PCOS - Taylor

PCOS pathophysiology involves what key abnormalities?

Abnormal GnRH and LH secretion plus insulin resistance, leading to excess androgen production and anovulation.

What are the 3 diagnostic criteria for PCOS?

Hyperandrogenism, oligo-ovulation, and polycystic ovaries on ultrasound.

How many PCOS diagnostic criteria are required?

At least 2 of the 3 criteria must be present after excluding other known disorders.

What findings can indicate hyperandrogenism in PCOS?

Clinical hirsutism and/or hyperandrogenemia such as elevated testosterone.

What menstrual pattern supports oligo-ovulation in PCOS?

Fewer than 9 menstrual periods per year or otherwise infrequent/irregular ovulation.

What classic ultrasound appearance may be seen in PCOS?

Small follicles arranged around the ovarian edge in a "string of pearls" appearance.

What disorders should be excluded before diagnosing PCOS?

Hyperprolactinemia and thyroid abnormalities.

What are common reproductive manifestations of PCOS?

Irregular menses and infertility.

What are common cutaneous manifestations of PCOS?

Hirsutism, acne, and androgenic alopecia.

What are common metabolic conditions associated with PCOS?

Type 2 diabetes, metabolic syndrome, hyperlipidemia, obesity, hypertension, MASLD, and obstructive sleep apnea.

What are major long-term reproductive complications of PCOS?

Reduced fertility, pregnancy complications, and increased risk of endometrial hyperplasia or cancer.

What are the main treatment goals in PCOS?

Maintain a normal endometrium, block androgen activity, reduce insulin resistance, reduce weight, and improve fertility.

What lifestyle weight-loss goal is recommended in PCOS?

A 5-10% reduction in body weight.

Which medication is first-line in Taylor's lecture for improving insulin sensitivity in PCOS?

Metformin.

Which therapy is first-line for irregular menstrual cycles in PCOS?

Hormonal contraception.

What benefit does hormonal contraception provide in PCOS besides cycle regulation?

It can improve hirsutism.

Which medications are add-on antiandrogen options for hirsutism in PCOS?

Spironolactone and finasteride.

What is the first-line medication for ovulation induction in PCOS?

Letrozole.

How does letrozole promote ovulation in PCOS?

It inhibits aromatase, decreases conversion of androgens to estrogens, lowers peripheral estrogen, and increases FSH to promote ovulation.

How does clomiphene promote ovulation in PCOS?

It binds estrogen receptors in the hypothalamus, reduces estrogen negative feedback, and increases LH and FSH to promote ovulation.