polycystic ovarian syndrome (PCOS)

Question 1

what is PCOS?

Answer 1

complex condition of ovarian dysfunction affecting 5-20% of women of reproductive age

Question 2

what hormones are involved in PCOS?

Answer 2

• hyperinsulinaemia (due to peripheral insulin resistance)
• high levels of LH (due to disordered LH production)
• increased androgen production ⇒ excess small ovarian follicles, irregular/absent ovulation, hirsutism
• overlaps with metabolic syndrome

Question 3

how is PCOS generally managed?

Answer 3

• wt reduction

- if require contraception: COCP to help regulate her cycle and induce a monthly bleed

Question 4

how is hirsutism and acne in PCOS managed?

Answer 4

• COCP
• if no response to COCP: topical eflornithine
• spironolactone, flutamide, finasteride under specialist supervision

Question 5

how is infertility in PCOS managed?

Answer 5

1. wt reduction
2. specialist supervision - full fertility work-up
3. clomifene - 1st line ovulation induction drug
4. metformin - alternative to clomifene
5. gonadotrophins - 2nd line
6. IVF (if 1st and 2nd line fail)

Question 6

what are the complications of PCOS?

Answer 6

• obesity
• T2DM
• subfertility
• miscarriage
• endometrial CA