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Polycystic Ovary Syndrome A s ummary of RCOG Green-top guideline. HDR Women’s Health 11 th April 2012 By Dr Mahya Mirfattahi GP ST3. Why is it important?. Common disorder Chronic anovulatory infertility & hyperandrogenism Oligomenorrhoea, hirsuitism & acne - PowerPoint PPT Presentation
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HDR Women’s Health
11th April 2012By Dr Mahya MirfattahiGP ST3
POLYCYSTIC OVARY SYNDROMEA SUMMARY OF RCOG GREEN-TOP GUIDELINE
Why is it important?•C
ommon disorder•C
hronic anovulatory infertility & hyperandrogenism• Oligomenorrhoea, hirsuitism & acne
•Obesity, impaired glucose tolerance, type 2 diabetes and sleep apnoea
•Adverse cardiovascular risk profile • Hypertension, dyslipidaemia, obesity, insulin resistance
Diagnosis•R
otterdam criteria•2
of 3• Polycystic ovaries (>12 peripheral follicles or increased
ovarian volume >10cm3)• Oligo- or anovulation• Clinical and/or biochemical signs of hyperandrogenism
Making the diagnosis•R
aised LH/FSH ratio is no longer a diagnostic criteria•R
ecommended baseline screening tests• TFTs• Serum prolactin• Free androgen index (total testosterone divided by SHBG x
100)• Note; if testosterone >5 nmol/l exlude androgen-secreting
tumours • Consider 17-hydroxyprogesterone• Test for Cushing syndrome if clinical suspicion
How should women be counselled?•L
ong-term risks to health•A
dvise regarding weight control & exercise
•Offer a glucose tolerance test if • Obese (BMI >30)• Strong family history of type 2 diabetes • >40 years
•Offer screening with annual fasting glucose
Cardiovascular risk•N
ote; conventional cardiovascular risk calculators have not been validated in women with PCOS
•BP and lipid profile• Treat BP as according to NICE guidelines• Lipid lowering treatment is not recommended routinely &
should be prescribed by a specialist• Mainly raised TG, total & LDL cholesterol
•Sleep apnoea• Ask about snoring & daytime fatigue/somnlonence
Pregnancy•H
igher risk of gestational diabetes• Screen before 20 weeks gestation• Greatest in those requiring ovulation induction & obese
women•M
etformin is currently not licensed for use in pregnancy
Cancer risk•O
ligo- or amenorrhoea in women with PCOS may predispose to endometrial hyperplasia & carcinoma• Good practice to recommend treatment with progestogens to
induce a withdrawal bleed at least every 3-4months•N
o association with breast or ovarian cancer
Treatment•L
ifestyle advice on diet & exercise• Loss of significant weight has been reported to result in
spontaneous resumption of ovulation, improvement in fertility, increased SHBG & normalisation of glucose metabolism
•Reduces likelihood of developing type 2 diabetes in later life
Drug therapy•I
nsulin-sensitising agents have not been licensed in UK for women who are not diabetic• Metformin & thiazolidinediones have been shown to have
short-term effects on insulin resistance & thereby reduce risk of developing type 2 diabetes• Metformin shown to modestly reduce androgen levels• No evidence of long-term benefits or support in prevention of
cardiovascular disease•W
eight-reduction drug may be helpful in reducing insulin-resistance through weight loss
Surgery•O
varian electrocautery should be reserved for selected anovulatory women with normal BMI• Persistence of ovulation & normalisation of serum androgens• May affect reproductive capacity of ovaries
Advice for hirsutism & acne•I
mpact on women’s self-image & psychological effects•I
nsufficient evidence in favour of either metformin or COCP•L
icensed treatments for hirsutism include COCP, cosmic measures (laser, electrolysis, bleaching, waxing, shaving) and topical facial eflornithine (Vaniqa)
•Non-licensed treatments• Spironolactone, antiandrogens (flutamide, finasteride, high
dose cyproterone acetate), metformin