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Polycystic Ovary Syndrome (PCOS)

PCOS is one of the most common endocrine conditions in women that emerges at puberty. The clinical features include hyperandrogenism (oligomenorrhoea, hirsutism, acne), ovulation disorders, and a polycystic ovarian morphology.


It presents with:

  • Hyperandogenism - Oligomenorrhoea, Hirsutism, Acne

  • Insulin resistance - Obesity, OSA, Acanthosis nigricans

  • Subfertility

  • Mood swings, depression, anxiety

  • Male pattern baldness


Differentials - Hypothyroidism, Premature ovarian failure, Cushing’s syndrome


Patients with PCOS are at an increased risk of Endometrial cancer. This risk is related to the oligomenorrhea, therefore can be reduced by ensuring regular periods.


N.B. The pancreas has to produce more insulin, which promotes androgen release but prevents follicular development, therefore leading to anovulation and multiple partially-developed follicles → Polycystic ovaries.


Investigations

  • LH:FSH ratio - Will be raised 2x

  • Testosterone - Will be raised

  • Fasting and OGTT - For insulin resistance

  • TVUS


N.B. Raised LH:FSH also helps exlude menopause, in which the ratio would’ve been normal.

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“Polycystic ovary” © Je Hyuk Lee (Licensed under CC-BY 3.0) https://creativecommons.org/licenses/by/3.0/


Rotterdam diagnostic criteria - PCOS can be diagnosed if 2 of the following are present:

  • 12+ cysts seen in one ovary/ovarian volume > 10 cm3

  • Oligo/anovulation

  • Clinical/biochemical features of hyperandrogenism (hirsutism and acne)

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Management

A vital part of the management is Weight loss! It can help to:

  • Restores ovulation

  • Makes periods more regular

  • Improves fertility

  • Improves hisurtism and acne


Other options include COCP, Topical Eflornithine (for hirsutism), Clomiphene (1st line to improve fertility), Ovarian drilling (damage hormone producing cells of ovary).



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