PCOS

Question 1

What is PCOS

Answer 1

a disorderof the HPO axis which is characterised by ovulatory dysfunction and hyperandrogenism.

in some cases characterised by raised LH and testosterone

Question 2

What is the Rotterdam Criteria

Answer 2

Diagnostic criteria for PCOS: which requires any 2 of the following

• ​Clinical or biochemical hyperandrogenism
  
  • ​Clinical: hirituism, acne or androgenic alopecia
  • Biochemical: raised total free testosterone or LH
• Chronic Anovulation
  
  • ​<9 menses/year
• Polycystic morphology on pelvic USSS

Question 3

What would you see of pelvic USS that is a diagnostic indicator of PCOS

Answer 3

12 or more peripheral antral follicles or increased ovarian volume >10cm³

Question 4

Common and uncommon signs and symptoms of PCOS

Answer 4

Common

• irregular menstruation (75%)
• hirituism (60%)
• acne (15-25%)
• weight gain/high BMI (30-80%)
• Hypertension

Uncommon:

• androgenic alopecia/scalp hair loss
• Acanthos nigricans (due to insulin resistance)
• excess sweating/oily skin

Question 5

Long Term Complications of PCOS to be aware of?

Answer 5

• Infertility or Subfertiliy
• Issues in Pregnancy
  
  • Gest diabetes, Gest hypertension/PET, preterm labour, CVD
• CVD
  
  • ​dyslipidaemia, hypertension, metabolic syndrome
• T2DM
• OSA
• Fatty Liver Disease
• Psychological complications
  
  • depression, anxiety, lower QOL
• Endometrial cancer/hyperplasia
  
  • inc risk due to amenn/oligo

Question 6

Investigations to do in a women with suspected or diagnosed PCOS?

Answer 6

• T2DM risk: screen by OGTT (2hr post fasting) if impaired then require annual test
  
  • if pregnant screen at 24-28 weeks
• CVD risk:
  
  • ​assess risk factors
• OSA
  
  • ​ask individual about snoring, daytime fatigue, somnolence
• Depression, anxiety, poor QOL
  
  • ​depression screen!

Question 7

First Line management of PCOS

Answer 7

Weight gain and lifestyle modifications

COC could be appropriate if also needing contraception

Question 8

Management of hirituism and acne in PCOS

Answer 8

A COC pill can be used.

Always weigh against increased risk of VTE

Question 9

Management of infertility in the setting of a PCOS patient?

Answer 9

• Weight Reduction
• Clomifene,
  
  • ​Note the increased risk of multiple pregnancies with this
    
    • +/- metformin (if obese) to stimulate ovulation
• Recombinant FSH
  
  • direct ovarian stimulation, also inc risk of multiple pregnancies

Question 10

How does clomifene citrate work to increase fertility?

Answer 10

It is anti-oestrogen and therefore increases FSH in the early follicular stage

Answer 11

A cluster of conditions that increase your risk of CVD, stroke and T2DM

Three or more of the following

• Abdominal obesity
• High triglycerides
• Low HDL
• Hypertension
• Insulin Resistance (high fasting plasma glucose)