POLYCYSTIC OVARY SYNDROME
(PCOS) EXAM QUESTIONS AND
ANSWERS
List diagnostic criteria for PCOS - ANSWER-1. Menstrual dysfunction
○Primarily chronic anovulation
2. Clinical or biochemical signs of hyperandrogenism
○Excluding other causes (e.g., thyroid disease, congenital adrenal hyperplasia, prolactin
excess, androgen-secreting tumors, Cushing's syndrome)
3. Polycystic ovaries (via ultrasound)
○ ≥12 follicles in at least one ovary measuring 2-9 mm in diameter and/or increased
ovarian volume (>10 ml)
Polycystic ovary - ANSWER-• Bilateral enlarged ovaries
• More than 12 follicles per ovary that are less than 10 mm (usually 2-9 mm)
• Follicles typically represent a "pearl necklace" on ultrasound
• Transvaginal ultrasound: gold standard to detect polycystic ovaries
Women should be screened for risk factors
CVD risk assessment - ANSWER-
Treatment Goals - ANSWER-• Maintain normal endometrium
• Block actions of androgen on target tissues
• Reduce insulin resistance and hyperinsulinemia (when present)
• Correct anovulation and improve fertility (if desired)
• Weight reduction (if applicable)
• Prevent long-term complications
• Treatment based on symptoms and goals
• Short-term and long-term goals should be set
Non-pharmacologic Therapy - ANSWER-1. Weight reduction
• Decreasing body weight 5-10%
• Diet: 500-1000 kcal/d reduction, <30% cal fat, <10% from saturated fat, increased
fiber, whole-grain breads, cereals, fruits, and veggies
• Exercise: at least 30 min/day of mild-mod intensity
• Bariatric surgery (in qualified patients)
2. Psychotherapy
3. Hair removal
Pharmacologic Therapy: Hirsutism - ANSWER-1st line. Oral contraceptives
, 2nd line. Spironolactone. 25-50mg starting dose
○ May take 6-9 months for improvement
○ Combination with COC improves hirsutism
3rd line. Finasteride, flutamide, eflornithine
Spironolactone - ANSWER-Antiandrogens
○ Reduces hair growth by 40-88% when used in large doses (100-200 mg daily)
○ May take 6-9 months for improvement
○ Combination with COC improves hirsutism in up to 75% of women, treats
hormonal/metabolic manifestations of PCOS, and avoids potential teratogenic effects
Metformin MOA in PCOS - ANSWER-• Appropriate dose for PCOS
• Improves insulin sensitivity
• Decreases testosterone concentrations by 20-50% in women with PCOS
• Improves ovulation rate
• Increases SHBG
• Decreases LH, LH:FSH ratio, and BMI
Metformin dose - ANSWER-1500mg/day
what patient populations are ideal canidates for metformin use with PCOS? - ANSWER-
In women with PCOS that have:
1. T2DM or impaired glucose tolerance who fail lifestyle modification
2. Menstrual irregularity who cannot take or do not tolerate combined hormonal
contraceptives
Formulate a clinical plan for non-pharmacologic and pharmacologic therapy for patients
with PCOS - ANSWER-
Ovulation Induction Agents - ANSWER-• Clomiphene citrate*
• Letrozole*
• Gonadotropins (e.g., low dose FSH)
• Laparoscopic ovarian surgery
*Recommended first-line in guidelines for anovulatory infertility in women with PCOS
Letrozole vs Clomiphene - ANSWER-Letrozole better for ovulation and live births
Metformin vs Clomiphene vs Combination - ANSWER-Combination better for ovulation
Clomiphene better than Metformin for ovulation, live births
What is PCOS? - ANSWER--Syndrome of ovarian dysfunction along with the cardinal
features of
hyperandrogenism and polycystic ovary morphology.
(PCOS) EXAM QUESTIONS AND
ANSWERS
List diagnostic criteria for PCOS - ANSWER-1. Menstrual dysfunction
○Primarily chronic anovulation
2. Clinical or biochemical signs of hyperandrogenism
○Excluding other causes (e.g., thyroid disease, congenital adrenal hyperplasia, prolactin
excess, androgen-secreting tumors, Cushing's syndrome)
3. Polycystic ovaries (via ultrasound)
○ ≥12 follicles in at least one ovary measuring 2-9 mm in diameter and/or increased
ovarian volume (>10 ml)
Polycystic ovary - ANSWER-• Bilateral enlarged ovaries
• More than 12 follicles per ovary that are less than 10 mm (usually 2-9 mm)
• Follicles typically represent a "pearl necklace" on ultrasound
• Transvaginal ultrasound: gold standard to detect polycystic ovaries
Women should be screened for risk factors
CVD risk assessment - ANSWER-
Treatment Goals - ANSWER-• Maintain normal endometrium
• Block actions of androgen on target tissues
• Reduce insulin resistance and hyperinsulinemia (when present)
• Correct anovulation and improve fertility (if desired)
• Weight reduction (if applicable)
• Prevent long-term complications
• Treatment based on symptoms and goals
• Short-term and long-term goals should be set
Non-pharmacologic Therapy - ANSWER-1. Weight reduction
• Decreasing body weight 5-10%
• Diet: 500-1000 kcal/d reduction, <30% cal fat, <10% from saturated fat, increased
fiber, whole-grain breads, cereals, fruits, and veggies
• Exercise: at least 30 min/day of mild-mod intensity
• Bariatric surgery (in qualified patients)
2. Psychotherapy
3. Hair removal
Pharmacologic Therapy: Hirsutism - ANSWER-1st line. Oral contraceptives
, 2nd line. Spironolactone. 25-50mg starting dose
○ May take 6-9 months for improvement
○ Combination with COC improves hirsutism
3rd line. Finasteride, flutamide, eflornithine
Spironolactone - ANSWER-Antiandrogens
○ Reduces hair growth by 40-88% when used in large doses (100-200 mg daily)
○ May take 6-9 months for improvement
○ Combination with COC improves hirsutism in up to 75% of women, treats
hormonal/metabolic manifestations of PCOS, and avoids potential teratogenic effects
Metformin MOA in PCOS - ANSWER-• Appropriate dose for PCOS
• Improves insulin sensitivity
• Decreases testosterone concentrations by 20-50% in women with PCOS
• Improves ovulation rate
• Increases SHBG
• Decreases LH, LH:FSH ratio, and BMI
Metformin dose - ANSWER-1500mg/day
what patient populations are ideal canidates for metformin use with PCOS? - ANSWER-
In women with PCOS that have:
1. T2DM or impaired glucose tolerance who fail lifestyle modification
2. Menstrual irregularity who cannot take or do not tolerate combined hormonal
contraceptives
Formulate a clinical plan for non-pharmacologic and pharmacologic therapy for patients
with PCOS - ANSWER-
Ovulation Induction Agents - ANSWER-• Clomiphene citrate*
• Letrozole*
• Gonadotropins (e.g., low dose FSH)
• Laparoscopic ovarian surgery
*Recommended first-line in guidelines for anovulatory infertility in women with PCOS
Letrozole vs Clomiphene - ANSWER-Letrozole better for ovulation and live births
Metformin vs Clomiphene vs Combination - ANSWER-Combination better for ovulation
Clomiphene better than Metformin for ovulation, live births
What is PCOS? - ANSWER--Syndrome of ovarian dysfunction along with the cardinal
features of
hyperandrogenism and polycystic ovary morphology.
