polycystic ovary syndrome
Now PMOS!
| Headline | |
|---|---|
| Etiology | ↑ ovary androgen production ⇒ multiple small follicles = inhibits ovulation; associated with insulin resistance. PCOS ≠ polycystic ovaries (25-33% women). |
| Epidemiology | |
| Clinical presentation | - Oligo/amenorrhoea, heavy, irregular or prolonged periods, acne, hirsutism, obesity, infertility, male pattern balding, sleep apnoea - ↓ thyroid, congenital adrenal hyperplasia (esp if total testosterone >5) Ddx: |
| Pathogenesis | |
| Diagnostic investigations | OGTT, CVD screening. See Rotterdam criteria |
| Management | - symptomatic ctrl, lifestyle ∆ (↓ insulin → ↑ SHBG…) - regulating periods: COCP → ↓ LH, ↑ SHBG, protects endometrium - hirsutism: laser, cosmetic, anti-androgens (e.g. cyproterone) + contraceptive |
| Prevention |
Rotterdam criteria
2 of 3 of:
- Menstrual cycle >35d/<10 periods/year (chronic anovulation)
- Polycystic ovaries on USS
- Hyperandrogenism (free androgen index > 5 ⇒ biochemical hyperandrogenism) (FAI = total testosterone x100/SHBG)
- LH:FSH > 2 and normal FSH
- ↑ LH and ↑ FSH = premature ovarian insufficiency
- ↓ LH and ↓ FSH = hypogonadotrophic hypogonadism