Polycystic ovarian syndrome

Key points :

- It is the most common endocrinological disorder (12-18 % women in reproductive age)

- Presentations: Menstrual irregularity (>35 or < 21 day cycles), overweight, hirsutism, fertility issues, pre diabetes, gestational diabetes or early onset type 2 diabetes, not high risk ethnic groups (Asian, indigenous, Nth African)

- Rotterdam Diagnostic criteria:

• Requires 2 of 
• Oligo- or anovulation 
• Clinical and/or biochemical hyperandrogegism
• Polycystic ovaries; and exclusion of other aetiologies

- Differential diagnosis investigations: TSH, Prolactin and FSH (if premature menopause suspected), free testosterone, DHEAS, SHBG, 17 hydroxy progesterone, FSH, LH

- Total testosterone is often normal in PCOS. cFT is often elevated. 

- PCOS management areas include:

• Emotional health: depresion and anxiety is more common. Assess mental health is the key. 
• Lifestyle : aim for 5-10 % weight loss 
• Cardiometaboic health: Smoking cessation, check BP annually, lipid profile and OGTT every 2 years
• Weight management:5-10% weight loss 
• Fertility: weight loss if BMI > 25 is the first line treatment, metformin (500 mg daily, increase by 500 mg per fortnight up to 1500 mg - 2000 mg average dose) and clomiphene 
• Menstrual cycle regulation: lifestyle and metformin, OCP 
• Clinical hyperandrogenism (eg hirsutism): OCP, if OCP alone doesn't work after 6 months, then try anti androgen (spironolactone) 
• Sleep apnoea 

References:
https://jeanhailes.org.au/contents/documents/Resources/Tools/PCOS_GP_tool.pdf