PCOS (AB) Flashcards
(130 cards)
1
Q
What is the most common endocrinopathy in reproductive-age women?
A
Polycystic Ovarian Syndrome (PCOS)
2
Q
What percentage of reproductive-age women are affected by PCOS?
A
8-13% (70% undiagnosed)
3
Q
What are the two main criteria systems used to diagnose PCOS?
A
NIH and Rotterdam Criteria
4
Q
What is the prevalence of PCOS based on NIH criteria?
A
6-10%
5
Q
What is the prevalence of PCOS based on Rotterdam criteria?
A
0.15
6
Q
What are common menstrual abnormalities in PCOS?
A
Oligomenorrhea or amenorrhea with 1-2 month intervals and possible spotting or intermenstrual bleeding
7
Q
What causes hirsutism in PCOS?
A
Effects of androgens in the periphery
8
Q
Why do women with PCOS often experience infertility?
A
Due to anovulation
9
Q
What is a common ultrasound finding in PCOS?
A
Polycystic ovaries
10
Q
What are the 3 diagnostic criteria in the Rotterdam criteria for adults?
A
Oligo/amenorrhea
11
Q
How many criteria are required to diagnose PCOS in adults using Rotterdam criteria?
A
2 out of 3
12
Q
How many criteria are required to diagnose PCOS in adolescents using Rotterdam criteria?
A
3 out of 3
13
Q
What are the Rotterdam criteria for diagnosing PCOS in adolescents?
A
Oligo/amenorrhea
14
Q
How is PCOS diagnosed in menopausal women?
A
History of PCOS during reproductive years
15
Q
What is the ultrasound finding of polycystic ovaries?
A
> 12 follicles
16
Q
What group developed the consensus on women’s health aspects of PCOS?
A
Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group
17
Q
What does GnRH stimulate the pituitary gland to produce?
A
LH and FSH
18
Q
What hormone stimulates follicular growth and endometrial thickening?
A
Estrogen
19
Q
What triggers the LH surge that causes ovulation?
A
Estrogen reaching a certain threshold
20
Q
What hormone is produced after ovulation and helps maintain pregnancy?
A
Progesterone
21
Q
What happens if fertilization does not occur after ovulation?
A
Menstrual bleeding
22
Q
List 4 risk factors for PCOS.
A
Genetics
23
Q
What hormonal imbalance is seen in PCOS regarding GnRH pulsatile release?
A
Increased GnRH pulsatility leading to increased LH compared to FSH
24
Q
What ovarian cells produce excess androgens in PCOS?
A
Theca cells
25
What causes the arrest of follicular development in PCOS?
Increased androgens and decreased estrogen
26
What is the consequence of chronic anovulation in PCOS?
Endometrial hyperplasia and increased risk of endometrial cancer
27
What ultrasound finding is characteristic of PCOS?
"String of pearls" appearance with >12 small follicles
28
What metabolic complication is common in PCOS?
Insulin resistance
29
How does hyperinsulinemia contribute to hyperandrogenism in PCOS?
Increases ovarian androgen production and decreases SHBG
30
What pregnancy outcomes are associated with maternal PCOS and poor lifestyle habits?
Gestational diabetes
31
Why is early diagnosis and management of PCOS important?
To avoid long-term complications such as infertility
32
What are common symptoms of PCOS?
Oligomenorrhea
33
What is the minimum menstrual frequency considered normal for reproductive-aged women?
At least 8 cycles per year
34
What defines irregular menstrual cycles in adolescents 1-3 years post-menarche?
Cycle length <21 days or >45 days
35
What defines irregular menstrual cycles in women >3 years post-menarche to perimenopause?
Cycle length <21 days or >35 days
36
What defines primary amenorrhea in PCOS evaluation?
No menstruation by age 15 or >3 years post-thelarche
37
What are 4 long-term health consequences of PCOS?
Endometrial hyperplasia/cancer
38
What psychosocial issues are associated with PCOS?
Depression and anxiety
39
What percentage of weight loss can help improve fertility in PCOS?
2-5% weight loss
40
What lifestyle factors increase PCOS risk during pregnancy?
High-fat low-fiber diet
41
Why is intrauterine androgen exposure a risk factor for PCOS?
