Managing PCOS in General Practice. John Eden UNSW, RHW. Conflict of interest statement. In the last 10 years, I have been a paid scientific adviser for
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A Morphologic diagnosis
One in four women have PCO on scan
Revised 2003 Rotterdam ESHRE/ASRM
(2 out of 3) –
IR occurs in 30-60% of women with PCOS (Dunaif, 1992)
IR is a post-receptor phenomenon, multifactorial & is mostly sited in the fat, muscle & liver, but the ovaries remain spared.
Raised serum insulin levels stimulate ovarian androgen production & decrease hepatic SHBG production.
IR is associated with adverse CVS surrogates (raised lipids, especially triglycerides & hypertension)
Insulin sensitizers (metformin, the glizones) improve the androgenic profile & may induce ovulation.
Ms TG, 14y young woman with irregular heavy periods with flooding. She has about 3-4 periods a year.
Tests show she has PCOS, but no evidence of metabolic syndrome.
She is anaemic with low iron studies.
Ultrasound scan shows an 8cm normal uterus
Tranexamic acid flooding. She has about 3-4 periods a year.
A 25y woman having 1-2 periods per year. flooding. She has about 3-4 periods a year.
BP 150/90; BMI 32. General exam nad, except acanthosis both axillae.
Cholesterol 6; TG 4.5
Fasting glucose 5.8
Fasting insulin 50u/l
Treat IR flooding. She has about 3-4 periods a year.
28 year old with PCOS & heavy periods. flooding. She has about 3-4 periods a year.
She also has acne & excess hair.
Normal BP and no evidence of metabolic syndrome
OCP (& spironolactone) flooding. She has about 3-4 periods a year.
28 year old woman with 12m infertility. She has 6 periods a year. Tests confirm PCOS. BMI 31.
Check other fertility factors year. Tests confirm PCOS. BMI 31.
Metformin or clomiphene
Monitor ovulation when cycles regular
(BBT charts, LH kits)
58 year old post-menopausal woman with excess facial hair. Most is light, ‘peach-fuzz,’ and some dark course terminal hair. She is not on HRT.
Serum androgens normal.
Eflornithine cream Most is light, ‘peach-fuzz,’ and some dark course terminal hair. She is not on HRT.