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PCOS
OSCE PLAB 2
6
Medical
Graduate
06/26/2025
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Term

1. What is PCOS?

 Definition
COS is a hormonal and metabolic disorder affecting 5–20% of women of reproductive age. It involves:
✔ Hyperandrogenism (excess male hormones like testosterone)
✔ Oligo-ovulation or anovulation (irregular or absent periods)
✔ Polycystic ovaries (multiple small follicles seen on ultrasound)
Term

Key Features:

 Definition

  • Insulin resistance (body struggles to use insulin properly → high blood sugar).

  • Obesity (common but not required—lean PCOS exists).

  • Increased risk of diabetes, heart disease, and infertility.
Term

Symptoms of PCOS

 Definition

 

Symptoms vary but commonly include:

Menstrual Irregularities

  • Oligomenorrhea (fewer than 8 periods/year).

  • Amenorrhea (no periods for 3+ months).

  • Heavy or prolonged bleeding (due to lack of ovulation).

  • Androgen Excess (High Testosterone)

    • Hirsutism (excess facial/body hair).

    • Acne (persistent, often on face/back).

    • Male-pattern baldness (thinning hair at the crown).

    Metabolic & Physical Signs

    • Weight gain (especially abdominal fat).

    • Acanthosis nigricans (dark, velvety skin patches in armpits/neck).

    • Fatigue & mood swings (due to hormonal fluctuations).

    Fertility Issues

    • Anovulation (no egg release → difficulty conceiving).

    • Higher miscarriage risk (linked to insulin resistance).
Term

How is PCOS Diagnosed?

 Definition

Rotterdam Criteria (Need 2 out of 3)

  1. Polycystic ovaries on ultrasound (12+ small follicles or enlarged ovaries).

  2. Oligo-ovulation/anovulation (irregular/absent periods).

  3. Clinical or biochemical hyperandrogenism (excess hair, acne, or high testosterone).

Tests to Rule Out Other Conditions

  • Thyroid function tests (hypothyroidism can mimic PCOS).

  • Prolactin levels (high prolactin can stop periods).

  • 17-hydroxyprogesterone (to rule out congenital adrenal hyperplasia).

  • Glucose tolerance test (checks for insulin resistance/diabetes).
Term

Long-Term Health Risks

 Definition

 

⚠ Type 2 Diabetes (up to 50% develop prediabetes/diabetes by age 40).
⚠ Cardiovascular Disease (high cholesterol, hypertension).
⚠ Endometrial Cancer (from unopposed estrogen due to lack of ovulation).
⚠ Obstructive Sleep Apnea (linked to obesity and insulin resistance).
⚠ Depression & Anxiety (hormonal imbalances + body image struggles).
Term

Treatment & Management

 Definition

A. Lifestyle Modifications (First-Line Treatment)

✔ Weight loss (5–10% body weight) → improves insulin sensitivity, restores ovulation.
✔ Low-glycemic diet (whole grains, lean protein, healthy fats).
✔ Regular exercise (30+ mins/day, mix of cardio + strength training).
✔ Stress management (yoga, meditation – cortisol worsens insulin resistance).

B. Medications

Symptom Treatment Options
Irregular periods Birth control pills (COCP), progesterone therapy
Insulin resistance Metformin (improves ovulation, reduces diabetes risk)
Hirsutism/acne Anti-androgens (spironolactone, cyproterone), topical eflornithine
Fertility issues Clomiphene (induces ovulation), Letrozole (better for PCOS)

C. Surgical Options (Rarely Needed)

  • Ovarian drilling (laparoscopic procedure to induce ovulation).

  • Bariatric surgery (if severe obesity + metabolic complications).

D. Fertility Support

  • Ovulation induction (Clomid/Letrozole + monitoring).

  • IVF (if other treatments fail).
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