Polycystic ovary syndrome

Question 1

Definition

Answer 1

Hormonal disorder characterised by hyperandrogenism insulin resistance and anovulation.

Question 2

Epidemiology

Answer 2

Family history of PCOS
Obesity
Insulin resistance

Question 3

Signs

Answer 3

• Hirtuism
• Acne
• Polycystic ovaries on USS

Question 4

Symptoms

Answer 4

• Irregular or absent menstrual periods
• Infertility
• Weight gain

Question 5

Diagnosis

Answer 5

• Transvaginal USS: ‘string of pearls’ appearance with follicles arranged at the periphery of the ovaries
• Hormonal blood tests:
  = elevated LH
  = elevated testosterone
  = low sex hormone-binding globulin (SHBG)
  = Low FSH
  = Raised LH:FSH

Question 6

Diagnostic criteria

Answer 6

The Rotterdam criteria:
A woman must have at least two of the following three features:
= Polycystic ovaries on ultrasound : ≥12 follicles on one developing ovary or ovarian volume >10cm 3
= Oligo- or anovulation
= Clinical or biochemical signs of hyperandrogenism : examples include acne or hirsutism

Question 7

Treatment

Answer 7

FIRST LINE: Life modifications:
= dietary
= regular exercise
= weight loss
SECOND LINE:
- Metformin
- COCP
- Clomiphene: induce vulation
- Ovarian drilling: laprascopic surgery procedure creates multiple holes in the ovaries by diathermy, inducing ovulation and improving fertility

Question 8

Complications

Answer 8

• Infertility
• Metabolic syndrome: obesity, hypertension, hypercholesterolaemia, insulin resistance, CVD
• Type 2 diabetes
• Acanthosis nigricans
• Endometrial hyperplasia and cancer
• Anxiety and depression
• Obstructive sleep apnoea