Polycystic Ovarian Syndrome
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.
Plus
- other endocrine disorders need to be excluded
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
- Free androgen index (FAI = testosterone / SHBG x100 – one yellow top tube to biochemistry)
- TSH if clinical suspicion
- LH/FSH and prolactin if 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)
Reason for referral
- infertility- refer infertility service
- Symptom control - if initial treatments not effective refer to endocrinology (for hirsuitism and further investigation) or gynaecology (for menstrual disorder) for consideration of anti-androgens or metformin
-
for 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)