PCOS Flashcards
(4 cards)
What is PCOS?
- Polycystic Ovarian Syndrome
- Not every cyst is PCOS
- It is a common condition these days - maybe more de to higher levels of obesity
- PCOS is a metabolic disease related to elevated androgens and fasting insulin, abnormal relative ratio of LH and FSH - causing disordered ovarian folliculogenesis, chronic anovulation
Some confusion about what is PCOS versus polycystc overies. You need at least two of the following three criteria - ologo or anolvulatory cycles, clinical and/or hyperandrogenism (eg mald pattern baldness), and third is polycystic ovaries on ultrasound
What are the signs and symptoms of PCOS?
Symptoms
* Amenorrhoea or oligomenorrhoea - lack of periods or fewer
* Hyperinsulinaemia, Acanthosis nigricans: a marker of insulin resistance (dark dry patches on skin)
* Overweight, and difficulty losing weight
* Multiple ovarian follicles on ultrasound
* Androgen excess symptoms, Hirsutism and/or thinning of the head hair or
male pattern balding), Acne vulgaris, deeper voice and change in body structure
* Family history of diabetes, menstrual
irregularity, male baldness men side of
the family…….
Longterm issues
* Longstanding unopposed oestrogen stimulation -> increased risk of endometrial cancer.
* Abnormalitities in lipid profilies and increased risk of CVD.
What are the biochemical features/ pathophysiology?
Biochemical features to look out for
* Increased serum androgen
* Decreased SHBG
* Increase LH and serum LH:FSH ratio >2
* Increase prolactin in some cases
* Increase oestrogen levels, oestradiol can be
increased but typically is low or normal
* Increased fasting insulin or fasting glucose;
fasting insulin levels of 10–14 IU/L are
indicative, > 20 IU/L are diagnostic
Starts of as a metabolic/Endocrine disorder
* Insulin resistance, leading to hyperinsulinaemia: insulin receptors found in
the ovary and the adrenal cortex
* Causes higher pulsatile output of LH, affected via negative feedback to chronically elevated oestrogen levels.
* Excessive LH decreases hepatic SHBG synthesis
* LH alongside the elevated insulin levels,
stimulates ovarian androgen secretion and
some adrenal androgen secretion
* Weight: An increase in fatty tissue leads to the conversion of androgens to oestrone
(aromatisation), and thus increasing the levels
of acyclic oestrogens.
Other things involved
* Leptin
* Hyperandrogenism: inhibits FSH so
inhibiting development and maturation of the follicles, thereby increasing the number of immature follicles
* Hyperprolactinemia
* Endogenous opioids
* Chronic inflammation part of the picture, raised inflammatory markers
* Decreased microbiome diversity
What is orthodox treatment for PCOS?
Orthodox Treatment:
* Metformin (hypoglycaemic) - to get a hold of the insulin resistance
* OCP - to make sure menstruating regularly
* Spironolactone
* Progesterone
* Clomiphene - if infertile
