Ovaries: PCOS

Question 1

What is Polycystic Ovarian Syndrome (PCOS)?

Answer 1

PCOS is characterised by hyperinsulinaemia, high LH and cystic ovaries

Affects 20% of women of reproductive age with peak incidence at 30-40 years.

Question 2

What are common symptoms of PCOS?

Answer 2

• Sub/Infertility
• Menstrual Disturbances - Oligomenorrhea/Amenorrhoea
• Hyperandrogenism - Hirsutism, Acne
• Obesity
• Insulin resistance - Acanthosis Nigricans

Question 3

What imaging technique is used for investigating PCOS?

Answer 3

Pelvic ultrasound showing multiple cysts on the ovaries.

Question 4

What blood tests are relevant for diagnosing PCOS?

Answer 4

• Hormone levels: FSH, LH, prolactin, TSH and Testosterone
• Glucose Tolerance

Question 5

What are the Rotterdam criteria for diagnosing PCOS?

Answer 5

**2/3 of the following criteria are required: **
* Oligo- or Amenorrhoea
* Signs of hyperandrogenism: Hirsutism, acne or elevated total/free testosterone
* Polycystic ovaries (USS) - 12+ follicles (2-9mm) in one or both ovaries and/or increased ovarian volume (10cm³ +)

Question 6

What is a **general **management strategy for PCOS?

Answer 6

• Weight reduction if appropriate
• Combined Oral Contraceptive Pill (COC) - regulate cycle + induce monthly bleed

Question 7

What is the first-line treatment for hirsutism and acne in PCOS?

Answer 7

Oral Contraceptive Pill.

Question 8

What are the second and third line treatments for hirsutism and acne?

Answer 8

• 2nd line: Topical Eflornithine
• 3rd line: Spironolactone, flutamide, finasteride (specialist supervision)

Question 9

What management strategies are suggested for infertility related to PCOS?

Answer 9

• Weight loss if required
• Possible research into use of metformin and gonadotrophins

Question 10

Fill in the blank: PCOS affects _______ of women of reproductive age.

Answer 10

20%

Question 11

True or False: Hyperandrogenism includes symptoms such as hirsutism and acne.

Answer 11

True