POLYCYSTIC OVARIAN SYNDROME
EXAM QUESTIONS AND ANSWERS
What is the Diagnostic Criteria for PCOS according to the guidelines and must have any
2 of the following (AOP) - ANSWER-Use the Rotterdam Criteria (must have any two of
the following) and also do a diagnosis of exclusion.
1. Androgen excess
2. Ovulatory dysfunction
3. Polycystic ovaries
*so you don't necessarily have to have PCO to have PCOS*
Diagnosis of exclusion:
-hyperprolacinemia
-thyroid disease
-congenital adrenal hyperplasia
When diagnosing patients with PCOS it's really a diagnosis of exclusion...(THC) -
ANSWER-Excluding:
Thyroid Disease (both hyper and hypo)
Hyperprolactinemia
Congenital adrenal hyperplasia
What are the 3 main labs we use for diagnosing PCOS - ANSWER-1. Thyroid Function
tests (to rule this out)
2. Serum Prolactin (to assess for hyperprolactinemia)
3. 17-hydroxyprogesterone (to rule out adrenal disorder)
Metabolic complications associated with PCOS (is a syndrome) - ANSWER-1. Infertility
2. Cutaneous manifestations- acne, alopecia, excessive hair growth
3. Pregnancy complications- pre-clampsia, GDM, preterm delivery
4. Obesity
5. T2DM
6. CV complications
7. Sleep apnea
8. Endometrial cancer
Treatment for PCOS #8
(L,H,C,L,A,M,O,I) - ANSWER-Lifestyle modifications
Hormonal Contraceptives
Clomiphene
Letrozole
Anti-androgens
Metformin
Ovarian drilling
IVF
, What can you do for lifestyle modifications - ANSWER-Calorie restricted diet with 30
min of exercise a day at moderate intensity- this improves weight loss and reduces CV
risk factors and diabetes risk.
What is FIRST LINE management for menstrual abnormalities and hirsutism -
ANSWER-Hormonal contraceptives- these inhibit ovarian androgen production.
Use a combination of hormone contraceptive and at the LOW dose.
The most important component of hormonal Contraceptive is - ANSWER-Estrogen:
Reduces secretion of LH and FSH from the pituitary by decreasing GnRH. Estrogen
increases sex binding globulin and reduces bioavailable androgen.
Dose of estrogen 30-35 mg combined w/progesterone
Progestin: Reduces endometrial proliferative effect of estrogen and suppresses LH
levels and susequent androgen production
Which progestin has the least androgen activity and you should use it. - ANSWER-
Norgestimate
Clomifene is first line therapy for - ANSWER-Fertility
Brand name is clomid.
MOA of CLomifene - ANSWER-SERM
Blocks estrogen inhibitory activity at pituitary and hypothalmus and reduces feedback
inhibition
Upregulates LH, FSH, and GnRH
-Clomifene binds to estrogen receptors in the ovaries and kind of turns off estrogen
production so then the hypothalmus ramps up the release of GnRH which then release
LH and FSH
Dosing of clomifene - ANSWER-50 mg PO x 5 days: if no ovulation then increase dose
by 50 mg each subsequent cycle with a max of 150 mg a day.
Adverse Effects of CLomifene - ANSWER-Hot flashes
Abdominal discomfort/bloating
Blurred vision
Ovarian enlargement
Pregnancy Category of clomifene - ANSWER-X- once pregnant stop!
Letrozole (Femara) originally developed for breast cancer. MOA is.. - ANSWER-
Aromatase is an enzyme that converts testosterone to estradiol.
Aromatase inhibitor- there is a decrease in estrogen and this stimulates release of LH
and FSH
EXAM QUESTIONS AND ANSWERS
What is the Diagnostic Criteria for PCOS according to the guidelines and must have any
2 of the following (AOP) - ANSWER-Use the Rotterdam Criteria (must have any two of
the following) and also do a diagnosis of exclusion.
1. Androgen excess
2. Ovulatory dysfunction
3. Polycystic ovaries
*so you don't necessarily have to have PCO to have PCOS*
Diagnosis of exclusion:
-hyperprolacinemia
-thyroid disease
-congenital adrenal hyperplasia
When diagnosing patients with PCOS it's really a diagnosis of exclusion...(THC) -
ANSWER-Excluding:
Thyroid Disease (both hyper and hypo)
Hyperprolactinemia
Congenital adrenal hyperplasia
What are the 3 main labs we use for diagnosing PCOS - ANSWER-1. Thyroid Function
tests (to rule this out)
2. Serum Prolactin (to assess for hyperprolactinemia)
3. 17-hydroxyprogesterone (to rule out adrenal disorder)
Metabolic complications associated with PCOS (is a syndrome) - ANSWER-1. Infertility
2. Cutaneous manifestations- acne, alopecia, excessive hair growth
3. Pregnancy complications- pre-clampsia, GDM, preterm delivery
4. Obesity
5. T2DM
6. CV complications
7. Sleep apnea
8. Endometrial cancer
Treatment for PCOS #8
(L,H,C,L,A,M,O,I) - ANSWER-Lifestyle modifications
Hormonal Contraceptives
Clomiphene
Letrozole
Anti-androgens
Metformin
Ovarian drilling
IVF
, What can you do for lifestyle modifications - ANSWER-Calorie restricted diet with 30
min of exercise a day at moderate intensity- this improves weight loss and reduces CV
risk factors and diabetes risk.
What is FIRST LINE management for menstrual abnormalities and hirsutism -
ANSWER-Hormonal contraceptives- these inhibit ovarian androgen production.
Use a combination of hormone contraceptive and at the LOW dose.
The most important component of hormonal Contraceptive is - ANSWER-Estrogen:
Reduces secretion of LH and FSH from the pituitary by decreasing GnRH. Estrogen
increases sex binding globulin and reduces bioavailable androgen.
Dose of estrogen 30-35 mg combined w/progesterone
Progestin: Reduces endometrial proliferative effect of estrogen and suppresses LH
levels and susequent androgen production
Which progestin has the least androgen activity and you should use it. - ANSWER-
Norgestimate
Clomifene is first line therapy for - ANSWER-Fertility
Brand name is clomid.
MOA of CLomifene - ANSWER-SERM
Blocks estrogen inhibitory activity at pituitary and hypothalmus and reduces feedback
inhibition
Upregulates LH, FSH, and GnRH
-Clomifene binds to estrogen receptors in the ovaries and kind of turns off estrogen
production so then the hypothalmus ramps up the release of GnRH which then release
LH and FSH
Dosing of clomifene - ANSWER-50 mg PO x 5 days: if no ovulation then increase dose
by 50 mg each subsequent cycle with a max of 150 mg a day.
Adverse Effects of CLomifene - ANSWER-Hot flashes
Abdominal discomfort/bloating
Blurred vision
Ovarian enlargement
Pregnancy Category of clomifene - ANSWER-X- once pregnant stop!
Letrozole (Femara) originally developed for breast cancer. MOA is.. - ANSWER-
Aromatase is an enzyme that converts testosterone to estradiol.
Aromatase inhibitor- there is a decrease in estrogen and this stimulates release of LH
and FSH
