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Clinical Opal - Hirsutism and irregular menstrual cycles

20 October 2023 - A/Prof Stephen Barnett

Patient Information

Lena, a 33-year-old Indigenous woman, presents to her GP in a remote Australian community. She's concerned about irregular menstrual periods, weight gain, and facial hair growth over the past year. Her medical history indicates that she has had no major health issues.

Clinical Examination including blood pressure, heart rate, and a general physical examination indicate all results within normal limits. On gynaecological examination, Lena has signs of hirsutism and reports irregular menstrual cycles over the past 12 months.

Based on Lena's presentation, which of the following diagnoses is most likely?

A) Early Menopause
B) Polycystic Ovary Syndrome (PCOS)
C) Hypothyroidism
D) Endometrial cancer

 

 

Polycystic Ovary Syndrome (PCOS)


Lena's symptoms, including irregular menstrual periods, weight gain, and hirsutism, align with clinical manifestations of PCOS. Current guidelines by the Royal Australian College of General Practitioners (RACGP) emphasise the importance of considering PCOS as a diagnosis in women with these symptoms, especially when other underlying causes like early menopause or thyroid disorders are ruled out.

Diagnostic criteria, as per RACGP guidelines, include irregular menstrual cycles, clinical signs of hyperandrogenism (such as hirsutism), and excluding other potential causes. Further evaluation, including ultrasound and hormonal assessments, is typically recommended to confirm the diagnosis.

As a PCOS sufferer, patients like Lena have a higher risk of premature heart disease and diabetes.  Monash University has recently released new guidelines for the assessment and management of PCOS.  This include five algorithms that summarise the key recommendations including:

  1. Screening, diagnostic assessment, risk assessment and life-stage
  2. Prevalence, screening, diagnostic, assessment and treatment of emotional wellbeing
  3. Lifestyle
  4. Pharmacological treatment for non-fertility indications
  5. Assessment and treatment of infertility


With over 13% of women globally suffering from PCOS and more than two thirds suffering undiagnosed, these guidelines contain new resources designed to help clinicians improve patient care through early diagnosis with improved diagnostic tools including hormone tests instead of ultrasound, treatment recommendations including lifestyle management, assessment & treatment of infertility and approaches to care to support the psychological distress of diagnosis.

Related Courses

You can learn more on PCOS and other Women’s Health topics via our Accredited Women’s Health In General Practice Course.

 

References

PCOS guidelines https://www.monash.edu/medicine/mchri/pcos/guideline

Swannell C (2018) Australian-led PCOS guideline an international first The Medical Journal of Australia, AMA October https://www.mja.com.au/journal/2018/australian-led-pcos-guideline-international-first 

 

A/Prof Stephen Barnett
A/Prof Stephen Barnett

Stephen is a GP Supervisor, Medical Educator, GP academic and Medical Director of Medcast. He has completed a PhD on Virtual Communities of Practice in GP Training.

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