PCOS + PMS

Question 1

PMS (Premenstrual syndrome)

Answer 1

Occurrence of somatic, psychological and emotional symptoms in luteal phase - thought to be caused by changing levels of progesterone and oestrogen

95% of women to some degree
5% women severely debilitated

Question 2

Symptoms of PMS?

Answer 2

Abdo: bloating, cramps
Mastalgia
Cyclical weight gain
Psych: headache, irritability, depression, fatigue

Question 3

Conservative management of PMS?

Answer 3

reduce caffeine and alcohol, stress reduction, exercise

Question 4

Medical management of PMS?

Answer 4

COCP - most effective is Yasmin

Transdermal oestrogen

GnRH analogues - usually short term (switch off ovarian activity, so use HRT if long-term)

CBT + SSRIs

Question 5

Pathophysiology of PCOS?

Answer 5

1. Increased GnRH –> increase in LH –> no ‘LH surge’ –> no ovulation
2. Basal increase in LH –> multiple immature ovarian follicles
3. Insulin resistance –> hyperinsulinaemia (compensatory)

LH + hyperinsulinaemia –> increased ovarian androgens –> acne and hirsutism

Question 6

Clinical features of PCOS?

Answer 6

Oligo/amenorrhoea (75%)
Hirsutism and acne
Sub-fertility (75%) and/or recurrent miscarriage (50-60% women)
Obesity (40%)
Acanthus nigricans (areas of increased skin pigmentation)

Question 7

Diagnosis of PCOS

Answer 7

2+ of:

1. oligo/amenorrhoea
2. Hirsutism (clinical or biochemical - hyperandrogenism)
3. polycystic ovaries on USS

Question 8

Blood tests in PCOS

Answer 8

FSH: normal in PCOS
raised in ovarian failure, low in hypothalamic

Prolactin (exclude prolactinemia - pituitary tumour)

Testosterone: raised in PCOS and androgen secreting tumours

LH: often raised (but not diagnostic)

TSH: To rule out thyroid dysfunction

Question 9

Other investigations into PCOS?

Answer 9

TV USS

Diabetes screen (particularly if obese)

Question 10

Management of PCOS

Answer 10

COCP (regulates menstruation - need 3-4 periods a year to protect endometrium)

Cyclical oral progesterone (regulates menstruation)

Metformin - for hyperinsulinaemia or CVD risk (discontinue in pregnancy)

Lifestyle: diet + exercise

Question 11

Sub-fertility medication in PCOS?

Answer 11

Clomiphene - used to induce ovulation when sub fertility present

Question 12

Complications of PCOS?

Answer 12

Type II diabetes (50%)
Gestational DM (30%)
Nb. reduced risk with weight reduction

Endometrial cancer - due to unopposed oestrogen due to amenorrhoea