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Polycystic Ovarian Syndrome

Refer to General Gynae Clinic

Definition

  • Irregular or absent ovulation (menstruation)and
  • Clinical and/ or biochemical signs of raised androgens 

Ultrasound is not necessary to diagnose PCOS. The Ultrasonographers at RCHT do not accept referrals from GPs to look for cysts alone.

  • other endocrine disorders may need to be excluded 

Reason for referral

  • Infertility- refer infertility service
  • Symptom control- if initial treatments below not effective refer to

Endocrinology for hirsuitism and further investigation

And\or

Gynaecology for menstrual disorder for consideration of anti-androgens or metformin

  • Surveillance of endometrium, or endometrium >15mm

Thick or unusual appearance on scan (if oligo-/amenorrhoic and unable or unwilling to have cycle controlled with hormone treatments, she will need endometrial thickness assessment by ultrasound scan)

Information to include in the referral letter to General Gynae Clinic

  • History of Raised Androgens, e.g. hirsuitism, acne etc. including severity of Sx.  
  • Menstrual history
  • Metabolic disturbance
  • Obesity

Investigations prior to referral

  • Free androgen index (FAI = testosterone / SHBG x100 – one yellow top tube to biochemistry)

If testosterone greater than 5 consider androgen secreting tumour

  • TSH if clinical suspicion
  • LH/FSH and prolactinif anovulation
  • If testosterone greater than 5 consider androgen secreting tumour

Treatment options please include which ones tried and response

  • Weight loss, exercise for all
  • COCP/dianette  (androgenic Sx and cycle control)
  • Cyclical progestogens (cycle control)
  • Mirena (cycle control)
  • Vaniqua (hirsuitism)

Download Polycystic Ovarian Syndrome PDF

 

Date reviewed                     20/6/2019

Next review due                  20/6/2020

Sifter name                          Anna Harrold

Contributors                         Joanna Parry, RCHT Consultants

 

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