Running head: POLYCYSTIC OVARIAN SYNDROME 1
Polycystic Ovarian Syndrome Protocol
Carson Newman College
Courtney Connolly
POLYCYSTIC OVARIAN SYNDROME 2
1. Topic: Polycystic Ovarian Syndrome
Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is a
common health problem, 1 in 10 women of childbearing age are diagnosed with PCOS. PCOS is
caused by an imbalance of reproductive hormones. This hormonal imbalance creates problems
within the ovaries. The ovaries make the egg that is released each month as part of a healthy
menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released
during ovulation. In the US, it is the most common cause of infertility (Weaver 2018).
PCOS is usually defined as a clinical syndrome, not by the presence of ovarian cysts. But
typically, ovaries contain many 2- to 6-mm follicular cysts and sometimes larger cysts containing
atretic cells. Ovaries may be enlarged with smooth, thickened capsules or may be normal in size
(Weaver 2018).
”This syndrome involves anovulation or ovulatory dysfunction and androgen excess of
unclear etiology. However, some evidence suggests that patients have a functional abnormality
of cytochrome, as a result, androgen production increases” (Weaver 2018).
Polycystic ovary syndrome (PCOS) is a complex condition that is most often diagnosed
by the presence of two of the three following criteria: hyperandrogenism, ovulatory dysfunction,
and polycystic ovaries. Because these findings may have multiple causes other than PCOS, a
careful, targeted history and physical examination are required to ensure appropriate diagnosis
and treatment (Center 2017).
2. Goal of Therapy
There is no cure for PCOS, but symptom management is the focus. Treatment plan based
on symptoms, plans for having children, and risk of long-term health problems such as
diabetes and heart disease. Many women will need a combination of treatments to include
reduction of androgen levels, to induce ovulation for women desiring conception, to reduce
body weight and to reduce long-term health risks of diabetes mellitus and cardiovascular
disease (Center 2017).
3. Data Base
A. Subjective Findings
1. Patient report: Women with PCOS may report excessive hair growth in
unwanted places such as upper lip, chin, back, etc, weight gain, irregular menses
and acne.
2. Typical subjective complaints: Complaints may include weight gain,
excessive hair growth, slight hirsutism, acne, darkening of skin, skin tags, and
thinning of hair.
POLYCYSTIC OVARIAN SYNDROME 3
3. Less common associated symptoms: PCOS can have many symptoms that
mimic other diagnosis making it harder to diagnosis and requiring a rule out of
other diagnosis before diagnosing PCOS. PCOS can cause inflammation, insulin-
resistance, anxiety, depression and difficulty getting pregnant.
B. Objectives Findings: description and rational by body system
1. Vital signs: BP, HR, Weight, Respirations and Temp.
2. General survey: Overall state of health determined by appearance, hygiene,
and demeanor. Pt may appear depressed.
3. Skin: Hyperpigmentation of the skin at the nape of the neck, axillae, area
beneath the breasts, and exposed areas.
Excessive body hair in a male distribution pattern
Acne
4. Abdomen: Inspection for appearance, abdominal obesity and palpation for
tenderness or masses. Patient may experience tenderness upon palpation.
5. Pelvic: External exam looking for the presence of secondary sex
characteristics. Bimanual exam, ovaries and adnexae should be palpated for signs
of enlargement and the presence of any tumors or cysts.
C. Analysis
1. Nursing diagnosis
Disturbed body image related to body changes aeb increased weight and
abnormal hair growth.
Knowledge deficit related to unknown diagnosis aeb testing to rule out
other diagnosis.
Anxiety related to embarrassing symptoms aeb abnormal hair growth,
weight changes, voice changes, etc.
2. Medical diagnosis
Polycystic Ovarian Syndrome
3. Common differential diagnosis
Insulin resistance
Pregnancy
Thyroid dysfunction
Hyperprolactinemia
Nonclassical congenital adrenal hyperplasia
Hypothalamic amenorrhea
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Primary ovarian insufficiency
Androgen-secreting tumor
Cushing syndrome or acromegaly
D. Plan
Diagnostic:
There are three diagnostic guidelines for PCOS: the NIH Criteria,
Rotterdam Criteria, and the Androgen Excess and PCOS Society criteria.
The NIH criteria requires the following: hyperandrogenism and
oligomenorrhea in the absence of other androgen disorders.
The Rotterdam Criteria must have two of the following:
hyperandrogenism, oligomenorrhea, and/or polycystic ovaries.
Lastly, the Androgen Excess and PCOS Society criteria require that
patients with PCOS have hyperandrogenism and either oligomenorrhea or
polycystic ovaries (Weaver, 2018).
