1
Q
Main presenting complaint?
A
- Oligomenorrhoea/ Amenorrhoea
- has a specific pattern of anovulatory bleeding ( no monthly LH-surge- does not ovulate regularly every month- but the endometrium gets laid down all that time (estrogen working)- when periods do come there is heavy bleeding.)
2.Infertility
Long term Issues:
-Metabolic Syndrome
-Endometrial Cancer
2
Q
History of PCOS:
A
- Nature of cycle
- Anovulatory Pattern - Hirsutism
- On contraception?
- struggling with weight?
- PCOS in 1st degree relative?
PCOS is genetic
6.New or worsening acne?
- Voice changes?
If present and male pattern hair loss then not PCOS, refer urgently
3
Q
What to look on examination of PCOS?
A
- Hirsutism (face, abdo, back)
- Acne
- Striae on abdomen
- BMI
- BP
6.Pelvic Exam will be normal
(ovaries do enlarge but never palpable)
4
Q
What is the Rotterdam Criteria for diagnosis of PCOS?
A
- Oligomenorrhoea
- Virulising features
*Biochemical
-Testosterone (High)
-Sex Hormone Binding
Globulin (Low)
-LH > FSH
*Clinical
- Investigation
- PCO on scan
* > 12 follicles in the ovary
* Volume of ovary increased
Metabolic Screen (fasting sample)
- Insulin
- Glucose
- Lipids
- Triglycerides
5
Q
What is the management of PCOS?
A
- Cycle Control
- can give COC
* will cause regular shedding of endometrium
- can give DMPA (injectable progesterone)
- can give Mirena
- will completely thin down the endometrium, will cause amenorrhoea
-Weight loss will improve cycles also
- Infertility Management
- Weight loss
-Refer (reproductive clinic)
BMI needs to be under 35
- Cycle plus infertility issue
- give cyclical provera (Not a contraception) - Aesthetic Management
- Waxing/Laser
-Diane
for acne
COC also works for acne
- Metabolic Syndrome
- Lifestyle changes
-Metformin
can help in losing weight
- Anti-hypertensive
- Statins
Young pts have high blood and diabetes because of PCOS.
-
gynae
flashcards
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