TEALE FENNING

premgunny · Joined: 09 Apr 2008 Posts: 16

[b]A 30yr old woman recently diagnosed with PCOS came to see you in gynae clinc very much worried about her longterm health and appearance

1) What are the issues you will discuss with her?
2) What are the stratergies for risk reduction?
3) How will you manage hirsutism? [/b]

Hi Guys,

Try this one.

premgunny

premgunny · Joined: 09 Apr 2008 Posts: 16

PCOS is very common condition occurs in 1 in 20 women of reproductive age group. The diagnosis depends upon Rotterdam criteria as evidence of PCO >/= 12 peripheral follicles, .10cm3 ovarian volume, oligo or anovulation, clinical or biochemical evidence of hyperandrogenism.

Woman needs to be informed of metabolic effect like insulin resistance risk of diabetes mellitus especially if risk factor like increased BMI, age >40, family h/o type 2 DM- Offer GTT, without other risk factors- fasting blood sugar annually.
During pregnancy increased risk of gestational diabetes especially obese PCO who needed ovulation induction, offer GTT before 20weeks and refer to combined Obstetric & diabetic team if positive.
Cardio vascular risk is increased but routine treatment is not recommended.
risk of Obstructive sleep apnoea common in obese PCO , offer investigation like plasma insulin and insulin glucose ratio and treatment.
Increased risk of endometrial hyperplasia and cancer due to unopposed estrogen effect. no impact on breast and ovarian cancer. Discuss importance of withdrawal bleed if ammenorrhea more than 4months.

Patient information leaflet to be given and document in notes.

manoj · Joined: 22 Jun 2008 Posts: 6

1. PCOS is a common disorder seen by Gynaecologist associated with chronic anovulatory infertility and hyperandrogenism, many women are obese with PCOS and have a higher prevalance of type 2 diabetes mellitus and sleep apnoea than observed in general population. They also exhibit a higher cardiovasular risk profile with increased incidence of hypertension, dyslipidemia and insulin resistance.

2. Advice on weight control/reduction and exercise with/without drugs like orlistat/sibutramine to improve hyperandrogenism, may reduce cardiovascular risks profile and improve ovulation with respect to fertility.
If BMI>30, family history of type2 diabetes and over 40yrs associated with increased risk of diabetes and so offer glucose tolerance test.
If associated with sleep apnoea(independent risk factor for ischaemic heart disease) offer investigation and treatment, also treat if hypertension exists.
Planning pregnancy and diagnosed with PCOS offer screen for diabetes and treat to minimise potential risks associated with pregnancy( this can be a full essay)

3. Explain Hirsutism is difficult to manage and includes treatments with drugs like combined oral contraceptive pills with anti-androgenic progestogens like cyproterone acetate (side effects with weight gain, breast tenderness, headache, gastrointestinal upsets, hepatotoxicity). If COCP contraindicated medoxyprogestrone acetate can be used on its own.
Spironolactone is an antiandrogen but caution with hypotension and hyperkalaemia.
Finasteride and Flutamide similar to spironolactone but caution to use with proper contraceptive as it can emasculate a male fetus.
Treating diabetes and weight reduction can improve hyperandrogenism and should be emphasised.
For severe hirsutism GnRH analogue with addback can be considered.
Topical treatment with eflornithine(vaniqa) and mechanical hair removal/ laser are other alternatives