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Polycystic Ovary Syndrome (PCOS) A Graded Exam | Questions with complete Solutions
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Polycystic Ovary Syndrome (PCOS) AGraded Exam | Questions with complete
Solutions
• Possible genetic predisposition
• Premature puberty
• Obesity with insulin resistance
• Diabetes mellitus
• Use of antiepilepsy drug valproate
Identify some possible risk factors for PCOS:
• Impaired fasting blood glucose
• Excessive facial hair, Acanthosis nigricans
• Insulin resistance with the acanthosis
• Weight gain
• Irregular periods
• Increased LH:FSH ratio (usually 1:1), hers is more around 3:1
• Rule Out: Thyroid (good), Testosterone WNL
What are the s/sx indicating ZM has PCOS?
Goals of therapy:
- Maintain normal endometrium
- Block androgen actions on tissues
- Reduce insulin resistance and hyperinsulinemia
- Reduce weight
- Prevent long-term complications
What are the goals of therapy for PCOS treatment?
Response to therapy is usually 3-9 months:
,- Important to have short- and long-term goals
What is the timeframe for therapy response for PCOS treatment?
Weight loss:
- 5-10% weight loss effective in improving ovulation and metabolic
disease Diet:
- Low sat-fats, high fiber, low-glycemic-index-carbohydrate foods, high
protein Exercise:
- Muscle strengthening improves insulin sensitivity
What are non-pharmacologic therapy options for the treatment of PCOS?
1. Combined oral contraceptives (COCs)
2. Progesterone
3. Insulin sensitizers
4. Hirsutism agents
5. Ovulation induction agents
Pharmacologic treatment for PCOS is specific to presenting symptoms and patient-specific
goals. Generally, what are five categories of agents that can be utilized in treatment?
An increase in exercise with dietary change
Per the ACOG Treatment Recommendations (2018) for PCOS, what has been consistently
shown to reduce diabetes risk comparable or better than medication?
Adding Eflornithine to laser treatment is superior in the treatment of hirsutism than
laser alone
Per the ACOG Treatment Recommendations (2018) for PCOS, what is the
recommended treatment for PCOS associated Hirsutism?
Ovulation induction: Aromatase inhibitor, Letrozole is first-line
Per the ACOG Treatment Recommendations (2018) for PCOS, what is the
recommended treatment for ovulation induction?
Insulin resistance: Insulin-sensitizing agents is associated with a decrease in circulating
androgen levels, improved ovulation rate, and improved glucose tolerance
Per the ACOG Treatment Recommendations (2018) for PCOS, what is the recommendation
for PCOS associated insulin resistance?
, Healthy eating and regular physical activity recommended for everyone with PCOS
- Weight loss of 5-10% in 6 months is considered successful weight reduction in those with
excess weight
Per the Int'l Evidence-Based Guideline for the Assessment and Management of PCOS
2018, what is recommended for everyone with PCOS?
Hyperandrogenism and/or irregular menstrual cycles: COCs
- No specific types or dose are recommended
- May add Metformin for metabolic features
- May add Antiandrogen for Hirsutism if no improvement in 6 mos. using COC +
cosmetic treatment, or for androgen-related alopecia
Per the Int'l Evidence-Based Guideline for the Assessment and Management of PCOS 2018,
what is recommended for hyperandrogenism and/or irregular menstrual cycles associated with
PCOS?
Weight, hormonal, & metabolic outcomes: Metformin + lifestyle changes
- Inositol considered experimental therapy
Per the Int'l Evidence-Based Guideline for the Assessment and Management of PCOS
2018, what is recommended for positive weight, hormonal, and metabolic outcomes?
Infertility: Letrozole first line for ovulation induction, followed by other agents (Clomiphene
> Metformin)
- Gonadotropins are second-line (preferred over Clomiphene + Metformin)
Per the Int'l Evidence-Based Guideline for the Assessment and Management of PCOS
2018, what is recommended for infertility?
Dermatologic symptoms of hyperandrogenism (hirsutism, acne):
- First-line therapy is OCP therapy (EE 20-35mcg, antiandrogen progestin); OCP may be more
effective than CHC ring or patch
- In combo with anti-androgen for mild-moderate hirsutism and alopecia: Spironolactone
Per the AACE/ACE & AES Guide to Best Practices in Eval and Treatment of PCOS (2015), what is the
recommendation for dermatologic symptoms of hyperandrogenism (i.e., hirsutism, acne)?
Adolescents: Metformin to reduce androgen excess and improve ovarian function
- Can use Spironolactone, but it’s teratogenic, so use ongoing OCP
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