WOMEN'S HEALTH PCOS EXAM
QUESTIONS AND ANSWERS
Ovaries become Cystic when: - ANSWER-- Increased androgen block follicular
development - follicles degenerate
o increased levels of testosterone - cause increase in LH and decrease in FSH - leading
to follicles to stall in the development process
- Lower estradiol because there is no dominant follicle to produce the increase
- Lower estradiol causes persistent increased LH
- Increased LH stimulates theca & interstitial cells to produce androgens (testosterone)
- Anovulation produces no corpus luteum
- Atretic follicles migrate to periphery
- Ovary enlarges and interstitial tissue thickens
Uterus in PCOS: - ANSWER-with no regular cycling and no ovulation, there is no
corpus luteum so there is a decrease in progesterone, increase in body fat produces
increase in estrone; increase in estrogen levels causes unopposed thickening of
endometrium; no regular shedding of the endometrium which can lead to hyperplasia
Uterus is at increased risk for what in PCOS? - ANSWER-o Endometrial cancer - 3x's
higher in pt's with PCOS
o Endometriosis
o Fibroids
Infertility in PCOS due to: - ANSWER-- Lack of ovulation
- Delayed ovulation - contributing to timing of transport and implantation
- Decreased progesterone levels: inability to sustain pregnancy and rate of miscarriage
up to 45%
Diagnostic Criteria for PCOS: Endocrine Society recommends using Rotterdam Criteria
- ANSWER-At least TWO of the following criteria:
o Androgen excess
Clinical: hirsutism, acne, or androgenic
Biochemical: elevated total, bioavailable or free serum T level
o Ovarian dysfunction - oligo or anovulation
o Polycystic Ovaries - ovarian size, morphology on ultrasound
, Ovarian volume >10ml either ovary
Presence of 12 or more follicles without a dominant follicle
Labs indicating PCOS: - ANSWER-- Free testosterone >80
- SHBG decreased resulting in higher free testosterone
- Lipid profile - elevated lipids
- FBS >115
- Fasting insulin * NOT all women with PCOS are insulin resistant
o >15-20 borderline
o >29 insulin resistant
o Or ratio of > 1:10 (insulin to glucose)
- 2-hr Glucose Tolerance Test (post 75gm load)
o 1-hr insulin level >100 = diagnosis
o 2-hr glucose level
>180 = glucose intolerant
>200 = diabetes
- LH/FSH - must be done cycle day 2-5 (can't be on COC because alters these
hormones)
o If LH is 2-3x's higher than FSH
o LH >20 (15-20 borderline)
o 25% of women with PCOS have a normal LH'
- Thyroid - TSH and free T4
- Prolactin - r/o pituitary problem
-17-OHP (hydroxyprogesterone) - draw prior to 8am
o normal is less than 200
o can r/o CAH which can mimic PCOS
-dexamethasone suppression - r/o Cushing's syndrome
Differentials for PCOS - ANSWER-Pregnancy
Hyperandrogenism
Primary ovarian insufficiency
Androgen-secreting tumor
QUESTIONS AND ANSWERS
Ovaries become Cystic when: - ANSWER-- Increased androgen block follicular
development - follicles degenerate
o increased levels of testosterone - cause increase in LH and decrease in FSH - leading
to follicles to stall in the development process
- Lower estradiol because there is no dominant follicle to produce the increase
- Lower estradiol causes persistent increased LH
- Increased LH stimulates theca & interstitial cells to produce androgens (testosterone)
- Anovulation produces no corpus luteum
- Atretic follicles migrate to periphery
- Ovary enlarges and interstitial tissue thickens
Uterus in PCOS: - ANSWER-with no regular cycling and no ovulation, there is no
corpus luteum so there is a decrease in progesterone, increase in body fat produces
increase in estrone; increase in estrogen levels causes unopposed thickening of
endometrium; no regular shedding of the endometrium which can lead to hyperplasia
Uterus is at increased risk for what in PCOS? - ANSWER-o Endometrial cancer - 3x's
higher in pt's with PCOS
o Endometriosis
o Fibroids
Infertility in PCOS due to: - ANSWER-- Lack of ovulation
- Delayed ovulation - contributing to timing of transport and implantation
- Decreased progesterone levels: inability to sustain pregnancy and rate of miscarriage
up to 45%
Diagnostic Criteria for PCOS: Endocrine Society recommends using Rotterdam Criteria
- ANSWER-At least TWO of the following criteria:
o Androgen excess
Clinical: hirsutism, acne, or androgenic
Biochemical: elevated total, bioavailable or free serum T level
o Ovarian dysfunction - oligo or anovulation
o Polycystic Ovaries - ovarian size, morphology on ultrasound
, Ovarian volume >10ml either ovary
Presence of 12 or more follicles without a dominant follicle
Labs indicating PCOS: - ANSWER-- Free testosterone >80
- SHBG decreased resulting in higher free testosterone
- Lipid profile - elevated lipids
- FBS >115
- Fasting insulin * NOT all women with PCOS are insulin resistant
o >15-20 borderline
o >29 insulin resistant
o Or ratio of > 1:10 (insulin to glucose)
- 2-hr Glucose Tolerance Test (post 75gm load)
o 1-hr insulin level >100 = diagnosis
o 2-hr glucose level
>180 = glucose intolerant
>200 = diabetes
- LH/FSH - must be done cycle day 2-5 (can't be on COC because alters these
hormones)
o If LH is 2-3x's higher than FSH
o LH >20 (15-20 borderline)
o 25% of women with PCOS have a normal LH'
- Thyroid - TSH and free T4
- Prolactin - r/o pituitary problem
-17-OHP (hydroxyprogesterone) - draw prior to 8am
o normal is less than 200
o can r/o CAH which can mimic PCOS
-dexamethasone suppression - r/o Cushing's syndrome
Differentials for PCOS - ANSWER-Pregnancy
Hyperandrogenism
Primary ovarian insufficiency
Androgen-secreting tumor
