise - mainstay of treatment to increase insulin sensitivity
→ Smoking cessation
→ Treat diabetes, HTN, dyslipidaemia and sleep apnoea

10
Q

What is the pharmacological treatment? what are they used for?

A
  1. COCP - controls bleeding, reduces unopposed oestrogen
  2. Metformin - improves insulin sensitivity
  3. Clomifene - induces ovulation
  4. anti-androgen - hirsutism
  5. Spirinolactone - anti-androgenic
11
Q

What is the surgical treatment of PCOS

A

ovarian drilling