Polycystic ovarian syndrome (PCOS)

Question 1

What is polycystic ovarian syndrome?

Answer 1

Polycystic ovarian syndrome (PCOS) is a common condition causing metabolic and reproductive problems in women.

Question 2

How to differentiate between menopause/ovarian failure and PCOS as a cause of amenorrhoea (lack of menstruation) and infertility?

Answer 2

Measure LH, FSH and oestrogen

Low oestrogen = menopause/ovarian failure

High oestrogen = PCOS

Question 3

What are the 3 diagnostic criteria for PCOS?

Answer 3

Any 2 from the following 3:

• Hyperandrogenism
• Polycystic ovaries on USS
• Amenorrhoea

Question 4

What is the name for the diagnostic criteria for PCOS?

Answer 4

Rotterdam criteria

Question 5

Only 1 feature of the Rotterdam criteria is needed to diagnose PCOS. True/false?

Answer 5

False

At least 2 of the 3 components are required to diagnose PCOS

Question 6

Key features of PCOS?

Answer 6

Oligomenorrhoea (irregular menstrual periods) or amenorrhoea (lack of menstrual periods)

Infertility

Obesity (in about 70% of patients with PCOS)

Hirsutism

Acne

Hair loss in a male pattern

Question 7

What investigations can be used for PCOS?

Answer 7

Testosterone

Sex hormone-binding globulin

Luteinizing hormone

Follicle-stimulating hormone

Prolactin (may be mildly elevated in PCOS)

Thyroid-stimulating hormone

Question 8

What hormonal blood test readings are typically shown in PCOS?

Answer 8

Raised luteinising hormone

Raised LH to FSH ratio (high LH compared with FSH)

Raised testosterone

Raised insulin

Question 9

In PCOS, a common hormonal blood test reading is raised FSH with increased FSH:LH ratio. True/false?

Answer 9

False

Raised LH and raised LH:FSH ratio (high LH compared to FSH)

Question 10

Imaging method used in suspected PCOS?

Answer 10

Pelvic ultrasound

Question 11

What imaging technique is gold standard for visualising the ovaries?

Answer 11

Transvaginal ultrasound

Question 12

What is the common appearance of the ovarian follicles in PCOS when viewed in imaging?

Answer 12

The follicles may be arranged around the periphery of the ovary, giving a “string of pearls” appearance.

Question 13

What is a significant lifestyle management factor for PCOS?

Answer 13

Weight loss

Weight loss alone can result in ovulation and restore fertility and regular menstruation, improve insulin resistance, reduce hirsutism and reduce the risks of associated conditions.

Question 14

General management for PCOS?

Answer 14

Weight loss

Low glycaemic index, calorie-controlled diet

Exercise

Smoking cessation

Antihypertensive medications where required

Statins where indicated (QRISK >10%)

Question 15

What can PCOS increase the risk of?

Answer 15

Obesity, type 2 diabetes, hypercholesterolaemia and cardiovascular disease.

General management of PCOS aims to reduce the risks of these developing.

Question 16

What is the difference between hirsutism and hypertrichosis?

Answer 16

Hypertrichosis refers to excessive hair growth beyond normal variation for a patient’s age, sex, or race or for a particular body area.

Hirsutism refers to an abnormal excess of hair growth solely in androgen-dependent areas of the body in females i.e. beard and moustache.

Question 17

When are antihypertensives used in PCOS?

Answer 17

When QRISK score > 10%.

QRISK score will tell you whether patient is at low, moderate or high risk of developing CVD in the next 10 years.

Question 18

What is insulin resistance?

Answer 18

Refers to a lack of response to the hormone insulin, resulting in high blood sugar levels

Question 19

What features and complications should be checked for in patients with PCOS?

Answer 19

Endometrial hyperplasia and cancer

Infertility

Hirsutism

Acne

Obstructive sleep apnoea

Depression and anxiety

Question 20

What is the initial management for infertility in PCOS?

Answer 20

Weight loss - can restore regular ovulation

Question 21

What is the initial management for hirsutism in PCOS?

Answer 21

Weight loss may improve and is usually explored as an option after options for hair removal, such as waxing, shaving and plucking have proven ineffective

Question 22

What is the first-line management for acne in PCOS?

Answer 22

COCP (combined oral contraceptive pill)

Question 23

What can COCP use increase the risk of?

Answer 23

Can increase the risk of VTE (venous thromboembolism).