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Flashcards in PCOS Deck (10):
0

5 main complications of persistent anovulation?

High estrogen state:

Diabetes, endometrial cancer, hyperlipidemia, metabolic syndrome, cardiovascular disease

1

Patient with suspected PCOS – diagnostic labs?

Other tests?

1. TSH and prolactin
2. FSH/LH
3. Serum testosterone
4. DHEA-S and 17-hydroxyprogesterone

Glucose intolerance screening, endometrial biopsy

2

Diagnostic criteria for PCOS?

1. Oligomenorrhea
2. Hyperandrogenism (acne, hirsutism) excluding other causes
3. Evidence of multiple cysts on the ovary via transvaginal ultrasound

3

Other causes of hyperandrogenism that must be ruled out?

1. CAH (High DHEA-S/17-hydroxyprogesterone)
2. Hyperprolactinemia
3. Adrenal/ovarian tumors (Ovarian mass or leydig tumor)
4. Cushing's
5. Thyroid disorders

4

PCOS – definition?

Condition of unexplained hyperandrogenic chronic anovulation associated with excessive estrogen

5

When to do an endometrial biopsy in PCOS?

In patients with long-standing anovulation unopposed estrogen exposure

6

Treatment goals in PCOS?

1. Reduce circulating androgen levels
2. Protect endometrium from unopposed estrogen (to reduce cancer risk)
3. Weight loss and lifestyle changes
4. Monitor for diabetes and cardiovascular disease

7

Patient with PCOS desires pregnancy - Will likely need?

Clomiphene citrate – SERM that blocks estrogen receptor, causing increased estrogen production. Leads to better follicle recruitment.

8

Primary management of PCOS? Mechanisms? Can also give?

OCP

1. Regulates bleeding
2. Limits unopposed estrogen
3. Increases sex hormone binding globulin (decreases free androgen)
4. Suppresses ovarian Androgen production

Metformin

9

Impatient with chronic anovulation due to PCOS – most likely cancerous lesion? Treatment? Treatment if patient desires pregnancy?

Adenocarcinoma of the endometrium

Hysterectomy and surgical staging

High-dose progestin therapy and repeat endometrial sampling 2-3 months (recommend hysterectomy after childbirth)