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Polycystic ovarian syndrome PCOS

  

PCOS is a common ovarian endocrine disorder, which is often complicated by chronic anovulatory sub-fertility and hyperandrogenism.


History and examination

  • History, including menstrual, obstetric (particularly miscarriages) and family historyCheck medication historyClinical examination including BMI and waist measurement, blood pressure, hirsutism, acne and acanthosis

Investigations

  • FSH, LH, oestradiol, prolactin, TSH, free T4, thyroid peroxidase antibodies, testosterone, SHBG (sex hormone binding globulin), androstenedione, DHEAS between days 2-5 of menstrual cycle.
  • Fasting lipids and fasting glucose if BMI > 30 kg/m2
  • Pelvic ultrasound (optional)

Rotterdam criteria for diagnosis of PCOS – Two of the following three criteria

  • Polycystic ovaries (12 or more peripheral follicles with or without increased ovarian   volume greater than 10 cm3, can be unilateral PCO).
  • Oligo- or anovulation
  • Clinical and/or biochemical signs of hyperandrogenism.

Management

Advice weight loss for all overweight women – patients to be offered community-based weight loss programmes such as Counterweight or Slimming World.

Address the presenting symptom:

  • Infrequent periods /amenorrhoea: Induce bleed with COC pill or progestagen only pill.
  • Sub-fertility: pre-conception advice on diet, smoking, exercise, folic acid, rubella and referral to the Centre for Reproductive Medicine (CRM) at UHCW.
  • Hirsutism/acne: consider COC and treat acne.
  • Metabolic syndrome: Assess cardiovascular risk, including HbA1c. Consider if referral to an endocrinologist is needed.

Patients with suspected PCOS can be referred to a hospital gynaecologist or to the community gynae clinic, City of Coventry Health Centre. For community gynae, refer via the NHS eReferral Service: “Gynaecology Consultant Menopause and Hormone Related Problems”.

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