Polycystic Ovarian Syndrome
Definition
Rotterdam Criteria:
Any 2 of:
Epidemiology
Risk Factors
Aetiology
Unknown
Pathogenesis
Insulin resistance --> ++ insulin --> ++ LH --> theca cells (convert androgen + ostrogen) over responsive --> ++ size ++ androgen
Clinical Features
Triad: Hirsutism, anovulation, obesity
++ androgen: hirsutism, balding, acne
DDX
Prolactinaemia, thyroid, congenital adrenal hyperplasia, cushing's syndrome, drugs (Na valproate)
Investigations
Bloods: D3 ostrodiol, D5 LH, D21 progesterone, LH:FSH (++), testosterone, prolactin (++), SHBG (--), BSL/ OGTT, lipids, TFT,
Imaging: US (>/=5 follicles along periphery), laparoscopy (enlarged ovaries)
Management
Source
OHCS 8th Ed 2009
Dr Toly Pavlov 2014
Rotterdam Criteria:
Any 2 of:
- Oligo/Anovulation
- Hyperandrogenism
- Polycystic Ovaries
Epidemiology
- 5% of female population
- 85% ++ androgen
- 30% anovulation
- 20-30y
Risk Factors
- Obesity
- DM/ IGT
- Metabolic syndrome
- CVD
- OSA
- Psychological issues
Aetiology
Unknown
Pathogenesis
Insulin resistance --> ++ insulin --> ++ LH --> theca cells (convert androgen + ostrogen) over responsive --> ++ size ++ androgen
Clinical Features
Triad: Hirsutism, anovulation, obesity
++ androgen: hirsutism, balding, acne
DDX
Prolactinaemia, thyroid, congenital adrenal hyperplasia, cushing's syndrome, drugs (Na valproate)
Investigations
Bloods: D3 ostrodiol, D5 LH, D21 progesterone, LH:FSH (++), testosterone, prolactin (++), SHBG (--), BSL/ OGTT, lipids, TFT,
Imaging: US (>/=5 follicles along periphery), laparoscopy (enlarged ovaries)
Management
- Lifestyle changes (SNAP)
- Metformin (dec insulin resistance --> restore menstrual cycle) + clomifene (to conceive)
- COCP/ spironolactone (hypoanadrogenic)
- Mirena
- Ovarian drilling (reduce steroid production) if clomifene ineffective
Source
OHCS 8th Ed 2009
Dr Toly Pavlov 2014