PCOS Flashcards
(26 cards)
What is the definition of PCOS?
PCOS is a common endocrine disorder affecting 6-12% of women of reproductive age.
It is a chronic, heterogeneous condition with reproductive, metabolic, and psychological implications.
What are the key characteristics of PCOS?
PCOS is characterized by:
- Hyperandrogenism (clinical or biochemical)
- Ovulatory dysfunction (irregular or absent ovulation)
- Polycystic ovarian morphology (by ultrasound)
What are the diagnostic criteria for PCOS according to the Rotterdam Criteria?
2 out of 3 required:
* Oligo/anovulation
* Clinical and/or biochemical signs of hyperandrogenism
* Polycystic ovaries on ultrasound
What is the normal physiology of the menstrual cycle involving the HPO axis?
GnRH from the hypothalamus stimulates FSH and LH secretion. FSH promotes follicle development; LH triggers ovulation. Estrogen and progesterone provide feedback.
What typically occurs during ovulation in the menstrual cycle?
Ovulation typically occurs mid-cycle (~day 14).
What is the LH:FSH ratio in PCOS?
In PCOS, there is an increased LH:FSH ratio.
What are the clinical features of PCOS?
Clinical features include:
* Menstrual irregularities (oligomenorrhea, amenorrhea)
* Hirsutism, acne, alopecia
* Infertility
* Obesity or difficulty losing weight
* Acanthosis nigricans (insulin resistance marker)
What should be included in the history for the diagnostic workup of PCOS?
History should include:
* Age at menarche
* Cycle regularity, duration, and flow
* Symptoms of hyperandrogenism
* Weight changes and lifestyle habits
* Infertility or difficulty conceiving
* Family history of PCOS, diabetes, or metabolic conditions
* Medication use
What physical exam findings are relevant for diagnosing PCOS?
Relevant physical exam findings include:
* BMI and waist circumference
* Blood pressure
* Signs of hyperandrogenism (hirsutism, acne, alopecia)
* Acanthosis nigricans
* Thyroid palpation and galactorrhea check
What serum tests are important in the diagnostic workup for PCOS?
Serum tests include:
* LH, FSH, total testosterone, DHEAS
* Fasting glucose and insulin, HbA1c
* Prolactin, TSH
What is the differential diagnosis for PCOS?
Differential diagnosis includes:
* Congenital adrenal hyperplasia
* Androgen-secreting tumors
* Hyperprolactinemia
* Hypothyroidism
* Cushing’s syndrome
What are the management goals for PCOS?
Management goals include:
* Address patient’s concerns
* Menstrual regulation
* Cosmetic issues (hirsutism, acne)
* Infertility
* Long-term metabolic health
What are the first-line lifestyle modifications for PCOS management?
First-line lifestyle modifications include:
* Diet: Low glycemic index, high fiber
* Exercise: At least 150 minutes/week of moderate activity
* Weight loss improves ovulation and insulin sensitivity
What are the mechanisms of Combined Oral Contraceptives (COCs) in managing PCOS?
COCs suppress LH and FSH, reduce ovarian androgen production, and increase SHBG to reduce free testosterone.
What are common side effects of Combined Oral Contraceptives (COCs)?
Side effects include:
* Nausea
* Breast tenderness
* Weight gain
* Venous thromboembolism risk
What is the mechanism of action of spironolactone in treating hirsutism and acne?
Spironolactone is an androgen receptor antagonist that inhibits androgen production.
What are the potential side effects of spironolactone?
Side effects include:
* Hyperkalemia
* Menstrual irregularities
* Breast tenderness
What is the mechanism of metformin in managing PCOS?
Metformin improves insulin sensitivity, decreases hepatic gluconeogenesis, and may restore ovulation.
What are common side effects of metformin?
Common side effects include:
* GI upset (nausea, diarrhea)
* Vitamin B12 deficiency
What are the surgical options for managing PCOS?
Surgical options include:
* Laparoscopic ovarian drilling
* IVF in cases of failed ovulation induction
What are the risks associated with laparoscopic ovarian drilling?
Risks include:
* Adhesions
* Ovarian failure
What should be monitored for long-term management of PCOS?
Monitor:
* BMI, waist circumference
* Lipid profile, HbA1c
* BP and mood disorders
True or False: PCOS is a multifactorial disorder requiring individualized treatment.
True
