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  • Dr.Niraj Mahajan
  • Dr.Niraj Mahajan
  • Dr.Niraj Mahajan
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    Polycystic Ovarian Syndrome (PCOS)

    By AdminPosted On 11-Nov-2016

    1. PCOS diagnosis

    The Rotterdam criteria are used for PCOS diagnosis, with two out of three of the following criteria being diagnostic EXCEPT

    a) Polycystic ovaries (either 12 or more follicles or increased ovarian volume [> 10 cm3])

    b) Oligo-ovulation or anovulation

    c) Clinical and/or biochemical signs of hyperandrogenism.

    d) Exclusion of other entities that would cause excess androgen activity

    e) LH/ FSH ration > or equal to 2:1

    f) Raised BMI ≥ 25 kg/m2

    Correct Answer: d,e,f. In 2003 a consensus workshop in Rotterdam (The Rotterdam criteria) have suggested a broader definition for PCOS. It should be noted that the PCOS diagnosis can only be made when other aetiologies for irregular cycles, such as thyroid dysfunction, acromegaly or hyperprolactinaemia, have been excluded if there is clinical suspicion. This criteria was covered in 2006, by the Androgen Excess PCOS Society, who suggested a tightening of the diagnostic criteria to all of the following;

    1) excess androgen activity

    2) oligoovulation/anovulation and/or polycystic ovaries

    3) exclusion of other entities that would cause excess androgen activity

    So option d) should also be part of PCOS diagnostic criteria. As question was asked only for Rotterdam criteria,answer is excluding a,b ad c. (Ref: RCOG 2014)

    2. Hirsutism in PCOS

    Recommended baseline biochemical test for hyperandrogenism/ Hirsutism in PCOS is


    a) Free testosterone

    b) Total testosterone

    c) Free and total testosterone

    d) Free androgen index

    e) SHBG

    Correct Answer: d) Free androgen index. Although free and total testosterone is used in the diagnosis of PCOS, the recommended baseline biochemical test for hyperandrogenism is free androgen index (total testosterone divided by sex hormone binding globulin [SHBG] x 100). (Ref: RCOG 2014)

    3. How should women with PCOS be screened for type II diabetes?

    a) Random blood suger

    b) Oral glucose challenge test with 50 g glucose

    c) 2-hour post 75 g oral glucose tolerance test

    d) Oral glucose tolerance test with 100 g glucose

    e) Fasting and postprandial sugers

    Correct Answer: c) 2-hour post 75 g oral glucose tolerance test. Women presenting with PCOS who are overweight (body mass index [BMI] ≥ 25 kg/m2) and women with PCOS who are not overweight (BMI 40 years), personal history of gestational diabetes or family history of type II diabetes, should have a 2-hour post 75 g oral glucose tolerance test performed. (Ref: RCOG Guidelines 2014)

    4. What is recommended as the first line of treatment of PCOD?

    a) OC pills

    b) Clomiphene citrate

    c) Lifestyle management including diet, exercise and weight loss

    d) Cyproterone acetate

    e) Metformin

    Correct Answer: c) Lifestyle changes, including diet, exercise and weight loss, are initiated as the first line in pcos for improvement of long-term outcomes and should precede and/or accompany pharmacological treatment. In women with pcos/ pcod and excess weight, a reduction of as little as 5% of total body weight has been shown to reduce insulin resistance and testosterone levels as well as improving body composition and cardiovascular risk markers.


    5. Ovarian electrocautery (drilling/ LEOS) in PCOS

    Ovarian electrocautery (pcos/ pcod drilling/ LEOS) should be considered for selected pcos/ pcod patients, especially those with a raised BMI, as an alternative to ovulation induction.

    a) True

    b) False

    Correct Answer: b) False. Above sentence is True for normal BMI patients with pcos/ pcod and not in raised BMI. A long-term cohort study has shown persistence of ovulation as well as normalisation of serum androgens and SHBG up to 20 years after laparoscopic ovarian electrocautery in over 60% of subjects, particularly if they have a normal BMI.

    6. Weight Reduction in PCOS

    Which of the following drug helps pcos patients reduce androgen levels, reduce weight, reduce insulin resistance and cardiovascular risk markers?


    a) OC pills

    b) Clomiphene citrate

    c) Metformin

    d) Cyproterone acetate e.g. Krimson-35 or Diane-35

    Correct Answer: c) Metformin has been shown to have beneficial short-term effects on insulin resistance and other cardiovascular risk markers in women with pcos without type II diabetes. There is evidence that metformin may modestly reduce androgen levels by around 11% in women with pcos compared to placebo and modest reductions in body weight have been reported.


    7. Withdrawal Bleed

    It is good practice to recommend treatment with progestogens to induce a withdrawal bleed at least every —- months in PCOS.

    a) One

    b) Two

    c) Three

    d) Four

    e) Five

    Correct Answer: c and d. Every 3 to 4 months. Oligo- or amenorrhoea in women with pcos may predispose to endometrial hyperplasia and later carcinoma. Women with pcos have a 2.89-fold increased risk for endometrial cancer. In women with pcos/ pcod, intervals between menstruation of more than 3 months (corresponding to fewer than four periods each year) may be associated with endometrial hyperplasia. Regular induction of a withdrawal bleed with cyclical progestogens, oral contraceptive pills or endometrial protection gained by exposure to gestogens by devices such as the Mirena system – would be advisable in oligomenorrhoeic women with pcos/ pcod treatment as part of good clinical practice.


    8. Hirsutism

    Which of the following statements about definition of Hirsutism is correct?


    a) Hirsutism is excessive facial hair.

    b) Hirsutism is excessive distribution of facial and body hair in a female distribution pattern.

    c) Hirsutism is excessive distribution of facial and body hair in a male distribution pattern.

    d) Hirsutism is excessive distribution of body hair.

    Correct Answer: c) Hirsutism is excessive distribution of facial and body hair in a male distribution pattern. Hirsutism is the excessive hairiness on women in those parts of the body where terminal hair does not normally occur or is minimal – for example, a beard or chest hair. It refers to a male pattern of body hair (androgenic hair) and it is therefore primarily of cosmetic and psychological concern.

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    Dr. Niraj Mahajan

    MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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