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Q1: Diagnosis (2 min)
"What are the Rotterdam criteria for PCOS?"
- 2 of 3 required:
- Oligo/anovulation (irregular periods)
- Hyperandrogenism (clinical: hirsutism, acne; or biochemical: high testosterone)
- Polycystic ovaries on US (12+ follicles or volume over 10mL)
- Exclude: 17-OH progesterone (CAH), prolactin, TSH
Q2: Pathophysiology (2 min)
"Describe the pathophysiology of PCOS."
- Insulin resistance → hyperinsulinaemia
- High insulin → ovarian theca cells produce excess androgen
- High insulin → reduced SHBG → more free testosterone
- Elevated LH:FSH ratio (>2:1)
- Androgens → follicular arrest → anovulation → polycystic ovaries
- Vicious cycle with obesity
Q3: Management (3 min)
"How do you manage PCOS?"
- LIFESTYLE first: weight loss 5 to 10%, exercise, diet
- Cycle control: combined OCP (endometrial protection)
- Hirsutism: OCP + spironolactone if needed
- Insulin: metformin
- Fertility: letrozole (first-line, superior to clomiphene)
- Monitoring: annual glucose + lipids
Q4: Long-term risks (2 min)
"What are the long-term risks in PCOS?"
- Type 2 diabetes (4x risk)
- Endometrial cancer (3x risk — unopposed oestrogen)
- Cardiovascular disease (dyslipidaemia, hypertension)
- Metabolic syndrome
- Obstructive sleep apnoea
- Psychological: depression, anxiety