PCOS Flashcards
What is PCOS?
A disorder of unknown comprising of oligomenorrhoea, hyperandrogenism and polycystic ovaries on USS.
Many also have metabolic syndrome (insulin resistance, hypertension, dyslipidaemia and visceral fat) which results in an adverse cardiovascular risk profile with a higher incidence of T2DM and sleep apnoea.
How does PCOS present?
Oligomenorrhoea Subfertility Hirsutism Acne Acanthosis nigricans Obesity
How is PCOS diagnosed?
The Rotterdam Criteria (2/3 present)
- polycystic ovaries on USS (>12 cysts/ovarian volume >10cm^3)
- oligo/anovulation
- clinical/biochemical signs of hyperandrogenism
First, rule out other causes of oligo/anovulation.
Exclude androgen-secreting tumours if hyperandrogenism.
What are the other causes of oligo/anovulation?
Cushing’s syndrome Hyperprolactinaemia Thyroid dysfunction Androgen-secreting tumours Congenital adrenal hyperplasia
What is the management of PCOS?
Weight loss is the mainstay
Treat co-morbidity - hypertension, dyslipidaemia, T2DM
Metformin - may increase insulin-sensitivity in the short-term, may also help menstrual disturbance and ovulatory function.
COCP - regulates bleeding and decreases risk of endometrial cancer due to unopposed oestrogen
Norethisterone - induce withdrawal bleeding for women who cannot take oestrogen
Cosmetic/anti-androgen (topical/oral) treatment for hyperandrogenism
How is PCOS treated in a woman who would like to conceive?
Weight loss/?metformin (unlicensed)
Ovulation induction
- Clomifene citrate (1st line)
- Ovarian drilling (2nd line)
What are the risks with clomifene citrate?
Multiple pregnancy
Ovarian cancer
Ovarian hyperstimulation
What are the risks with ovarian drilling
Pre-term birth
Gestational diabetes
Pre-eclampsia
Large baby
What are the long-term consequences of PCOS?
Gestational diabetes
T2DM
Endometrial cancer
Cardiovascular disease
