» Definition of PCOS?
- A condition in women characterized by irregular or no menstrual periods, acne, obesity, and excess hair growth due abnormal ovarian function and hyperandrogenism (abnormally elevated androgen levels)
» Pathophysiology of PCOS?
- Factors related to genetics, obesity, sedentary lifestyle, intrauterine androgen exposure
- Insulin resistance -> acanthosis nigricans + hyperinsulinemia -> ↑ androgenic enzymes + ↓ SHBG
- Increased GnRH pulsatile release -> ↑ LH: FSH ratio -> theca cells -> androgen excess
- ↑ free testosterone -> hirsutism, acne, alopecia
- ↑ LH:FSH ratio and unopposed estrogen -> irregular menses, amenorrhea, anovulation, infertility and with time -> endometrial hyperplasia and risk of endometrial ca
» Investigations of PCOS?
- Cycle d2-3 hormonal profile (FSH, LH, E2, TSH, testosterone, prolactin)
- 17-hydroxyprogesterone (to r\o late-onset congenital adrenal hyperplasia)
- 24-hr urine cortisol (to r\o Cushing’s)
- US: showing multiple peripheral cysts (20-100 cystic follicles in each ovary) + stromal hyperplasia + thickened ovarian capsule
» Diagnosis of PCOS?
- Based on Rotterdam criteria; 2 of 3:
- Menstrual dysfunction
- Hyperandrogenism, either clinically or biochemically
- Polycystic ovaries on US (≥ 12 peripheral cysts, 2-9 mm in diameter)
- With exclusion of other causes
» Treatment of PCOS according to symptoms?
- For everything and everyone –> life style modifications: quit smoking, weight loss, exercise
- Irregular menses –> OCP (progesterone component will prevent endometrial hyperplasia)
- Hyperandrogenism (hirsutism, acne, alopecia) -> OCP (by suppressing LH stimulation of theca cells + inc SHBG), spironolactone (prevents peripheral conversion of androgens)
- Hirsutism: physical measures (bleaching, waxing, electrolysis)
- Acne: topical benzoyl peroxide, tretinoin cream
- Insulin resistance -> metformin
- Infertility -> metformin + ovulation induction: clomiphene citrate, human menopausal gonadotropin
» Prognosis\complications of PCOS?
- Increased risk of cardiovascular and cerebrovascular diseases
- Insulin resistance -> increased risk of T2DM
- Increased of endometrial hyperplasia and endometrial Ca (no association w\ breast or ovarian ca)