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]