Obstetrics and Gynecology · MU Sofia

46. PCOS (polycystic ovarian syndrome)

Covers polycystic ovary syndrome, starting with its prevalence and the Rotterdam diagnostic criteria, including the ultrasound thresholds and the conditions that must be excluded first. It then outlines the insulin resistance and LH-driven androgen pathophysiology, followed by a table of reproductive, metabolic and other features and risks. The closing section sets out management for irregular periods, hirsutism, infertility and metabolic screening.

Inside: 5 sections · 1 table · 15 flashcards · 2 min

Topic 46 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 5 sections, about 228 words (2 min of reading), with 15 flashcards.

In this note

  1. Introduction
  2. Diagnosis: Rotterdam criteria (2 of 3)
  3. Pathophysiology
  4. Features and risks
  5. Management

Introduction

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age (about 8–13%). It is a cause of anovulatory infertility, hirsutism and long-term metabolic disease.

Diagnosis: Rotterdam criteria (2 of 3)

  1. Oligo- or anovulation (irregular or absent periods).
  2. Hyperandrogenism: clinical (hirsutism, acne, alopecia) or biochemical (raised testosterone, free androgen index).
  3. Polycystic ovaries on ultrasound: ≥ 20 follicles in one ovary or ovarian volume ≥ 10 ml (or raised AMH).

Other causes must be excluded: thyroid disease, hyperprolactinaemia, non-classic congenital adrenal hyperplasia (17-OH progesterone), Cushing syndrome, androgen-secreting tumours (very high testosterone, rapid virilisation).

Pathophysiology

  • Insulin resistance with compensatory hyperinsulinaemia (in most, worse with obesity) stimulates ovarian androgen production and lowers SHBG.
  • Raised LH pulse frequency, LH:FSH ratio often > 2, drives theca cell androgens.
  • Follicles start growing but arrest: anovulation and the polycystic appearance.

Management

  • Weight loss (5–10%) and exercise: improves cycles, fertility and metabolic risk.
  • Irregular periods: combined oral contraceptive or cyclical progestogens (at least 4 withdrawal bleeds a year protect the endometrium), or the levonorgestrel IUS.
  • Hirsutism: combined pill (with cyproterone acetate or drospirenone), spironolactone with contraception, cosmetic measures, eflornithine cream.
  • Infertility: letrozole first line for ovulation induction (clomiphene an alternative), metformin as an adjunct, then gonadotrophins (risk of OHSS), laparoscopic ovarian drilling, IVF.
  • Screen for diabetes (OGTT or HbA1c), lipids, BP, mood.

PCOS is diagnosed by any two of: irregular ovulation, high androgens, polycystic ovaries, once other causes are excluded.

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