Polycystic ovary syndrome Flashcards

1
Q

Definition

A

Multiple abnormally developing follicles developing in the ovaries.
Hormonal disorder characterised by hyperandrogenism insulin resistance and anovulation .

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2
Q

Risk Factors

A

Family history of PCOS
Obesity
Insulin resistance

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3
Q

Presentation

A
  • Oligomenorrhoea or amenorrhoea
  • Infertility
  • Obesity (in about 70% of patients with PCOS)
  • Hirsutism
  • Acne
  • Hair loss in a male pattern
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4
Q

Diagnosis

A
  • 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
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5
Q

Diagnostic criteria

A

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

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6
Q

Treatment

A

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

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7
Q

Complications

A
  • Infertility
  • Metabolic syndrome: obesity, hypertension, hypercholesterolaemia, insulin resistance, CVD
  • Type 2 diabetes
  • Acanthosis nigricans
  • Endometrial hyperplasia and cancer
  • Anxiety and depression
  • Obstructive sleep apnoea
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8
Q

Managing risk of endometrial cancer

A

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

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