Question 1- Diagnosis of PCO by INH criteria requires all except:
1- the presence of oligomenorrhea,
2- evidence of hyperandrogenism (clinical: acne/hisrsuitism/male type baldness or chemical: elevated testosterone level)
3- exclusion of other causes of hyperandrogenism and menstrual irregularity.
4- Poylcystic ovaries on US.
the right answer is 4. It in the Rotterdam criteria that PCO in ultrasound that is required. Two out of three of the following are required to make the diagnosis: oligomenorrhea, hyperandrogenism, and polycystic ovaries on ultrasound.
Question 2: in initial biochemical evaluation of the oligomenorrhea and/or hyperandrogenism all is required except:
1- Serum UCG
2- FSH
3- Prolactin
4- TSH
5- Total testosterone
6- 24 h urine cortisol.
The right answer is 6. 1 is first step to role out pregnancy. 2 will role out primary ovarian failure as a cause. 3 will role out prolacinoma as a cause, 4 will role out hypothyroidism as a cause. Total testosterone is measured to role out the rare cases of ovarian and adrenal tumors where the levels are likely to be high compared by PCO which will be mostly <150>
Question 3: The use of metformin in PCO was found to do all of the below except:
1- Non or mild effect on improving hirsuitism.
2- Non or non-proven mild effect on endometrial protection.
3- moderate effect on restoring ovulation (4 times the placebo).
4- Non or mild effect in restoring fertility.
5- moderate effect in improving insulin resistance.
6- moderate Birth defects in women on the drug during pregnancy.
7- Fetal loss is less in women with PCO who are in metformin than placebo.
Right answer is 6. For 1 and 2 BCP are more effective. Though metformin reduces elevated testosterone level it is not effective in treating hirsusitism in these patients. For 3 and 4 weight loss and exercise are the primary approach if it fails clomiphine is the most effective. Metformin induces ovulation in PCO and was found to be effective in some studies in treating infertility in these women, but in other studies found ineffective, the consensus is it is not effective. Clomphine induces ovulation in about 80% of PCO patients and 50% conceive with it. the effect of metformin however in obese women with obese women with PCO and insulin resistance is favorable. It is considered safe in pregnancy from metanalysis of studies conducted so far. Fetal loss is less in women who get pregnant on metformin than placebo and women with PCO on metformin may need a contraception method if pregnancy is not desired.
