Makindo Medical Notes.com

Polycystic ovary syndrome (PCOS) is the commonest cause of anovulation in young women

About

• Most common cause of infertility and hirsutism in women
• 4-8% of women have PCOS
• The diagnosis is largely clinical

Aetiology

• Stromal hyperplasia of the ovaries, leading to excess secretion of testosterone
• Formation of multiple follicular cysts
• There is an increase in LH and Obesity and Insulin resistance
• Metabolic syndrome / syndrome X

Clinical

• Obesity (not always)
• Dysfunctional uterine bleeding or amenorrhoea
• Acne, Alopecia, Insulin resistance
• Acanthosis nigricans, Male pattern balding

Investigations

• Increase in LH and Normal FSH
• Increased Oestrone/Oestradiol
• Increased Testosterone, DHEAS, Androstenedione
• Reduced sex hormone-binding globulin
• Prolactin may be increased
• OGTT - look for diabetes or impaired glucose tolerance
• Ovarian ultrasound may be useful but not necessary to confirm diagnosis as the diagnosis is made irrespective of the finding of ovarian cysts

Differential

• Congenital adrenal hyperplasia, Prolactinoma, Acromegaly
• Cushing's syndrome, Ovarian tumour s, Adrenal tumour s

Management

• Reduce weight helps if obese and reduce Insulin resistance + possible role for metformin and referral to a dietician.
• Metformin may help to restore ovulation in conjunction with a low-calorie diet.
• Regular progesterone therapy for 12 days every three months will give a regular withdrawal bleed or the oral contraceptive pill with cyproterone acetate (an antiandrogen) will give a regular period and improve hirsutism and acne.
• Induce ovulation with clomiphene for those who wish to conceive
• Use OCP to suppress ovarian steroidogenesis
• Screen for diabetes - weight reduction is part of the management of obese patients

Complications

• Increased risk of endometrial carcinoma
• Risk of developing diabetes mellitus and cardiac disease