Login

Polycystic Ovarian Syndrome

 

Definition (2 out of following 3 criteria)

  • Irregular or absent ovulation (menstruation)
  • Clinical and/ or biochemical signs of raised androgens 
  • Polycystic ovaries on USS, defined as the presence of 12 or more follicles in one or both ovaries and/or increased ovarian volume

Ultrasound is not necessary to diagnose PCOS. The Ultrasonographers at RCHT do not accept referrals from GPs to look for cysts alone and polycystic ovaries do not have to be present to make the diagnosis of PCOS.

Other endocrine disorders may need to be excluded.


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 prolactin if anovulation/amenorrhoea


Treatment options*:

  • Weight loss, exercise for all
  • COCP/dianette (androgenic Sx and cycle control)
  • Cyclical progestogens eg. Medroxyprogesteone 10mg daily for 14 days every 1-3 months (cycle control)
  • Mirena (cycle control)
  • Vaniqua (hirsuitism)


Referral:

Infertility - refer to Infertility service

Symptom control - if initial treatments (see above*) not effective:

  • Hirsutism – Refer to Endocrinology

And\or

  • Menstrual Disorders/Consideration of anti-androgens or metformin- Refer General Gynaecology

Surveillance of endometrium, or endometrium >10mm on USS

  • If the woman has amenorrhoea >3 months prescribe a cyclical progestogen to induce a withdrawal bleed, then refer for a TV USS to assess endometrial thickness. If endometrial thickening present >10mm or has an unusual appearance, refer (either Routine or Urgent/2ww accordingly) for endometrial sampling.
  • If the woman is unwilling/unable to use hormones, seek A&G or refer Gynaecology. Regular USS (every 6-12 months) is likely required to assess endometrial thickness and morphology.


Information to include in the referral letter to General Gynae Clinic:

  • History of Raised Androgens, e.g. hirsutism, acne etc. including severity of Sx.  
  • Menstrual history
  • Metabolic disturbance
  • Obesity
  • Treatments tried* and response to treatments
  • TV USS report (attached)

 

References: cks.nice.org.uk/topics/polycystic-ovary-syndrome/

Date reviewed                    January 2021

Next review due                 January 2022

Author:                                Dr S Burns

Contributors:                      Lisa Verity, Susan Bates Consultant Gynaecologists, RCHT

 

Version 1.2