QuickDoc.

Medical guidelines and references.

QuickDoc is targeted for medical professionals only. It is not intended to replace clinical experience and judgement.
Unless explicitly stated, copyright of all material in this website remains that of QuickDoc.

Female Health

PCOS

Updated: 23rd Nov 2023

Background

·         1/3 have have polycystic ovaries [>= 10 follicles per ovary]

·         of these 1/3 will have PCOS

Symptoms

·         Menstrual disturbance – oligomenorrhoea, amenorrhoea, DUB, infertility

·         Hirsutism, acne, male-pattern hair loss

Defination

·         Polycystic ovaries + one or more of symptoms or raised testosterone and/or LH

Investigate

·         1st week of period:  TFT, U&Es, Prolactin, LH, FSH, Testosterone, SHBG, Glucose, cortisol

·         USS

·         Findings: High LH, testosterone Low SHBG Normal FSH

·         FAI [free androgen index] >= 5 indicates PCOS [= total testosterone * 100/SHBG]

·         If free testosterone is > 4.8, refer to exclude androgen hypersecretion [Cushing’s syndrome, adrenal gland or ovarian tumours…]

Management

·         Menstural irregularities – COC to regulate periods

·         Hersutism – Waxing, shaving, bleeching, lose weight, eflornithine cream 11.5% [Vaniqa in conjunction with waxing, shaving… effective in 30%], Dianette as COC – refer for finasteride, GnRH analogs, Spironolactone, metformin…

·         Infertility – refer [weight loss can stimulate ovaries, anti-oestrogen, gonadotrophins, metformin or ovarian drilling]