What would be the most important questions to ask while taking the history of a patient with polycystic ovary syndrome (PCOS)?
The most important questions to ask when taking the history of a patient with PCOS include those related to menstruation, infertility, and infertility, and weight and lifestyle histories. Asking the patient about menarche age and if the first menstruation episode was spontaneous or was induced using hormones is essential (Pereira & Kreider, 2017). Also, it is important if the patient has been using contraceptives or any other drugs which can interfere with the menstruation cycle. The history is crucial because hormonal contraceptives can change the menstrual cycle. Furthermore, the use of hormonal contraceptives for a long time may present a challenge in determining a PCOS patient's menstrual pattern. Probing the patient on infertility and determining if they have in the past been treated for infertility is imperative because it may indicate anovulation (Pereira & Kreider, 2017). Obtaining information from the patient on her weight and way of living is crucial specifically to identify if changes in the menstrual cycle corresponded with an increase in weight.
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What emotional issues would you have to consider with a PCOS patient?
Symptoms associated with PCOS can interfere with self-esteem, especially in young women. Acne, obesity, and worries related to fertility concerns, among others, may negatively affect self-esteem. It is, therefore, important to consider issues such as anxiety, depression, and likely binge eating in women with PCOS (Pereira & Kreider, 2017). Depression rate in PCOS patients can be as high as 40 percent, hence the need to assess psychological issues.
What specialists would you possibly refer the patient to, and why?
I would possibly refer the patient to a mental health counselor, dietician, and a workout and fitness expert. If psychological concerns such as anxiety or depressive symptoms would be identified, appropriate assessment and treatment/therapy from a specialist would be required. Weight is directly related to fertility and ovulation issues in women suffering from PCOS. Referral to a workout and fitness expert would be essential if the patient is overweight or obese. Depressive symptoms tend to improve with lifestyle modifications that involve diet regulation and aerobic resistance workouts (Pereira & Kreider, 2017).
Discuss the comorbidities associated with PCOS.
There are multiple comorbidities related to PCOS. Approximately 30 to 70 percent of women diagnosed with PCOS are obese. Although obesity is not considered as one of the factors that cause PCOS, extra weight can cause other related problems such as insulin resistance, glucose intolerance, and increased risk for cardiovascular disease (Pereira & Kreider, 2017). In the United States, women with PCOS have an increased rate of obesity when compared with those from other countries. Abdominal obesity that is characterized by excess visceral adiposity is prevalent in patients with PCOS. This is closely linked to cardiovascular disease, insulin resistance, and diabetes mellitus (Pereira & Kreider, 2017). Furthermore, obesity is linked to a higher risk for negative pregnancy outcomes for those who want to become pregnant. It is also associated with a significant increase in the risk of developing gestational diabetes research indicates that the odds ratio for having type 2 diabetes mellitus is 2 when the BMI is adjusted and 2.8-3.8 when it is not adjusted (Pereira & Kreider, 2017). However, it is still not identified if diabetes mellitus is a result of obesity, PCOS, or both. PCOS is associated with cardiovascular disease and arterial disorders. Women suffering from PCOS have a double fold possibility of developing cardiovascular disease. Also, they have a 1.5 increased risk when the body mass index is adjusted. Women with PCOS, in most cases, have high levels of triglycerides and low high-density lipoprotein cholesterol. Sleep apnea, metabolic syndrome, and steatohepatitis that is not linked to alcohol are also seen in women with PCOS. Patients with PCOS also have a higher risk of developing endometrial hyperplasia. In addition, they are most likely to develop endometrial cancer caused by increased estrogen exposed to the endometrium because of anovulation (Pereira & Kreider, 2017).
Discuss the relationship between fatty liver disease and PCOS. What education would you provide for this patient about developing fatty liver disease?
The majority of the women who have PCOS are obese and developed insulin resistance. Both obesity and insulin resistance are associated with fatty liver disease. As a result, the liver is inflamed and experiences accumulation of fat in the liver. Education on dietary restrictions to prevent fatty liver disease would be provided. Besides, lifestyle changes such as exercise alongside the consumption of a healthy diet to promote weight loss for an obese patient would be given. These would help improve the problem of insulin resistance and reduce the amount of visceral fat accumulated.
What medications might you start a PCOS patient on, and why?
Metformin is one of the possible medications to start with for PCOS patients. The drug is proposed as a treatment for different PCOS symptoms and insulin resistance, which is prevalent in PCOS. Metformin can restore regular menstruation, frequency of ovulation, and improve fertility. The medication can help decrease the amount of testosterone hence improve symptoms that are associated with hyperandrogenism, cause weight loss, and reduce progression a pre-diabetes condition to T2DM (Pereira & Kreider, 2017). However, metformin is not recommended as a first-line treatment for infertility related to PCOS. Also, it is not proposed to be used alone in treating PCOS. Metformin should be used to treat the damaged fasting glucose, tolerance, and diabetes-related to PCOS. I addition, combined OCPs or medroxyprogesterone acetate, among others, could be used to offer protection to the endometrium.
What evidence-based guidelines did you find for PCOS?
To identify abdominal adiposity, BMI should be determined and wait for circumference taken in each visit. For Whites and Blacks, awaits circumference above thirty-five inches and 31.5 inches for the Hispanics, Asians, American Indians, and Europeans indicate abdominal adiposity (Pereira & Kreider, 2017).
Screening of PCOS patients after every 24 months or before if there is an increase in weight or other identified risks.
Assess blood pressure in every visit.
Reference
Pereira, K., & Kreider, K. E. (2017). Caring for Women with Polycystic Ovary Syndrome. Nurse Practitioner, 42 (2), 39–47.
