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7 Cards in this Set
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Ix for PCOS |
FSH (increased in ovarian failure, decreased in hypothalamic disease, normal in PCOS) Prolactin (exclude prolactinoma) TSH serum testosterone (if hirsutism) LH (often raised in PCOS, not diagnostic) USS Diabetes screen |
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Tx for PCOS: (aside from fertility) |
Diet and exercise advice COCP Cyproterone acetate or spironolactone (antiandrogens --> AVOID CONCEPTION!!) Topical antiandrogen Metformin |
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Tx for hyperprolactinaemia |
Dopamine agonist (inhibits prolactin release) |
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What can be used to induce ovulation in PCOS? |
Clomifene |
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What is the MOA of comifene? How long can it be used for? |
Inhibits oestrogen receptors in the hypothalamus Inhibits negative feedback of oestrogen on gonadotropin release Increase in FSH and LH Limited to 6 mths use |
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What can be used to induce ovulation in hypothalamic hypogonadism or if clomifene has failed? |
Gonadotrophins --> daily subcut injection of FSH +/- LH to stimulate follicular growth Monitor follicular development with USS Once follicle is of adequate size for ovulation, artifically stimulate the process by hCG injection or recombinant LH |
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What are the side effects of ovulation induction? |
Multiple pregnancy Ovarian hyperstimulation syndrome- ovaries hyperstimulated causing large and painful follicles, can be fatal. Use lowest effect dose and monitor with USS |
