PCOS

July 5, 2023 Maladywise

8 to 13% of women
Consider if irregular periods, overweight, hirsutism acne, infertility, prediabetes, GDM or early T2DM

Irregular periods

Clinical hyperandrogenism

Biochemical androgens

Ultrasound

Should not be used in those <8 years after menarche due to high incidence of multi-follicular ovaries
Only needs if irregular cycles OR hyperandrogenism only
Can identify the complete PCOS phenotype

Lifestyle
- Healthy eating
- Regular physical activity 30 minutes daily
- Realistic weight loss goals 5 to 10%
Hyperandrogenism
- Cosmetic options
- COCP - aim for the lowest effective dose
- Spironolactone 100 to 200mg daily
Menstrual cycle regulation
- Lifestyle effects help
- All COCP helps, no one is more effective
- Progestogens alone may be used cyclically or an IUD
- Metformin improves ovulation and re-establishes cycle
  - 500mg daily, increase by 500mg every 1 to 2 weeks up to 1500 or 2000mg
Fertility
- BMI > 25 = start with weight loss
- 5 to 10% of weight loss may assist in cycle control and fertility
- Drug options include Letrozole or Clomiphene
- Metformin can be trialled
- Refer to fertility specialist if unable to conceive
  - 12 months if < 35 years
  - 6 months if > 35 years
Weight management
- Education alone and unachievable goals are generally unsuccessful
- Simple behavioural changes that are sustainable
- Calorie deficit of 2000kJ daily need for weight loss
- 250min of moderate exercise per week
- Consider
  - Dietitian
  - Exercise physiologist
  - Psychologist
Cardiometabolic health
- Smoking cessation
- BP check annually
- Lipids profile at baseline then 2 to 4 yearly
- Diabetes screening every 1 to 3 years
Mental and emotional health
- Higher risk of moderate to severe anxiety and depression
- Screen eating disorders
Sleep apnoea
- Screen and monitor clinically