Makindo Medical Notes

Related Subjects: |Anatomy of the Uterus |Anatomy of the Ovary |Gynaecological History Taking |Colposcopy |Premature Menopause |Polycystic Ovary syndrome

🌸 Polycystic Ovary Syndrome (PCOS) is the most common cause of anovulation in young women, often leading to infertility and hirsutism.

📖 About

• PCOS is the leading cause of infertility and hirsutism in reproductive-age women.
• It affects around 4–8% of women worldwide.
• Diagnosis is usually clinical, supported by labs and imaging where necessary.

🧬 Aetiology

• Ovarian stromal hyperplasia → increased androgen (testosterone) secretion.
• Multiple follicular cysts disrupt ovulation.
• Hormonal imbalance: ↑ LH, relatively low/normal FSH; often linked to obesity and insulin resistance.
• Frequently associated with Metabolic Syndrome (Syndrome X) – insulin resistance, hypertension, hyperlipidaemia.

🩺 Clinical Features

• ⚖️ Obesity (not universal).
• 📆 Menstrual irregularities: oligomenorrhoea, amenorrhoea, or dysfunctional bleeding.
• 💇 Signs of androgen excess: acne, alopecia, hirsutism.
• 🟤 Acanthosis nigricans (dark skin patches, usually neck/axillae).

🧪 Investigations

• Hormones: ↑ LH, relatively normal/low FSH; ↑ Testosterone, DHEAS, Androstenedione; ↑ Oestrone.
• ↓ SHBG → higher free androgens.
• Occasionally ↑ Prolactin.
• OGTT for diabetes risk (high prevalence of insulin resistance).
• Ultrasound: “string of pearls” multiple cysts – though not required for diagnosis.

🔍 Differential Diagnosis

• Congenital adrenal hyperplasia
• Prolactinoma
• Acromegaly
• Cushing’s syndrome
• Ovarian/adrenal tumours

💊 Management

• ⚖️ Weight reduction – improves ovulation & metabolic profile (dietician referral helpful).
• 💊 Metformin – enhances insulin sensitivity, may restore ovulation.
• 🩸 Progesterone therapy every 3 months to prevent endometrial hyperplasia, or combined OCP with cyproterone acetate for cycle regulation & anti-androgen effect.
• 👶 Clomiphene – first-line ovulation induction for infertility.
• OCPs help with acne, hirsutism, and menstrual regulation.
• Routine diabetes screening (especially in overweight patients).

⚠️ Complications

• ⬆️ Risk of endometrial carcinoma from unopposed oestrogen.
• ⬆️ Risk of Type 2 diabetes and cardiovascular disease due to metabolic syndrome.