04.02 Nursing Care and Pathophysiology for Polycystic Ovarian Syndrome (PCOS)

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Hey guys, today we’ll be learning about polycystic ovarian syndrome, or PCOS. By the end of today’s lesson, you’ll have a better understanding of what PCOS is, how it’s caused, assessment findings and diagnostic testing used, treatment options, as well as patient education topics relating to this disease process.
So what exactly is polycystic ovarian syndrome or PCOS? So it is a hormone disorder that is common in females of reproductive age. So when I say hormone disorder, I mean that there is a problem with hormone regulation in the body. So there is a problem in the metabolism of androgens or estrogen, and there is usually excess androgen levels, which causes many of the symptoms seen with PCOS. So androgen hormones are present in females but not to the extent that they are seen in males. So this extra androgen prevents the release of an egg during the menstrual cycle which causes small cysts on the ovaries and causes them to be enlarged. Another key finding with PCOS is the presence of metabolic syndrome. So one of the key characteristics of metabolic syndrome seen with PCOS is the presence of insulin resistance - so basically the cells in the body don’t respond to insulin as they should, and as a result don’t use glucose for energy. All that extra circulating glucose leads to hyperglycemia, and since the glucose is not being used for energy, the body stores it - thinking it may need it for future use. When the body stores the glucose this leads to weight gain which can cause obesity, another characteristic of metabolic syndrome, if untreated. Extra insulin also causes the ovaries to increase production of androgen, which prevents ovulation. So you can see in this picture all of the little cysts that are present- which is where PCOS gets its name. Polycystic = many cysts. So this picture shows what an ovary with PCOS looks like. A normal ovary is smooth and not bumpy like this.

So there’s a couple key assessment findings that are seen with PCOS. First of all, the patient will have irregular menses due to decreased FSH levels and excess androgens. So this can look like a couple different things. They can have infrequent or prolonged periods, or anovulation, which is when the ovary doesn’t release an egg, preventing ovulation. This causes infertility because there is no egg available to be fertilized. Two other key assessment findings include acne and extra hair growth due to the androgen excess. The extra hair growth can be in patterns that are common for males, like facial and chest hair. Patients can also have symptoms of metabolic syndrome, like insulin resistance, hyperglycemia, and obesity, like I explained in the previous slide.

So diagnosis of PCOS is usually based on assessment findings as well as lab and imaging results. One of the lab tests that is usually used is thyroid function testing to rule out a thyroid problem, because symptoms seen with PCOS can mimic thyroid problems with the increased weight gain. So thyroid function tests are normally normal with PCOS. The LH and FSH ratio can be off in patients with PCOS - as high as 3:1. Just for a quick review, LH helps create sex hormones like testosterone and estrogen, and FSH stimulates the growth of ovarian follicles to mature the egg before it is released. Increased LH results in increased androgen production, which causes many of the symptoms seen with PCOS, as I’ve explained in the previous slides. Decreased FSH levels means that the ovaries are not stimulated, which prevents the egg from maturing. This prevents ovulation and leads to irregular cycles. So with the androgen excess, androgen levels will be elevated in these patients. Insulin levels are tested to evaluate if there is a component of metabolic syndrome, and the insulin level will be elevated in insulin resistance. Progesterone levels will also be low since progesterone is produced by the ovaries when they release an egg. So what is one of the key problems of PCOS? Irregular ovulation or anovulation, so if the body is not regularly releasing eggs, or not releasing them at all, so progesterone is not being produced, resulting in a low progesterone level. Another helpful diagnostic tool is using transvaginal ovarian ultrasound, which is when an ultrasound probe is inserted into the vagina. This helps the provider visualize the cystic ovaries and see if there is ovarian enlargement as well. Sometimes a pelvic CT or MRI may be ordered to have a better picture of the pelvic structures and to rule out a mass or very large ovarian cyst that may need to be removed surgically.

So the first line treatment for PCOS includes lifestyle modifications such as diet, exercise, and weight loss. A lot of times, these modifications can fix the problem and help with regulating ovulation. If lifestyle modifications don’t work, there are some medication options available. One of the top medications used for PCOS is Metformin, which helps regulate glucose levels and makes the body more sensitive to insulin. Spironolactone is also a top medication and is given to decrease androgen levels in the body, which directly improves many of the symptoms associated with PCOS. Oral contraceptives can be used to promote regular menses and ovulation. Another medication option includes fertility medications, because they can help promote fertility and hormone regulation.

Patient education will focus on lifestyle modifications, like diet, exercise, and weight loss. You can also teach about medications if they are indicated.

One of the nursing concepts relating to PCOS includes alterations in reproduction, as the patient with this diagnosis can struggle with fertility. Another nursing concept is an alteration in hormone regulation, because these patients usually have excess androgen levels which causes many of the symptoms they present with.
Okay guys, so let’s go over the key points for PCOS. So these patients will present with irregular menses, high androgen levels, and can present with metabolic syndrome - so hyperglycemia, obesity, and insulin resistance. Diagnostic testing options include lab testing, transvaginal ultrasound to view the cystic ovaries, and pelvic CT or MRI can be used to rule out a tumor or large ovarian cyst and visualize the pelvic structures. Treatment starts with lifestyle modifications including diet, exercise, and weight loss. Medications can be added to help promote regular menses and help with fertility. And our patient education will consist of the treatment options available - so teaching about the different lifestyle modifications as well as medication options if those are indicated.
Okay guys, that is it on our lesson on polycystic ovarian syndrome. Make sure to check out the other resources attached to this lesson. Now go out there and be your best self today, and as always, Happy Nursing!
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