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
Managing PCOS in General Practice
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.
Management options for the hirsute woman
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
A 25y woman having 1-2 periods per 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
28 year old with PCOS & heavy periods.
She also has acne & excess hair.
Normal BP and no evidence of metabolic syndrome
OCP (& spironolactone)
28 year old woman with 12m infertility. She has 6 periods a year. Tests confirm PCOS. BMI 31.
Check other fertility factors
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.