Updated: 9/29/2021

Polycystic Ovarian Syndrome

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
5
0
0
0%
0%
Evidence
9
0
0
0%
0%
Videos / Pods
1
Topic
Snapshot
  • A 25-year-old woman presents with excessive hair growth and abnormal menses. She reports shaving mulitple times to remove hair from her chin and chest, states that her menses has been irregular, and is currently sexually active and only uses condoms as a form of contraception. She is not on any medications. The patient is 5' 1" (155 cm) and weighs 165 lbs (75 kg). On physical examination, there is hair in the periareolar and linea alba region. There is also acanthosis nigricans in the posterior neck.
Introduction
  • Clinical definition
    • an acquired endocrinopathy characterized by
      • ovarian dysfunction
        • can lead to primary or secondary amenorrhea and oligomenorrhea which
          • prevents formation of the corpus luteum, impairing progesterone synthesis which leads to
            • unapposed estrogen proliferative effect on the endometrium that results in
              • bleeding
              • increased risk of endometrial hyperplasia and cancer 
      • hyperandrogenism
        • may present as acne and hirsutism
      • polycystic ovaries
  • Epidemiology
    • incidence
      • ~7% of reproductive-aged women
    • demographics
      • females only
    • risk factors
      • family history
      • obesity
  • Pathophysiology
    • mechanism is unclear
      • peripheral insulin resistance leads to hyperinsulinemia
      • ovarian stimulation leading to excess androgen production
  • Associated conditions
    • infertility
      • the most common cause of infertility in woman
    • menstrual dysfunction
    • hyperandrogenism
    • obesity
    • insulin resistance 
  • Prognosis
    • natural history of disease
      • patients may present for hirsutism, irregularities in their menses, obesity, and acanthosis nigricans
    • prognostic variable
      • favorable
        • weight loss
Presentation
  • Symptoms
    • menstrual dysfunction
      • e.g., dysfunctional uterine bleeding and amenorrhea
    • infertility
    • hirsutism
    • acne
  • Physical exam
    • obesity
    • hirsutism
    • acne
    • acanthosis nigricans  
      • a sign of insulin resistance
    • bilateral enlarged ovaries on pelvic exam
Imaging
  • Ovarian ultrasonography
    • indications
      • can be performed when pelvic examination is inadequate
    • findings
      • may show polycystic ovaries affecting one or both ovaries
Studies
  • Labs
    • total and free testosterone level
    • LH/FSH > 3
Differential
  • Cushing syndrome
  • Non-classical congenital adrenal hyperplasia
  • Androgen-secreting tumor
  • Pregnancy
  • Premature ovarian failure
  • Thyroid disease
    • hyper- or hypothyroidism
  • Prolactinoma
Treatment
  • Lifestyle
    • weight loss  
      • indications
        • for obese patients, weight loss is the first-line of treatment
        • for obese patients pursuing pregnancy
  • Pharmcologic
    • hormonal contraceptives    
      • indications
        • first-line of treatment for anovulation
        • first-line of treatment for hirsutism/acne
    • metformin
      • indications
        • first-line of treatment for the insulin resistance associated with PCOS
          • also known to improve ovulation and assist in reducing androgen levels to improve regular menstrual cycles
    • clomiphene citrate
      • indications
        • first-line of treatment for infertility caused by PCOS
        • can cause heterotopic pregnancy 
  • Operative
    • bariatric surgery
      • indications
        • for treatment of obesity
    • ovarian-drilling
      • indications
        • can be considered in patients who are refractory to clomiphene citrate
Complications
  • Complications
    • infertility
    • endometrial hyperplasia and cancer due to unopposed estrogen exposure  
    • associated with increased insulin resistance

Please rate topic.

Average 4.4 of 8 Ratings

Questions (5)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M2.GN.13.255) A 27-year-old woman presents to her primary care physician for difficulties getting pregnant. She and her husband have been having unprotected intercourse once per day without success for the past year. She reports irregular menses. She is otherwise healthy and is not taking any medications. Her temperature is 98.0°F (36.7°C), blood pressure is 144/88 mmHg, pulse is 83/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical examination is notable for acne and the finding in Figure A. The patient has a notable abdominal pannus without any rashes noted. The patient is subsequently worked up with a TSH, prolactin level, and hysterosalpingogram, all of which are normal. She is instructed to lose weight by her physician and prescribed a medication to help her achieve pregnancy. What potential side effect must the physician warn the patient about?

QID: 106211
FIGURES:
1

Facial hair

5%

(1/21)

2

Heterotopic pregnancy

33%

(7/21)

3

Lactic acidosis

43%

(9/21)

4

Increased insulin sensitivity

5%

(1/21)

5

Loss of bone mineral density

10%

(2/21)

M 7 E

Select Answer to see Preferred Response

Evidence (9)
VIDEOS & PODCASTS (1)
EXPERT COMMENTS (9)
Private Note