13) Gynaecological Problems - PCOS Flashcards
(47 cards)
Incidence of PCOS
10-15% (2-25%)
Incidence of PCOS in women with anovulatory subfertility
85%
Diagnostic criteria for PCOS
Rotterdam criteria.
Any two of:
- Polycystic ovaries on USS (>12 follicles 2-9mm in diameter or overall volume >10cm3)
- Oligo/anovulation
- Clinical or biochemical evidence of increased androgens (Increased free androgen index = total testosterone/SHBG x 100)
Which ethnicity is PCOS more common in?
SE Asian (+ more severe)
What percentage of people with PCOS have an affected first degree relative?
50%
What waist circumference is considered higher risk for PCOS/metabolic syndrome?
> 87cm (should ideally be <80cm)
What percentage of people with PCOS have raised LH levels?
40%
What is the effect of insulin on lipid levels in PCOS?
Increased lipids secondary to insulin as FFA are moved to liver and converted into LDL.
Biochemical investigations in PCOS
Androgens usually high or normal. SHBG usually low or normal. LH high or normal. FSH low or normal. Fasting insulin usually high. Prolactin usually normal (or occasionally slightly high) AMH usually high. Oestradiol usually high.
What percentage of body weight should women with PCOS aim to lose in first year after diagnosis?
5-10%
What measures can be used for weight loss in PCOS?
- Diet
- Exercise (30 min/day to maintain health, 60-90min/day to lose weight)
- Bariatric surgery if BMI >40 or BMI >35 and complications
- Orlistat
What weight loss results from bariatric surgery?
60% weight loss
What is the mortality associated with bariatric surgery?
1%
What is the reduction in PCOS after bariatric surgery?
From 45% to 7%
When should GTT be done in someone with PCOS?
If BMI >25 or other risk factors (including age>40 and ethnicity).
What do the GTT results mean?
Diabetic: >7.0, >11.1
Normal: <6.0, <7.8
Values in-between represent either impaired fasting glycemia or impaired glucose tolerance
When should an annual GTT be done?
If high risk - impaired fasting glycemia or impaired glucose tolerance
How often should people with PCOS have withdrawal bleeds?
Every 3-4 months
What monitoring if women with PCOS don’t have withdrawal bleeds?
TVUS.
<7mm unlikely to be hyperplasia.
>10mm indication for an induced withdrawal bleed, repeat scan and biopsy.
When to investigate for an alternative cause for hirsutism?
If vitalisation, rapid onset or testosterone >5.
Management of hirsutism
Physical treatments
- Laser, electrolysis
- Eflornithine (targets hair follicles)
Medical
- Dianette
- Yasmin
- Spironolactone
Benefits of metformin in PCOS
Benefits on insulin resistance and cardiovascular risk
What pregnancy rate for clomifene in PCOS?
60-70% within 6 cycles
Risk of multiple pregnancy with clomifene
10%
