PCOS - Polycystic Ovary Syndrome |
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| 2007-12-23 | No history |  | Add My version | |
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| Mind map PCOS - Polycystic Ovary Syndrome (from MedMaps.co.uk) - the online mind map resource for medical students and doctors. Gynaecology. Medicine. | |
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PCOS
DIAGNOSTIC CRITERIA (2 OF 3)
IMAGING
Enlarged ovaries
small stromal cysts on surface
1/3 women have polycystic ovaries
of these only 1/3 have syndrome
OLIGOMENORRHOEA or ANOVULATION
meassure early folicular phase LH/FSH
Elevated LH with normal FSH = PCOS
Increases risk Miscarriage (30-50%)
CLINICAL +- BIOCHEMICAL SIGNS OF HYPERANDROGENISM
MEASURE TESTOSTERONE
Elevated Free testosterone >2.5 = PCOS
Due to increased testosterone production by ovary and decreased SHBG (produced in Liver)
If >4.8 then exclude other causes eg) adrenal/oarian tumour
Virilization present
INCREASED RISK FACTORS
Edometrial Hyperplasia/Ca
due to unopposed oestrogen
oestrogens from peripheral conversion
Normally luteal phase progesterone antagonises oestrogen induced endometrial proliferation
Type 2 Diabetes (2x)
TIA (3x)
Cardiovascular
Hypertension
Low HDL-Cholesterol concentration
Hypertriglyceridaemia
Obesity
Central fat distibution
NO INCREASE IN MORTALITY
PATHOGENESIS
Insulin Resistance in adipose tissue & skeletal mscle
HYPERINSULINAEMIA
Insulin sensitivity in the ovary
Strong famillial aggregation
Studies point towards AD
SIGNS & SYMPTOMS
Oligomenorrhoea 30-50%
Ammenorhoea 20-50%
Hirsutism 65-70%
Acne 27-35%
Alopecia 3-6%
Infertility 20-75%
Overweight 40%
TREATMENT
COC
Regular period
Increases SHBG
Free testosterone
Incrases insulin resistance
May provoke Diabetes
Hirsutism
Anti androgens
Cyproterone acetate (in DIANETTE)
Spironolactone
Ocupy androgen binding sites on target tissues
Flutamide
NSAID (works by binding toandrogen recep)
hepatotoxicity
Finasteride
Peripheral conversion of testosterone to more potent form
Oestrogen (coc)
Topical ethornithine cream
METFORMIN
Improved ovulation rate
>improvement if metformin +clomifene
Not licensed for ovulation induction
improved frequency of menses
stimulates insulin sensitivity
serum testosterone
serum insulin
POP
Induce withdrawal bleeds
Decrases cancer risk in non ovulating PCOS
Increase fertility
Anti-oestrogens
Tamoxifen
Clomiphene
Requires USS monitoring in 1st month
risk multifollicular development
Risk of ovarian hyperstimulation syndrome
Risk Multiple preg (13%)
metformin
gonadotrophins
Risk of ovarian hyperstimulation syndrome
Lapelectrodiathermy of ovaries
As good as gonadotrophins
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