It programs metabolic dysfunction and increases risk for future PCOS
42
What is the hallmark biochemical feature of PCOS?
Hyperandrogenism
43
What causes insulin resistance in PCOS?
Excess insulin stimulates ovarian androgen production and reduces SHBG
44
Why is unopposed estrogen harmful in PCOS?
Leads to endometrial hyperplasia and cancer
45
What are common causes of abnormal uterine bleeding in PCOS?
Anovulation or breakthrough bleeding
46
What are 3 key elements in managing PCOS?
Lifestyle modification
47
What hormonal feedback mechanism is dysfunctional in PCOS?
Increased LH:FSH ratio
48
How does PCOS contribute to subfertility?
Anovulation and poor follicle maturation
49
How does obesity worsen PCOS symptoms?
Increases insulin resistance and androgen production
50
What is the impact of healthy maternal habits in PCOS pregnancies?
Normal fetal growth and reduced risk of metabolic disorders
51
What is the first-line management for overweight PCOS patients?
Weight loss and lifestyle modification
52
What is the relationship between insulin resistance and hyperandrogenism?
Insulin resistance promotes ovarian androgen production
53
What diagnostic criteria exclude other causes of hyperandrogenism in PCOS?
Rotterdam criteria requires exclusion of other androgen excess disorders
54
What menstrual abnormality is a hallmark of PCOS?
Oligomenorrhea
55
Why is lifestyle counseling important for pregnant women with PCOS?
To prevent metabolic programming that increases future PCOS risk in offspring
56
What is the primary cause of infertility in PCOS?
Anovulation
57
What are the clinical features of hyperandrogenism in PCOS?
Hirsutism
58
What endocrine axis is disrupted in PCOS?
Hypothalamic-pituitary-ovarian (HPO) axis
59
What are two common presentations of PCOS in adolescents?
Irregular menses and hyperandrogenism
60
Why is PCOS screening important in obese adolescents?
Obesity increases risk of insulin resistance and hyperandrogenism
61
What common sleep disorder is associated with PCOS?
Obstructive sleep apnea
62
What cardiovascular risk factors are increased in PCOS?
Hypertension
63
What is the recommended initial weight loss target for lifestyle modification in PCOS?
2-5% weight loss
64
What is the significance of net caloric intake in lifestyle modification for PCOS?
Significant overall decrease in net caloric intake
65
Which medication is commonly recommended for lifestyle modification in PCOS?
Metformin
66
How many menstrual cycles per year is considered oligomenorrhea in PCOS?
Less than 8 cycles per year
67
What type of uterine bleeding is commonly associated with anovulation in PCOS?
Abnormal uterine bleeding
68
What factors determine whether an endometrial biopsy is needed in PCOS?
Clinical scenario and length of exposure to unopposed estrogen
69
What is the first-line pharmacologic treatment for menstrual irregularities in PCOS?
Combined oral contraceptives (COCs)
70
What effect do COCs have on SHBG levels?
COCs increase SHBG levels
71
Which types of oral contraceptives are preferred for PCOS?
Those containing antiandrogenic progestins like cyproterone and estradiol
72
When are cyclic progestins used for menstrual irregularities in PCOS?
If COCs are contraindicated
73
When can progestins be given for irregular menses in PCOS?
Day 16 to day 25 of the cycle (up to 12 tablets per month)
74
When should an endometrial biopsy be considered regardless of age in PCOS?
In cases of prolonged exposure to androgens
75
What is the primary pharmacologic strategy for treating PCOS?
Combination of OCP and antiandrogen therapy
76
Which progestogens are preferred for PCOS treatment?
Less androgenic progestogens like norgestimate
77
Why should antiandrogens be used with OCPs in PCOS?
To prevent exposure during pregnancy
78
How do OCPs suppress ovarian androgens in PCOS?
By inhibiting LH stimulation of the ovary
79
What effect do OCPs have on adrenal androgens?
Decrease adrenal androgens (DHEAS) by ~30%
80
Which enzyme’s activity is inhibited by OCPs in PCOS?
5α-reductase
81
How does ethinyl estradiol in OCPs affect testosterone?
Increases SHBG
82
What are examples of androgen receptor blockers used for PCOS?
