Polycystic Ovarian Syndrome

Question 1

Definition

Answer 1

Characterised by oligomenorrhoea/amenorrhoea and hyperandrogenism (clinical or biochemical). Frequently associated with:

o Obesity
o Insulin resistance
o Type 2 diabetes mellitus
o Dyslipidaemia

Question 2

Aetiology

Answer 2

· Environmental factors

· Genetic variants

· Hyperinsulinaemia results in increased ovarian androgen synthesis and reduced hepatic sex hormone binding globulin (SHBG) synthesis

· This leads to an increase in free androgens (which gives rise to the symptoms)

Question 3

Diagnosis

Answer 3

Can be diagnosed with PCOS if 2/3 of the following apply:

• Oligomenorrhoea/amenorrhoea (irregular or infrequent periods)
• clinical/biochemical hyperandrogenism (signs on excess male hormones)
• presence of polycystic ovaries on ultrasound scan

Question 4

Epidemiology

Answer 4

· PCOS is the MOST COMMON cause of infertility in women

· Affects 6-8% of women

Question 5

Presenting symptoms

Answer 5

· Menstrual irregularities

· Dysfunctional uterine bleeding

· Infertility

· Symptoms of hyperandrogenism:
o Hirsutism
o Male-pattern hair loss
o Acne

Question 6

Signs on physical examination

Answer 6

· Hirsuitism

· Male-pattern hair loss

· Acne

· Acanthosis nigricans (sign of severe insulin resistance) - velvety thickening and hyperpigmentation of the skin of the axillar or neck

Question 7

Investigations (bloods)

Answer 7

· Bloods
o High LH
o High LH: FSH ratio
o High testosterone, androstenedione and DHEA-S
o Low sex hormone binding globulin

· Look for impaired glucose tolerance/T2DM:
o Fasting blood glucose
o HbA1c

· Fasting lipid profile

Question 8

Investigations (other)

Answer 8

· Other things to test for:

o Hyperprolactinaemia
o Hypo/hyperthyroidism
o Congenital adrenal hyperplasia (check 17OH-progesterone levels)
o Cushing’s syndrome

· Transvaginal USS: look for ovarian follicles and an increase in ovarian volume