PCOS Flashcards
What is PCOS?
Disturbance of reproductive,
endocrine, and metabolic function
Polycystic ovary syndrome (PCOS) is a common endocrine disorder, characterised by excess androgen production and the presence of multiple immature follicles (“cysts”) within the ovaries.
Aetiology/ Pathophysiology of PCOS:
The cause of PCOS is unknown but is thought to be due to a mix of genetic and environmental factors resulting in hormonal abnormalities (excess LH levels and insulin resistance).
2 most common hormonal abnormalities:
1. excess Luteinising hormone - – produced by the anterior pituitary gland in response to an increased GnRH pulse frequency.
This stimulates ovarian production of androgens.
- insulin resistance
– resulting in high levels of insulin secretion.
This suppresses hepatic production of sex hormone binding globulin (SHBG), resulting in higher levels of free circulating androgens.
Despite the high levels of LH, the increased circulating androgens suppress the LH surge (which is required for ovulation to occur). Follicles develop within the ovary, but are arrested at an early stage (due to the disturbed ovarian function) – and they remain visible as “cysts” within the ovary.
RF for PCOS?
50% first degree female relative affected
diabetes, irregular menstruation and/or a family history of PCOS are at an increased risk of developing polycystic ovary syndrome.
What diagnostic criteria is used in diagnosing PCOS?
Rotterdam Criteria
2/3 is diagnostic of PCOS
What are the Rotterdam Criteria?
- Biochemical or clinical hyperandrogenism
- Ovulatory dysfunction - amenorrhea or oligomenorrhea
- polycystic ovaries on ultrasound
Symptoms and potential late sequelae in PCOS?
Hirsutism, acne, alopecia -> T2DM
Menstrual disturbance -> Dyslipidemia
Infertility -> Hypertension
Obesity -> CVD, Endometrial carcinoma
Signs and symptoms include oligo-/amenorrhoea, infertility, hirsutism, obesity and acne.
Clinical features of PCOS?
– menstrual irregularities due to chronic anovulation (oligomenorrhea, amenorrhea), infertility due to anovulation, obesity in 50%, hyperandrogenism (acne vulgaris, seborrhea, alopecia, hirsutism (graded by Ferriman- Gallwey system)
How to grade hirsutism?
Ferriman-Gallwey system – <8 normal; 8-15 mild; >15 moderate-severe
What is your DDX of PCOS?
Hypothyroidism – obesity, hair loss and insulin resistance.
Hyperprolactinaemia – oligomenorhoea/amenorrhoea, acne and hirsutism.
Cushing’s disease – obesity, acne, hypertension, insulin resistance and depression.
What might you find on clinical examination?
hirsutism, acne, obesity, acanthosis nigricans, high BP
What might your investigations be?
- Rotterdam criteria
- Blood tests;
low fsh? high lh?
high testosterone?
low shgb?
low progesterone?
estradiol?
free androgen index?
androstendione?
other; GTT, TFT
infertility? AMH? show how many eggs left - Imaging - pelvic ultrasound
- string of pearls on US?
- >12 follicles measuring 2- 9mm and/or increased ovarian volume
Treatment of PCOS?
break down by;
menstrual irregularities
hyperandrogenism
metabolic derangements
infertility
How to treat menstrual irregularities in PCOS?
- combined OCP for irregular periods
- mirena coil for endometrial protection
- metformin improves menstrual frequency
How to treat hyperandrogenism in PCOS?
- hair removal
- weight reduction
- oral contraceptive
- ethinyl oestradiol with anti androgen e.g. dianette or yasmin - anti-adrogens e.g. spironolactone if unsuitable for COCP
How to treat metabolic derangements in PCOS?
- lifestyle modification
diet, exercise, weight loss - GTT
if BMI >30 or age >40, in preg at 24-28 weeks - Bariatric Surgery if PCOS + BMI >35
