Polycystic Ovary Syndrome Patient Case

Polycystic Ovary Syndrome Patient Cases
(Written by Dr. Kassandra Bartelme, Concordia University Wisconsin School of Pharmacy and Dr. Laura
Borgelt, University of Colorado - Denver School of Pharmacy)
PN is a 31 year old female who was referred to you by her OB/GYN for education and therapeutic
recommendations. She was diagnosed with PCOS when she was 24 years old. Labs at that time showed
she had an intact HPO axis (normal FSH and estrogen production). She was put on a combined hormonal
pill. That worked well to regulate her cycle and reduce her acne. She denies any problems while on the
pill. She went off the pill in October 2013 when she got married. Her husband and she have been trying
to get pregnant for about a year without success. Initially, she was tracking her body basal temperature
without much success as she found it difficult to check her temperature before moving in the morning
and therefore the temperatures were all over the place. She has recently tried tracking whether or not
she’s been ovulating using an ovulation prediction kit. She has not had a positive OPK in the past three
months that she’s been tracking it. She came to her OB/GYN to talk about her options. She is wondering
how having PCOS affects her ability to get pregnant and wonders what she can do about it.
SH: No tobacco, no alcohol, drinks 1 can of diet Coke daily, no illicit drug use, no intentional exercise
PMH: PCOS, diagnosed in 2010
Pre-natal vitamins 1 tablet PO once daily for supplementation
Vitamin D 2000 units 1 capsule PO once daily for supplementation
Allergies : NKDA
Height: 5’7”
ADRs: None
Weight: 185 lbs
BP: 119/62
P: 79
Urine hCG: negative
FBG: 105 mg/dL
TSH: 2.3 milli-international units/ml (0.5 – 5 milli-international units/ml)
1. How would you explain to PN how PCOS affects her ability to get pregnant?
2. What do you recommend to PN to assist her in getting pregnant?
3. What education points to share with PN?
Encounter #1:
KB is a 25 yr old female in clinic today for a co-consult with the medical resident and clinical pharmacists
because she does not have normal periods. She has not had a normal period since she was 13 years old.
She has now been trying to become pregnant for more than 15 months. She states the hair growth on
her upper lip has been growing thicker the past few years, but she gets it waxed routinely. She has
struggled with being obese and finds it hard to lose weight. She has walked 5 days/week for 20 minutes
for the past 6 months and lost 2 pounds. She is interested in finding out what is “wrong with her” so
she can become pregnant.
Allergies: none
Meds: none
Family history: father with diabetes
Social history: no tobacco, occasional alcohol
Vitals WNL
Height: 5’7”
Weight: 205 pounds
Assessment: possible PCOS as evidenced by patient history and clinical characteristics
Plan: draw pertinent laboratory values, have patient follow-up in 1 week. Continue exercise.
Encounter #2:
KB presents to clinic today for follow-up of lab values and evaluation of probably PCOS. No changes from
previous visit.
O: Significant lab findings:
LH:FSH ratio 3.5 (high)
TSH 3.5 IU/ml (normal)
free testosterone 70 ng/dl (high normal)
FPG 116 mg/dl
A: PCOS as evidence by menstrual dysfunction and hirsutism. Lab values support diagnosis. Impaired
glucose tolerance based on FPG (100-125 mg/dl).
P: Continue non-pharmacologic regimen, with more aggressive diet and exercise. Options for hair
removal discussed and referred to clinical pharmacy for pharmacotherapy recommendations.
Question #1: Would you consider an antiandrogen in KB for hirsutism?
Encounter #3:
KB has been referred to the clinical pharmacist for a therapy recommendation. She has been compliant
with her diet and exercise regimens, but unable to lose weight. She desires to become pregnant in the
near future.
O: BP 134/88 HR 74 Temp 98.7F Ht: 5’7” Wt: 204#
A: PCOS. Desire to meet patient and treatment goals. Options include ovulation-induction agents and
insulin sensitizing agents.
Question #2: What would you recommend?