PCOS

Data gathering

• Red flags
• Others – infrequent periods, acne, hair growth, mood, weight, problems getting pregnant
• Examine – BMI, acne, hirsutism, pelvic exam

Clinical management

• Investigations
  • Bloods – LH (raised), FSH (normal), testosterone (total and free), SHBG (low), HbA1c, lipids, TFTs
  • Pelvic USS

• Explanation
  • cysts on ovaries result in imbalance of hormones – affects periods, fertility, hormones, skin

• Treatment
  • Lifestyle
    • weight loss, diet, exercise, smoking cessation
  • Acne
    • as per usual acne treatment (+ consider Dianette)
  • Periods
    • If 3 or fewer periods per year, induce a bleed every 3 months using the COCP and scan for endometrial thickness
  • Hirsutism
    • hair removal, laser treatment, eflornithine
  • Fertility
    • refer to gynae to consider clomiphene

• Follow-up / Safety net
  • Patient information leafleft
  • If weight loss/fertility/hirsutism ongoing problem, consider gynae and dietician referral