PCOS?
- Dysfunction in hPG axis
- Leading cause of infertility worldwide (10%)
- Linked with metabolic syndrome and high insulin
Features of PCOS (Rotterdam criteria)?
- Rotterdam criteria (2/3 is diagnostic)
- Amenorrhoea or oligomenorrhoea
- Hyperandrogenism (deep voice, male pattern baldness, acne)
- USS evidence of cyst (12 in 1 ovary)
Other features of PCOS?
- Obesity
- Acanthosis nigricans from high insulin
- Mood disturbance
Investigations for PCOS?
- Positive Rotterdam
- LH:FSH ratio >3:1 on day 1-5 is diagnostic
- Pelvic USS shows string of pearls
Management of PCOS?
- Conservative: weightloss
- Medical
- Surgical: laparoscopic ovarian drilling
What is the medical management of PCOS?
- Fertility: clomifene 1st line (SERM), metformin 2nd line/adjunct
- COCP for contraception and hirsutism
What are the associations/complications of PCOS?
- Obesity, dyslipidaemia and T2DM all associated
- HTN and vascular problems
- Increased risk of endometrial cancer from lots of oestrogen
What is a cervical ectropion?
- When the internal columnar epithelium of the cervix is present on the external os
What causes cervical ectropion?
- Increased oestrogen
- COCP, lots of cycles, pregnancy
What is the commonest cause of minor bleed in 3rd trimester?
Cervical ectropion
What is the presentation of cervical ectropion?
PV bleeding and pain most common
How is ectropion managed?
- Benign but can be treated if problematic
- LA diathermy
- Silver nitrate
What are the age classifications for menopause?
- <40: premature (need HRT for bone support)
- 40-45: early
- Average age is 51
Menopause and perimenopoause definitions?
- Perimenopause: from onset of symptoms (up to 5 years before) to 1 year amenorrhoeaic (80% get symptoms)
- Menopause: retrospective diagnosis made after 1 year since LMP
What is the hormonal pattern in menopause?
- High FSH and LH
- Low oestrogen
How is menopause diagnosed?
- > 45 is clinical diagnosis
- <45 requires FSH blood test
What are the gynae symptoms of menopause?
- Vaginal dryness
- Period changes
- Decreased libido
What are the non-gynae changes in menopause?
- Dry skin
- Hot flushes (spontaneous, triggers by stress, caffeine, alcohol, change in temp)
- MSK pain
- Emotional lability
What does menopause increase the risk of?
- Osteoporosis
- CV disease from decreased oestrogen
- Pelvic organ prolapse
- Urinary incontinence
What is the management for menopause?
- No real treatment and most symptoms gone in 5 years
- HRT
- Tibolone (synthetic steroid hormone) acts as continuous HRT, must be amenorrheic for 1 year
- Clonidine - alpha antagonist
- CBT + SSRI
- Testosterone for libido
- Vaginal oestrogen and lube for dryness
What is the main reason for having HRT?
Vasomotor symptoms
How can VTE risk be reduced in menopause?
Give transdermally
What does progesterone increase the risk of?
- Breast cancer
- Risk returns to normal 5 years after treatment
What are some considerations for giving oestrogen only HRT?
- Increases endometrial cancer risk
- Only appropriate if patient had hysterectomy
