Overview

• Condition of ovarian dysfunction thought to affect between 5-20% of women of reproductive age.
• Rotterdam Criteria (need 2/3 for diagnosis) ⇒
  • Oligoovulation or Anovulation → presenting with irregular or absent menstrual periods.
  • Hyperandrogenism (Clinical or Biochemical) → characterised by hirsutism and acne.
  • Polycystic Ovaries on Ultrasound → 12 follicles in one ovary and 7 in the other.

Making Diagnosis

Clinical Features

• Oligomenorrhoea or amenhorrhoea.
• Subfertility.
• Obesity.
• Hirsutism (upper lips, lower abdomen) and acne.
• Acanthosis nigracans → thickened, rough skin typically found in the axilla or elbows. Occurs with insulin resistance.

Investigations

• Pelvic Ultrasound → ≥12 developing follicles in one ovary. Ovarian volume of more than 10cm^3.
• Baseline Bloods → raised LH (raised LH:FSH ratio), raised-to-normal testosterone, raised insulin, normal oestrogen. Also look at prolactin to rule out prolactinoma. SHBG may be low-to-normal.
• Screen for Diabetes → oral glucose tolerance test (OGTT). Taking a baseline fasting plasma glucose, giving a 75g glucose drink and then measuring plasma glucose 2 hours later.
  • Impaired Fasting Glucose → fasting glucose of 6.1-6.9 mmol/l.
  • Impaired Glucose Tolerance → plasma glucose at 2 hours of 7.8-11.1 mmol/l. Should have repeat OGTTs annually if impaired glucose tolerance.
  • Diabetes → plasma glucose at 2 hours >11.1 mmol/l.

Management Plan

• Reducing risks associated with obesity, T2DM, hypercholesterolaemia and CVD (LIFESTYLE ADVICE = 1ST LINE) → weight loss, improve diet, exercise, smoking cessation, antihypertensive medications where required, statins when indicated (QRISK >10%).
  • Weight loss alone can result in ovulation and restore fertility and regular menstruation, improve insulin resistance and reduce hirsutism. Orilstat (lipase inhibitor) may be used if BMI >30.