PCOS

Question 1

presentation PCOS

Answer 1

• Oligomenorrhoea or Amenorrhoea, Subfertility
  -androgen excess: Acne, Hirsutism, Male-pattern baldness
  -metabolic dysfunction: Central obesity, Insulin resistance
  -Psychological problems – Anxiety, Depression, Eating disorders

Question 2

complications of PCOS

Answer 2

• Insulin resistance (2x risk of Diabetes)
  Acanthosis Nigricans associated with IR
• Endometrial hyperplasia (Risk of Endometrial Cancer)
• Increased risk of CVD and stroke (obesity, hypertension, increased LDL and decreased HDL)
• Infertility

Question 3

diagnosis of PCOS requires 2 out of 3

Answer 3

Oligoamenorrhoeaoramenorrhoea
- Hyperandrogenism (Clinical – Hirsutism and Acne or Biochemical – raised testosterone >2.5nmol/L)
- Polycystic ovaries(≥12 follicles)

Question 4

blood tests of PCOS

Answer 4

normal or high oestrogen levels
lower sex hormone binding globulin associated with weight gain
raised testosterone
high LH compared with FSH
raised insulin

Question 5

imgaing PCOS

Answer 5

• Transvaginal ultrasound
  
  • Small peripheral ovarian cysts >10 per ovary
  • Ovarian volume >12 cm

not reliable in teens as multicystic ovaries are common

Question 6

treatment of PCOS

Answer 6

lifetsyle- increases SHBG and decreases androgens. decreases insulin levels and insulin resistance

second line- antiandrogen treatment. combined hormonal contraception, spironolactone, eflornithine cream for hirsutism

metformin
clomifene
mirena coil