PCOS

Secondary Amenorrhea and PCOS: A Comprehensive Overview

• Secondary amenorrhea can be caused by various conditions such as PCOS, pituitary disease, and ovarian deficiency
• PCOS is diagnosed using the Rotterdam Criteria, which requires two of the following: menstrual irregularity, hyperandrogenism, and polycystic ovaries
• The etiology of PCOS is unknown, but it may be linked to factors such as obesity, genetic factors, and disruption in the H-P-O axis
• Obesity is often linked to PCOS and can lead to increased production of androgens due to compensatory hyperinsulinemia
• The management of PCOS includes weight-loss strategies, OCPs for menstrual dysfunction, and treatment for hyperandrogenic symptoms
• Hirsutism, a common symptom of PCOS, affects 5-10% of pre-menopausal women and is usually diagnosed clinically using the Ferriman and Gallwey scale
• Hirsutism can be caused by conditions such as PCOS, NCCAH, and ovarian and adrenal androgen-secreting tumors
• Virilization is a more severe form of hyperandrogenism with masculinizing features and may result from an androgen-secreting tumor
• The diagnostic work-up for hirsutism includes evaluating total testosterone, DHEAS, and 17-OHP levels, followed by imaging to rule out androgen-secreting tumors
• The text references various sources including "Essentials of Obstetrics and Gynecology," "UpToDate Online," and "APGO Medical Student Educational Objectives"
• The information provided includes details on the physical examination, laboratory tests, and diagnostic criteria for PCOS and secondary amenorrhea
• The text also emphasizes the importance of evaluating for cardiovascular risks and managing components of the PCOS syndrome such as weight loss, menstrual dysfunction, hyperandrogenic symptoms, and type 2 diabetes and lipid disorders