PCOS

Question 1

what is PCOS

Answer 1

Heterogeneous endocrine disorder with unknown aetiology

Familial clustering
Accounts for 90% of cases of amenorrhoea

Question 2

features of PCOS

Answer 2

Hyperandrogenism
- Acne
- Hirsutism
- Obesity
Anovulation - doesnt -ovulate every cycle
Oligo/amenorrhoea
- Multiple ovarian follicles on ultrasound

Question 3

criteria used to diagnose PCOS ROTTERDAM

Answer 3

Rotterdam criteria- two out of three features must be present:

1. Clinical or biochemical signs of hyperandrogenism
2. Oligo- amenorrhoea
3. Ultrasound features must be 12 or more, in one or both ovaries)
   and/or
   Increased ovarian volume >10 cm3

Question 4

PCOS DD

Answer 4

• Simple obesity
• Premature ovarian failure
• Thyroid disease
• Hyperprolactinaemia
• CAH
• Androgen secreting tumours
• Cushing’s syndrome

Question 5

Ix for PCOS

Answer 5

blood test during follicular phase

• Sex Hormone Binding Globulin (SHBG)
• Total testosterone
• Free androgen index (FAI) SPECIFIC FEATURE OF PCOS
• FSH, LH
• TFT
• Prolactin

Question 6

primary intervention of PCOS

Answer 6

weight loss
exercise
cessation of smoking

Question 7

other Mx of PCOS

Answer 7

Encourage healthy lifestyle
Offer screening for impaired glucose tolerance
Ask about mental wellbeing and refer appropriately

Question 8

specific Mx of PCOS

Answer 8

depends on what she wants

wants regualr periods

wants to conceive

wants treatment for acne and/or hirsutism

Question 9

if they want regular periods dont want to conceive

Answer 9

COCP

cyclical progestogens

Question 10

if they want to conceive what specific Mx can we do

Answer 10

• Reduce BMI to <30
• Start Folic acid
• Baseline fertility assessment, including semen analysis on partner
• Refer to fertility services
• May require ovulation induction - need partner to test as well
• Metformin controversial

Question 11

if they want to treat their acne and/or hirsutism

Answer 11

COCP
Treatment for acne- retinoids, antibiotics etc as per dermatology
Hair removal methods- waxing, laser treatment

Question 12

long term implications of PCOS

Answer 12

• Type 2 diabetes
• Infertility
• Recurrent miscarriage
• Endometrial cancer - at a relative young age it is ass.
• Cardiovascular disease
• Obstructive sleep apnoea
• Pregnancy complications, such as pre-eclampsia and gestational diabetes
• Psychological disorders, such as anxiety anddepression

Question 13

pathophysiology of PCOS

Answer 13

disordered LH production and peripheral insulin resistance hENCE raised LH and insulin levels

results in increased androgen production which disrupts folliculogenesis

• excess small ovarian follicles
• irregular or absent ovulation
• hirsutism