Flashcards in PCOS Deck (5)
Diagnosis= 2 of
a. oligo-ovulation or anovulation
b. clinical/biochemicalevidence of hyperandrogenism
c. polycystic ovaries on ultrasonograms
abnormal HPO axis--> inappropriate gonadotropin
release (result of, not cause)
1. Insulin resistance leads to compensatory insulin hypersecretion
2. Promotes ovarian androgen output, promote adrenal androgen output.
3. High insulin levels also suppress hepatic production of sex hormone binding globulin (SHBG), which exacerbates hyper-androgenaemia +free circulating androgens. A
4. High levels of LH->result of an increased frequency of gonadotrophin-releasing hormone pulses from the hypothalamus.
5. Incomplete follicular development which results in polycystic ovarian morphology.
PCOS is associated with what findings
Can take months of treatment to see improvement in symptoms
1. Healthy eating, weight, physical activity
2. Menstrual irregularity->COCP (ethinylestradiol/cyproterone acetate, R/V in 3 months), medroxyprogesterone (same 12 days each month), norethisterone (same 12 days each month), mirena, metformin
3. Obesity->eating and exercise, low glycemic diet
4. Insulin resistance/T2DM->screen for diabetes w/ OGTT
5. Subfertility: Lifestyle (+weight loss) + Clomiphene (needs specialist referral) + metformin
6. CV rosl->diet, exercise, statin and ACEi