PCOS

Question 1

What does the Rotterdam criteria diagnose?

Answer 1

PCOS

Question 2

What are the diagnostic criteria of PCOS (Rotterdam)?

Answer 2

1. Oligomenorrhea/amenorrhea
2. Hyperandrogenism
3. Polycystic ovaries

Question 3

What is the Frank PCOS criteria?

Answer 3

All 3 symptoms: Oligomenorrhea, hyperandrogenism and polycystic ovaries.

Question 4

What is the Ovulatory PCOS criteria?

Answer 4

Hyperandrogenism, polycystic ovaries with REGULAR menstrual cycles.

Question 5

What is the Non-polycystic ovary type of PCOS?

Answer 5

Oligomenorrhea, hyperandrogenism, and NORMAL ovaries. (No cysts)

Question 6

What are the 4 hallmark treatments for PCSO?

Answer 6

1. weight loss
2. COC
3. Metformin
4. Referral to Endocrinologist

Question 7

Does PCOS increase the risk of uterine cancer?

Answer 7

Yes.

Question 8

Why does oral contraceptives or IUD help in PCOS?

Answer 8

They suppress the ovary (suppress ovulation dysregulation) and causing a bleed each month to shed the endometrial lining.

Question 9

How is Metformin helpful in PCOS management?

Answer 9

Helps with insulin resistance especially with increase adiposity.

Question 10

What is the treatment of PCOS if their main symptom is hyperandrogenism?

Answer 10

Spironolactone

Question 11

What are the features of hyperandrogenism in PCOS?

Answer 11

1. Hirsutism
2. Acne
3. Scalp hair loss (receding hair line)

Question 12

What is the condition called that involves thickening of the uterine wall?

Answer 12

Endometrial Hyperplasia

Question 13

Why is contraception recommended so strongly with PCOS?

Answer 13

The infrequent periods make them think they can’t get pregnant and when they start to correct the imbalances, they could ovulate and get pregnant.

Question 14

What two antiandrogen meds has the highest level of progestin?

Answer 14

Norgestrel or Levonorgestrel

Question 15

How long should you try COC for PCOS treatment without improvement of sx before you move to an antiandrogen medication?

Answer 15

6 months.

Question 16

What medication can you use as an antiandrogen if no fertility is desired? And what is the dose?

Answer 16

Spironolactone 50-100 mg BID.

Question 17

What are the 5 antiandrogen medications that have low progestin activity?

Answer 17

1. Ethynodiol (Kelnor, Zovia, Demulen)
2. Norgestimate (Sprintec)
3. Desogestrel (Isibloom)
4. Drospirenone (Yaz, Yasmin)
5. Dienogest (Valette, Jeanine)

Question 17

What are two antiandrogen medications that have a medium level of progestin activity?

Answer 17

1. Norethindrone (Errin)
2. Norethindrone acetate (Aygestin)

Question 18

What is the definition of Amenorrhea?

Answer 18

Absence of menses

Question 19

How long after developing breast buds should a girl get her first menses?

Answer 19

3-5 years

Question 20

What is the definition of primary amenorrhea?

Answer 20

No onset of menses by age 15-16 or within 3-5 years of thelarche (Tanner stage II)

Question 21

What is the definition of secondary amenorrhea?

Answer 21

No menses for 3 months in previously menstruating woman or 9 months in someone with previous oligomenorrhea.

Question 22

What is Turner Syndrome and why would it present with no menses by 15-16?

Answer 22

They have no uterus.

Question 23

Is pregnancy a cause for primary or secondary amenorrhea?

Answer 23

Both

Question 24

Is PCOS a type of primary or secondary amenorrhea?

Answer 24

Secondary

Question 25

Is an absence of a period from hormonal contraception a primary or secondary amenorrhea?

Answer 25

Secondary

Question 26

Is premature ovarian failure a type of primary or secondary amenorrhea?

Answer 26

Secondary

Question 27

Is menopause a type of primary or secondary amenorrhea?

Answer 27

Secondary

Question 28

Is Mullerian agenesis disorder (absence of uterus and vagina) a type of primary or secondary amenorrhea?

Answer 28

Primary

Question 29

Is hyperthyroidism a type of primary or secondary amenorrhea?

Answer 29

secondary

Question 30

What labs do you run for Amenorrhea?

Answer 30

1. hCG- rule out preg. 2. TSH 3. Ha1c- glucose metabolism 4. FSH 5. Prolactin (pituitary mass if elevated) 6. Total Testosterone 7. DHEA (optional) 8. 17-hydroxyprogesterone (in early follicular phase to r/o adrenal hyperplasia) *draw on day 1-5 of bleed early morning.

Question 31

What are the lab values for Functional Hypothalamic Amenorrhea?

Answer 31

-Low FSH -Low estradiol -precipitating factors (disordered eating or excessive exercise)

Question 32

What are the sx of hyperprolactinemia?

Answer 32

galactorrhea macroademona=neuro sx: vision changes & HA Serum prolactin elevated