Polycystic Ovarian Syndrome for PA
Start your One-Week Free Trial
Already subscribed? Log in »
Polycystic Ovarian Syndrome (PCOS) for the Physician Assistant Licensing Exam
- Definition:
- PCOS is a common endocrine disorder in women of reproductive age, characterized by hyperandrogenism, irregular menstruation, and polycystic ovaries. It is a primary cause of infertility and is associated with metabolic risks.
- Pathophysiology:
- Hyperandrogenism: Excessive androgen production disrupts normal follicle development, leading to anovulation and symptoms like hirsutism (excess body hair) and acne.
- Insulin Resistance: Frequently seen in PCOS, insulin resistance contributes to hyperinsulinemia, which stimulates ovarian androgen production and worsens the hormonal imbalance.
Clinical Manifestations
- Menstrual Irregularities:
- Includes oligomenorrhea (infrequent periods) or amenorrhea (absence of periods) due to anovulation.
- Hyperandrogenic Symptoms:
- Hirsutism: Male-pattern hair growth on the face, chest, or abdomen.
- Acne: Often due to elevated androgen levels.
- Alopecia: Hair thinning or male-pattern baldness in more severe cases.
- Metabolic Disturbances:
- Obesity and Insulin Resistance: Linked to a higher risk for type 2 diabetes and metabolic syndrome.
- Dyslipidemia: Often includes elevated LDL and triglycerides and reduced HDL.
- Infertility:
- Due to chronic anovulation and suboptimal endometrial receptivity, PCOS is a common cause of infertility.
Diagnostic Criteria
- Rotterdam Criteria: Requires two of the following three features, after ruling out other conditions:
- Oligo- or Anovulation
- Hyperandrogenism: Clinical signs or elevated androgens.
- Polycystic Ovaries: ≥12 follicles in each ovary (2–9 mm in size) or increased ovarian volume on ultrasound.
Management
- Pharmacologic Therapy:
- Combined Oral Contraceptives (COCs): First-line for menstrual regulation and reduction of androgen levels.
- Spironolactone: For hirsutism and acne; works by blocking androgen receptors.
- Metformin: Improves insulin sensitivity, often used in combination with lifestyle changes.
Key Points
- PCOS is characterized by hyperandrogenism, menstrual irregularities, and polycystic ovaries, leading to infertility and metabolic issues.
- Diagnosis uses the Rotterdam criteria, requiring two of three findings (oligo/anovulation, hyperandrogenism, polycystic ovaries).
- Management includes lifestyle changes, hormonal therapy (COCs), anti-androgens (spironolactone), and, for insulin resistance, metformin.
- Long-Term Risks include increased chances of type 2 diabetes, cardiovascular disease, and endometrial hyperplasia or cancer.