PCOS

• The 2 most common hormonal abnormalities present in PCOS are hyperandrogenism and hyperinsulinism.
• Hyperandrogenism occurs in PCOS due to an increased GnRH pulse frequency which in turn leads to increased LH secretion. Despite the high levels of LH, the increased circulating androgens suppress the LH surge, which is required for ovulation to occur. Follicles develop within the ovary, but are arrested at an early stage (due to the disturbed ovarian function) – and they remain visible as cysts within the ovary.
• Hyperinsulinism in PCOS can be owed to insulin resistance. This suppresses hepatic production of sex hormone binding globulin, resulting in higher levels of free circulating androgens.
• PCOS risk factors:

  • Diabetes
  • Irregular menstruation
  • Family history
  • Smoking
• Clinical features of PCOS:

  • Period changes
  • Infertility
  • Hirsutism
  • Obesity
  • Chronic pelvic pain
  • Depression
• The most common diagnostic criteria for PCOS is the Rotterdam criteria. It gives a diagnosis of PCOS if two out of three criteria are met:

  • Oligo ovulation or anovulation
  • Clinical and/or biochemical signs of hyperandrogenism
  • Polycystic ovaries on imaging
• Blood tests for PCOS:

  • Raised - Testosterone, LH
  • Normal - FSH
  • Low - SHBG, Progesterone
• PCOS management:

  • Induced bleeds at least 3 times a year using combined contraceptive pill or dydrogesterone
  • Weight management
  • Clomifene with metformin to induce ovulation
  • Cyproterone or spironolactone or finasteride and/or eflornithine for hirsutism.