Labs:
a. Thyroid Stimulating hormone
b. Follicle Stimulating hormone
c. Luteinizing hormone
d. Free serum testosterone
e. Prolactin level
f. HCG
g. 2 hour glucose tolerance test
h. Lipid profile
A pregnancy test if you have missed any periods
Pelvic ultrasound – To look for cyst on ovaries.
2. Refer to Gynecology for medication management and diagnostic procedures
3. Provided education for differential dx PCOS, as well as risk of diabetes and metabolic
syndrome. Emphasis on need for long term management verbalized by patient.
4. Discuss need to engage in physical exercise 3 or more days a week for 30 min. Also
discuss and provided information on 1600 kcal restriction for weight loss. Smoking
cessation education.
5. Follow up in 4 weeks to discuss results of testing and referral. Sooner if needed.
Medication (those not trying to conceive):
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Lessina (birth control): 1 tablet daily Taking the pill is the most common
way manage non-period related symptoms. In addition to lighter or fewer periods,
the hormones in pill can also reduce hair growth and acne breakouts. The
hormones in this type of pill work to prevent ovulation, decrease ovarian cysts,
and decrease the hormone related side effects from PCOS (Brewer, 2016).
Anti-androgen medicines. Spironolactone 50 mg, 1 tablet daily These
medicines block the effect of androgens and can help reduce scalp hair loss, facial
and body hair growth, and acne.
Metformin. 850 mg twice a day. After a few months of use, metformin may
help restart ovulation, but it usually has little effect on acne and extra hair on the
face or body. Recent research shows that metformin may have other positive
effects, including lowering body mass and improving cholesterol levels (Brewer,
2016).
Eflornithine cream 13.9% twice a day may help remove unwanted facial
hair.
Acne can be treated with the usual drugs (eg, benzoyl
peroxide, tretinoin cream, topical and oral antibiotics).
Medication (those trying to conceive):
For infertility, Clomiphene is first-line treatment.
Initial course: 50 mg once daily for 5 days. Begin on or about the fifth day of
cycle if progestin-induced bleeding is scheduled or spontaneous uterine bleeding
occurs prior to therapy. Therapy may be initiated at any time in patients with no
recent uterine bleeding.
Dose adjustment: Subsequent doses may be increased to 100 mg once daily for 5
days only if ovulation does not occur at the initial dose. Lower doses (12.5 to 25
mg daily) may be used in women sensitive to clomiphene or who consistently
develop large ovarian cysts (Pinkerton, 2019).
Patient education:
1. Weight loss and regular exercise are encouraged
2. Most people with PCOS are able to get pregnant, but it is usually easier for
those who are not overweight.
3. It is possible to live a full and normal life with PCOS.
4. If using antibiotics for acne, common side effects may include: nausea,
vomiting, diarrhea, and abdominal pain.
5. Metformin may induce ovulation, contraception is needed if pregnancy is not
desired.
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6. Birth control pills don't cure the condition, but they can improve many of its
symptoms, like irregular periods, acne, and facial hair. Birth control pills also
lower your risk of cancer of the uterus.
For the pill (COCs)
o Take at the same time of day every day
**Missed Pills**
1 missed pill- take it as soon as you remember
2 missed pills- take 2 pills the day you remember and 2 pills the next day
3 or more pills- use back up contraceptive for the remainder of the cycle, take a
pregnancy test if you do not start your period. Restart birth control with your next
period.
Common side effects of BCP:
Nausea
Vomiting
Weight gain
Breast tenderness
Spotting between periods
Lighter periods
Mood changes
Severe side effects- GO TO ER IMMEDIATELY
ACHES
o Severe abdominal pain
o Chest pain
o Severe headache
o Eye problems- vision changes
o Severe swelling/ severe pain in the extremities
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References
Brewer, M. (2016). Combined-estrogen-progestin-oral-contraceptives-patient-selection-
counseling-and-use. Retrieved June 15, 2020, from Weaver, N. (2018). Polycystic-ovary
syndrome-the-basics. Retrieved June 15, 2020, from
https://www.uptodate.com/contents/polycystic-ovary-syndrome-the basics?
topicRef=2163
Center for Women's Health. (2017). Retrieved June 15, 2020, from
https://www.ohsu.edu/womens-health/polycystic-ovary-syndrome
Pinkerton, J. (2019, July). Polycystic Ovary Syndrome (PCOS) - Gynecology and Obstetrics.
Retrieved June 15, 2020, from https://www.merckmanuals.com/professional/gynecology-
and-obstetrics/menstrual-abnormalities/polycystic-ovary-syndrome-pcos
Weaver, N. (2018). Polycystic-ovary-syndrome-the-basics. Retrieved June 15, 2020, from
https://www.uptodate.com/contents/polycystic-ovary-syndrome-the-basics?
topicRef=2163