Spironolactone and flutamide
83
What type of drug is finasteride?
5α-reductase inhibitor
84
Which antiandrogen is most frequently combined with ethinyl estradiol in PCOS treatment?
Cyproterone acetate
85
At what dose is spironolactone more effective for hirsutism?
200 mg/day for 3 months
86
What percentage reduction in hair shaft diameter is expected after 1 year of spironolactone treatment?
15-25% reduction
87
Why is flutamide rarely recommended for PCOS?
Risk of hepatic toxicity
88
What dose of finasteride is used in PCOS?
5 mg/day
89
When is finasteride considered in PCOS?
Second-line if spironolactone is not tolerated
90
How long does it take to see a response to hirsutism treatment?
About 6 months
91
What percentage of women respond successfully to hirsutism treatment within 1 year?
Approximately 70%
92
What are options for removing remaining excess hair after PCOS treatment?
Electrolysis or laser
93
How long should hirsutism treatment continue before stopping to assess recurrence?
3 years
94
When are cosmetic hair removal measures appropriate in PCOS?
For mild isolated hirsutism or after suppressive therapy
95
What are the definitive hair removal techniques?
Electrolysis and laser
96
How does electrolysis work?
Electrical energy destroys hair follicles
97
What are the four types of lasers used for hair removal?
Nd:Yag
98
What is the preferred term for androgenic alopecia in women?
Female pattern hair loss (FPHL)
99
Which enzyme activity is increased in female pattern hair loss with androgen excess?
5α-reductase
100
Where does hair loss typically occur in female pattern hair loss?
Frontal scalp and vertex
101
What is the mainstay treatment for female pattern hair loss in women?
Antiandrogens
102
Which medications are used to treat alopecia in PCOS?
Spironolactone
103
Is finasteride effective for female pattern hair loss in women?
No
104
What is the role of insulin sensitizers in PCOS treatment?
Proposed for androgen excess but not recommended as primary therapy
105
What is the mechanism of eflornithine cream for facial hirsutism?
Inhibits ornithine decarboxylase
106
What condition was eflornithine originally developed to treat?
Trypanosomal sleeping sickness
107
How long does it take to see improvement with eflornithine cream?
About 8 weeks
108
What percentage of women with acne have androgen excess?
About 52%
109
What hormone stimulates sebum production in acne?
Androgens
110
What is the first-line treatment for acne in PCOS?
Combination oral contraceptives
111
What type of progestins are preferred in OCPs for PCOS acne treatment?
Less androgenic progestins
112
What is the next step if OCPs alone are not successful for acne in PCOS?
Add antiandrogens
113
What criteria are used to diagnose PCOS?
Rotterdam criteria (oligomenorrhea
114
What criteria must adolescents meet to be diagnosed with PCOS?
All 3 of the Rotterdam criteria
115
What are the ultrasound criteria for diagnosing PCOS?
>12 follicles
116
What test is used to assess glycemic control in PCOS?
75g OGTT (glucose tolerance test)
117
What are the major causes of PCOS?
Genetics
118
What causes increased androgen production in PCOS?
Synergistic action of insulin and LH on theca cells
119
How does insulin affect SHBG in PCOS?
Inhibits SHBG production
120
What effect does insulin have on IGF-1 in PCOS?
Increases free IGF-1
121
How does hyperinsulinemia contribute to dyslipidemia in PCOS?
Increases free fatty acids
122
Why does PCOS cause anovulation?
Excess androgen halts follicular growth
123
What type of cholesterol predominates in PCOS?
LDL (bad cholesterol)
124
What long-term condition can thin patients with PCOS develop?
Diabetes mellitus
125
What diagnostic test is recommended for obese PCOS patients?
OGTT for type 2 diabetes screening
126
What cardiovascular effect is associated with PCOS?
Increased long-term cardiovascular risk
127
What is the management for endometrial thickening that persists despite progesterone treatment?
Endometrial biopsy
128
What percentage of weight loss can lead to ovulation improvement in PCOS?
5-10% weight loss
129
What dietary advice is recommended for PCOS patients?
Hypoglycemic diet
130
What surgical option is available for obese patients with PCOS?
Ovarian drilling
