HDR Women’s Health 11 th April 2012 By Dr Mahya Mirfattahi GP ST3 POLYCYSTIC OVARY SYNDROME A...
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Transcript of HDR Women’s Health 11 th April 2012 By Dr Mahya Mirfattahi GP ST3 POLYCYSTIC OVARY SYNDROME A...
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
•Metformin 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
•No 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
•Weight-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