Polycystic ovary syndrome Flashcards
Definition
Multiple abnormally developing follicles developing in the ovaries.
Hormonal disorder characterised by hyperandrogenism insulin resistance and anovulation .
Risk Factors
Family history of PCOS
Obesity
Insulin resistance
Presentation
- Oligomenorrhoea or amenorrhoea
- Infertility
- Obesity (in about 70% of patients with PCOS)
- Hirsutism
- Acne
- Hair loss in a male pattern
Diagnosis
- Transvaginal USS: ‘string of pearls’ appearance with follicles arranged at the periphery of the ovaries
- Hormonal blood tests:
= elevated LH (KEY TO REMEMBER)
= Raised LH:FSH (KEY TO REMEMBER)
= elevated testosterone
= low sex hormone-binding globulin (SHBG)
= Low FSH - OGTT is test of choice for screening diabetes in patients with PCOS
= Impaired fasting glucose – fasting glucose of 6.1 – 6.9 mmol/l (before the glucose drink)
= Impaired glucose tolerance – plasma glucose at 2 hours of 7.8 – 11.1 mmol/l
= Diabetes – plasma glucose at 2 hours above 11.1 mmol/l
Diagnostic criteria
The Rotterdam criteria:
A woman must have at least two of the following three features:
= Polycystic ovaries on ultrasound : ≥12 follicles on one developing ovary measuring 2-9mm OR ovarian volume >10cm 3 even without presence of cysts
= Oligo- or anovulation
= Clinical or biochemical signs of hyperandrogenism : examples include acne or hirsutism
Treatment
FIRST LINE: Life modifications:
= dietary
= regular exercise
= weight loss
= smoking cessation
= antihypertensive medications where required
= statins if QRISK > 10%
SECOND LINE:
- Orlistat (BMI > 30) or lipase inhibitor
- Metformin
- COCP
INFERTILITY Mx:
- Clomiphene: induce ovulation
- Ovarian drilling: laprascopic surgery procedure creates multiple holes in the ovaries by diathermy, inducing ovulation and improving fertility
- IVF
HIRTUISM:
- SPIRONOLACTONE
- Finasteride
- Laser hair removal
ACNE:
- Adapalene
- Topical azelaic acid
- Tetracyline Abx
Complications
- Infertility
- Metabolic syndrome: obesity, hypertension, hypercholesterolaemia, insulin resistance, CVD
- Type 2 diabetes
- Acanthosis nigricans
- Endometrial hyperplasia and cancer
- Anxiety and depression
- Obstructive sleep apnoea
Managing risk of endometrial cancer
Mirena coil for continuous endometrial protection
Inducing a withdrawal bleed at least every 3 – 4 months with either:
- Cyclical progestogens (e.g. medroxyprogesterone acetate 10mg once a day for 14 days)
- Combined oral contraceptive pill