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IOS 9

PCOS

QuestionAnswer
Anovulation 70-75% usually present with oligomenorrhea and or amenorrhea, infertility
Hyperandrogenism 70% present with hirsutism, achne, alopecia, virilization
Obesity 50% of PCOS present with abdominal obesity, waist to hip ratio>0.8
Insulin resistance 75% of PCOS present
S/S of PCOS Anovulation, hyperandrogensim, obesity, insulin resistance
3 mehanisms that act alone or synergistically to create clinical presentations in PCOS 1. Increased GnRH (excess sex hormones decrease FSH) 2.Defective sex hormone synthesis or metabolism thus increase LH (produce excess androgen) 3. Metabolic disorder in insulin action causing resistance
Long term risks of PCOS DM, CVD, Cancer
Diagnostic criterai for PCOS 2/3 1. Menstral dysfunction 2. CLinical or biochemical signs or hyperandrogenism 3. Polycystic ovaries (via ultrasound)> 12
Non-pharm treatment in PCOS Decrease weight 5-10% will reduce hyperandrogenism, decreae insulin resistance and decrease anovulation, Psycho, hair removal
Anovulation , hyperandrogenism, acne, hirsutism therapy COC-low estrogen and non-androgen progestin
Agent for hirsutism Spironolactone 100-200mg QD, take 6-9 months. Inhibits DHT from interacting with receptor,best with COC, due to teratogenic effect
Ovulation Induction agents Metformin, Clomiphene Citrate, Gonadotropins (LH &FSH)
Insulin secreting agents Metformin and Thiazolidinegiones (Rosiglitazone & Pioglitazone)
Clomiphene CItrate Causes increase in GnRH to cause increase in FSH & LH to promote follicale development (50-80% success- conception 35-50%) may only use for 3 cycles
Metformin MOA Decreases testosterone concentrations 20-50% and increases serum hepatic blood glucose production and decreases LH, LH:FSH ratios as well as BMI. 1500-200mg QD
GOALS of PCOS Maintain normal endometrium, block androgens, reduce insulin resistance, correct anovulation, weight reduction, prevent long term complications
PCOS plan Metformin 500mg QD tritrate up to TID, monitor renal function, and CBC, will stop if pregancy occurs, consider clomiphene citrate
Created by: liza001
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