Polycystic ovarian syndrome

Question 1

What is PCOS

Answer 1

Common condition causing metabolic and reproductive problems in women

Question 2

Characteristic features of PCOS

Answer 2

Multiple ovarian cysts
Infertility
Oligomenorrhea
Hyperandrogenism
Insulin resistance

Question 3

What is oligovulation

Answer 3

Irregular, infrequent menstrual periods

Question 4

What is oligomenorrhea

Answer 4

Irregular, infrequent menstrual periods

Question 4

What is oligomenorrhea

Answer 4

Irregular, infrequent menstrual periods

Question 5

What is hirsutism

Answer 5

Growth of thick dark hair, often in a male pattern eg facial hair

Question 6

What criteria is used for PCOS

Answer 6

Rotterdam

Question 7

What is the Rotterdam criteria

Answer 7

At least 2 of:
Oligoovulation or anovulation - irregular or absent periods
Hyperandrogenism - hirsutism + acne
Polycsystic ovaries on US or ovarian volume >10cm3

Question 8

Presentation of PCOS

Answer 8

Acne
Hirsutism
Hair loss in male pattern
Obesity
Infertility
Oligomenorrhea or amneorrhea

Question 9

Other related features of PCOS not characterising

Answer 9

Insulin resistance and diabetes
Acanthosis nigricans
CVD
Hypercholesterolemia
Endometrial hyperplasia and cancer
Obstructive sleep apnoea
Depression and anxiwty
Sexual problems

Question 10

What is acanthosis nigricans

Answer 10

Thickened rough skin found in axilla and on elbows, velvety texture w insulin resistance

Question 11

Hirsutism differentials

Answer 11

Medications
Ovarian or adrenal tumours -> androgens
Cushings syndrome
Congenital adrenal hyperplasia

Question 12

What medications can cause hirsutism

Answer 12

Phenytoin
Ciclosporin
Corticosteroids
Testosterone
Anabolic steroids

Question 13

Why PCOS linked with insulin resistance

Answer 13

Insulin promotes androgen release and supresses sec hormone binding globulin (liver), further promoting hyperandrogenism
High insulin -> haltinng follicle development -> annovulation
Diet, exercise and weigh tloss help manage

Question 14

Blood tests to diagnose PCOS and exclude other pathology

Answer 14

Testosterone
Sex hormone-binding globulin
Luteinising hormone
Follicle-stimulating hormone
Prolactin - mild elevation
TSH

Question 15

Typical hormonal picture pCOS

Answer 15

Raised LH, LH:FSH ratio, testosterone, insulin
Normal or raised oestrogen

Question 16

What is gold standard for visualising ovaries

Answer 16

Transvaginal US

Question 17

Diagnostic criteria for PCOS on US

Answer 17

> 12 developing follicles in one ovary
Ovarian volume >10cm

Question 18

What is the screening test of choice for diabetes in patients with PCOS

Answer 18

2-hour 75g oral glucose tolerance test
Prior to breakfast

Question 19

What do results of OGTT signal

Answer 19

• Impaired fasting glucose – fasting glucose of 6.1 – 6.9 mmol/l (before the glucose drink)
• Impaired glucose tolerance – plasma glucose at 2 hours of 7.8 – 11.1 mmol/l
• Diabetes – plasma glucose at 2 hours above 11.1 mmol/l

Question 20

What is important to reduce risk of in PCOS

Answer 20

Obesity
T2DM
hypercholesterolaemia
CVD

Question 21

How reduce risks ass with PCOS

Answer 21

Weight loss
low glycaemic index, calorie controlled diet
Exercise
Smoking cessation
AntiHPTN meds where required
Statins indicated (QRISK >10%)

Question 22

What should patients be assessed and managed for (ass features and complications of PCOS)

Answer 22

• Endometrial hyperplasia and cancer
• Infertility
• Hirsutism
• Acne
• Obstructive sleep apnoea
• Depression and anxiety

Question 23

What can weight loss do for PCOS

Answer 23

Ovulation - restore fertility and regular menstruation
Improve insulin resistance
Reduce hirsutism and reduce risks ass conditions

Question 24

What can prescribe for weight loss if women have BMI >30

Answer 24

Orlistat = lipase inhibitor stops absorption of fat in intestines

Question 25

What PCOS have risk factors for endometrial cancer

Answer 25

Obesity Diabetes Insulin resistance Amenorrhea

Question 26

Why does PCOS increase risk of endometrial cnacer

Answer 26

No corpus luteum due to annovulation = oestrogen without progesterone eg unopposed

Question 27

How to reduce risk of endometrial cancer in PCOS

Answer 27

Mirena coil Inducing a withdrawal bleed every 3-4 months with cyclical progesterons (medroxyprogesterone acetate) COCP

Question 28

Specialist options for managing infertility

Answer 28

Clomifene Laparascopic ovarian drilling IVF (Metformin and letrozole may restore ovulation under specialist, evidence unclear)

Question 29

What is laprascopic ovarian drilling

Answer 29

Surgeon punctures holes in ovaries using diathermy or laser therapy Improve womans hormonal profile and result in regular ovulation and fertility

Question 30

What do pregnant women with PCOS need testing for

Answer 30

Gestational diabetes using OGTT before pregnancy 24-28 weeks

Question 31

What COCP is used for hirsutism and acne

Answer 31

Co-cyprindiol (dianette)

Question 32

Pros and cons of co-cyprindiol

Answer 32

Licensed for hirsutism + acne anti-androgenic effect - regulates periods Significant increase VTE - stopped after 3 months of use

Question 33

What can be used for topical hirsutism on face

Answer 33

6-8 weeks to see significant improvement Will return within two months of stopping use

Question 34

Options for hirsutism

Answer 34

Electrolysis Laser hair removal Spirinolactone - mineralcorticoid, anti-androgen effects Finasteride - 5 alpha reductas inhibitor decreases testosterone production Flutamide - non steroidal anti-androgen Cyproterone acetate - anti-androgen and progestin

Question 35

What is first line for acne in PCOS

Answer 35

COCP - co-cyprindiol

Question 36

Other standard treatments for acne

Answer 36

* Topical adapalene (a retinoid) * Topical antibiotics (e.g. clindamycin 1% with benzoyl peroxide 5%) * Topical azelaic acid 20% * Oral tetracycline antibiotics (e.g. lymecycline)