PCOS & INFERTILITY EXAM QUESTIONS
WITH COMPLETE SOLUTIONS
goals of treatment PCOS - ANSWER-maintain normal endometrium
block androgen action at the target tissues
reduce insulin resistance and hyperinsulinemia
reduce weight
prevent long term complications
ovulation induction
non-pharm treatment infertility in PCOS - ANSWER-reduction of weight (5-10% will
reduce risk of miscarriage and reduce testosterone levels)
exercise: 30 min mod-vigorous exercise daily to reduce risk of metabolic syndrome
first line treatment of all PCOS - ANSWER-continuous oral contraceptive
estrogen and progesterone, monophasic
use a 3rd gen or later progesterone so it will have fewer androgenic effects
treatment progression irregular menses, hirsutism, acne PCOS - ANSWER-continuous
oral contraceptive > spironolactone > finasteride or dutasteride > metformin
AE spironolactone - ANSWER-bleeding, breast tenderness, monitor potassium,
headache, dizziness
AE 5-alpha reductase inhibitors - ANSWER-HA, hypertension, teratogenic
treatment progression insulin resistance PCOS - ANSWER-lifestyle modifications >
metformin
AE metformin - ANSWER-GI upset
d/c if pregnant unless diabetic
treatment progression hyperandrogenism - ANSWER-COC >
spironolactone/finasteride/dutasteride > topical vaniqua > cosmetic (bleaching, laser
removal, waxing, etc)
treatment progression for fertility PCOS - ANSWER-clomiphene or letrozole >
clomiphene + metformin, gonadotropin therapy, laprascopic ovarian drilling >
IVF
clomiphene start, when to increase dosing/ max, and monitoring - ANSWER-start: day
2-5 of menses
WITH COMPLETE SOLUTIONS
goals of treatment PCOS - ANSWER-maintain normal endometrium
block androgen action at the target tissues
reduce insulin resistance and hyperinsulinemia
reduce weight
prevent long term complications
ovulation induction
non-pharm treatment infertility in PCOS - ANSWER-reduction of weight (5-10% will
reduce risk of miscarriage and reduce testosterone levels)
exercise: 30 min mod-vigorous exercise daily to reduce risk of metabolic syndrome
first line treatment of all PCOS - ANSWER-continuous oral contraceptive
estrogen and progesterone, monophasic
use a 3rd gen or later progesterone so it will have fewer androgenic effects
treatment progression irregular menses, hirsutism, acne PCOS - ANSWER-continuous
oral contraceptive > spironolactone > finasteride or dutasteride > metformin
AE spironolactone - ANSWER-bleeding, breast tenderness, monitor potassium,
headache, dizziness
AE 5-alpha reductase inhibitors - ANSWER-HA, hypertension, teratogenic
treatment progression insulin resistance PCOS - ANSWER-lifestyle modifications >
metformin
AE metformin - ANSWER-GI upset
d/c if pregnant unless diabetic
treatment progression hyperandrogenism - ANSWER-COC >
spironolactone/finasteride/dutasteride > topical vaniqua > cosmetic (bleaching, laser
removal, waxing, etc)
treatment progression for fertility PCOS - ANSWER-clomiphene or letrozole >
clomiphene + metformin, gonadotropin therapy, laprascopic ovarian drilling >
IVF
clomiphene start, when to increase dosing/ max, and monitoring - ANSWER-start: day
2-5 of menses
