PCOS is a gynecologic and hormonal disorder

2. 
PCOS
Dr Hania Afzal
Resident Medicine

3. 
 Clinical or biochemical evidence of hyperandrogenism
 Oligoovulation or anovulation
 Polycystic ovaries on USG (the Roterdam criteria)
 5-10% of reproductive age women

4. 
Features
 Menstrual disorder
Amenorrhea to menorrhagia
 Skin disorders
Hirsuitism
Acne
 Insulin resistance
Early T2DM
Metabolic Syndrome
 Cardiovascular disease

5. 
 Perinatal complications
Preeclampsia
Gestational diabetes
 Endometrial cancer
d/t unopposed estrogen
Features

6. 
 Anovulation
 Premature ovarian failure(high FSH, LH)
 Functional hypothalamic amenorrhea(low to normal
FSH,LH)
 Discontinuation of hormonal contraceptives
 Pituitary adenoma
 Hyperthyroidism or hypothyroidism
DDs

7. 
 FSH
 LH
 Prolactin
 TSH
 HbA1c, BSF
 Lipid profile
 Testosterone, 17 hydroxy progesterone (clinical
hyperandrogenism)
 24 hr urinary free cortisol/low dose dexamethasone supression
test(cushingoid)
 Workup for congenital adrenal hyperplasia and androgen
secreting tumors
Investigations

8. 
 Weight reduction
 Exercise
 Metformin to reduce metabolic effects
 Regular monitoring of lipid profile and glucose
 Ovulation Induction
Clomiphene
Gonadotropins in low dose
Aromatase inhibitors (anastrozole)
Ovarian drilling
Treatment

9. 
 Doesn’t want pregnancy but not candidate for
contraception
medroxyprogesterone acetate 10mg/day PO for 1st 10
days of month
 If contraception desired
COCPs(also help in hirsuitism in 6-12 months)
Levonorgestrel releasing IUD
Treatment

10. 
 Hirsuitism
 Spironolactone 25mg TDs/QID
 Flutamide(non steroidal antiandrogen) 125-250mg
daily
 Finasteride (5 alpha reductase inhibitor) 5mg daily
 Topical eflornithine x BD for 6 months
 Depilatory creams/electrolysis/laser therapy
Treatment

11. 