Background

·         1/3 have have polycystic ovaries [>= 10 follicles per ovary]

·         of these 1/3 will have PCOS

Symptoms

·         Menstrual disturbance – oligomenorrhoea, amenorrhoea, DUB, infertility

·         Hirsutism, acne, male-pattern hair loss

Defination

·         Polycystic ovaries + one or more of symptoms or raised testosterone and/or LH

Investigate

·         1st week of period:  TFT, U&Es, Prolactin, LH, FSH, Testosterone, SHBG, Glucose, cortisol

·         USS

·         Findings: High LH, testosterone Low SHBG Normal FSH

·         FAI [free androgen index] >= 5 indicates PCOS [= total testosterone * 100/SHBG]

·         If free testosterone is > 4.8, refer to exclude androgen hypersecretion [Cushing’s syndrome, adrenal gland or ovarian tumours…]

Management

·         Menstural irregularities – COC to regulate periods

·         Hersutism – Waxing, shaving, bleeching, lose weight, eflornithine cream 11.5% [Vaniqa in conjunction with waxing, shaving… effective in 30%], Dianette as COC – refer for finasteride, GnRH analogs, Spironolactone, metformin…

·         Infertility – refer [weight loss can stimulate ovaries, anti-oestrogen, gonadotrophins, metformin or ovarian drilling]