PCOS Endocrinology Course

Lesson 1 • Androgen Excess and Steroidogenesis

Details theca cell hyperactivity and excess androgen biosynthesis pathways. Connects hyperandrogenism to clinical signs including hirsutism and acne.

Lesson 2 • Insulin Resistance in PCOS

Examines post-receptor insulin signaling defects unique to PCOS and their amplification of androgen production. Establishes the metabolic-reproductive axis central to management.

Lesson 3 • Hypothalamic-Pituitary-Ovarian Axis Dysfunction

Explains aberrant GnRH pulsatility and elevated LH-to-FSH ratios driving anovulation. Links axis dysregulation to follicular arrest and androgen excess.

Lesson 4 • Defining PCOS and Its Subtypes

Establishes diagnostic criteria across major classification systems and distinguishes phenotypic subtypes. Provides the conceptual baseline for all subsequent clinical reasoning.

Lesson 1 • Clinical History and Symptom Assessment

Structures the intake interview to capture menstrual irregularity, androgen symptoms, and metabolic history. Identifies red-flag features requiring urgent differential workup.

Lesson 2 • Pelvic Ultrasound Assessment

Applies PCOS-specific ultrasound criteria for follicle count and ovarian volume using current thresholds. Addresses transabdominal versus transvaginal technique selection.

Lesson 3 • Differential Diagnosis and Exclusion

Systematically rules out congenital adrenal hyperplasia, Cushing syndrome, thyroid disorders, and androgen-secreting tumors. Guides confirmatory testing for each mimic.

Lesson 4 • Biochemical Hormone Testing

Selects and interprets androgen panels, gonadotropins, and metabolic markers with attention to assay variability. Timing and pre-analytical factors are addressed to ensure result validity.

Lesson 1 • Nonalcoholic Fatty Liver Disease Screening

Identifies NAFLD prevalence and screening strategies relevant to PCOS-associated metabolic syndrome. Links hepatic steatosis to insulin resistance and treatment planning.

Lesson 2 • Insulin Resistance Assessment Methods

Compares fasting glucose-to-insulin ratios, HOMA-IR, and oral glucose tolerance testing for clinical utility. Selects the most appropriate tool based on patient profile.

Lesson 3 • Cardiovascular Risk Evaluation

Integrates traditional and PCOS-specific cardiovascular risk factors into composite risk scoring. Guides referral thresholds and preventive cardiology collaboration.

Lesson 4 • Type 2 Diabetes and Prediabetes Screening

Applies evidence-based screening intervals and HbA1c thresholds specific to PCOS risk profiles. Identifies patients requiring early pharmacologic intervention.

Lesson 1 • Ovarian Hyperstimulation Syndrome Prevention

Identifies OHSS risk factors specific to PCOS and applies preventive strategies including GnRH agonist triggers and coasting. Manages early OHSS presentation in outpatient settings.

Lesson 2 • Anovulation Mechanisms and Cycle Restoration

Explains follicular arrest and chronic anovulation at the cellular level, building on pathophysiology from Chapter 1. Connects mechanism to targeted intervention selection.

Lesson 3 • Assisted Reproductive Technology in PCOS

Adapts IVF stimulation protocols for PCOS patients to balance response and safety. Addresses freeze-all strategies and endometrial preparation for optimal implantation.

Lesson 4 • First-Line Ovulation Induction Agents

Compares letrozole and clomiphene citrate for efficacy, dosing, and monitoring in PCOS ovulation induction. Establishes letrozole as the preferred first-line agent based on current evidence.

Lesson 5 • Gonadotropin Therapy and Monitoring

Applies low-dose step-up gonadotropin protocols with intensive ultrasound monitoring to minimize OHSS risk. Defines cancellation criteria and cycle management decisions.

Lesson 1 • Acne Management in PCOS

Applies a stepwise acne treatment algorithm from topical retinoids to systemic antiandrogens in PCOS. Coordinates dermatology collaboration for refractory cases.

Lesson 2 • Combined Oral Contraceptives in PCOS

Explains how COCs suppress gonadotropins, reduce ovarian androgen output, and raise SHBG. Guides progestin selection based on androgenicity profile and patient risk factors.

Lesson 3 • Antiandrogen Pharmacotherapy

Compares spironolactone, flutamide, and finasteride for efficacy and safety in treating hirsutism and alopecia. Addresses mandatory contraception requirements and monitoring protocols.

Lesson 4 • Topical and Procedural Hirsutism Treatments

Integrates eflornithine cream and laser hair removal as adjuncts to systemic therapy for facial hirsutism. Sets realistic patient expectations for response timelines.

Lesson 1 • GLP-1 Receptor Agonists in PCOS

Evaluates emerging evidence for GLP-1 receptor agonists in PCOS-associated obesity and insulin resistance. Addresses patient selection, dosing initiation, and reproductive safety data.

Lesson 2 • Dietary Approaches for PCOS

Evaluates low-glycemic, Mediterranean, and low-carbohydrate diets for their effects on insulin resistance and androgens. Provides practical dietary prescription frameworks for clinical use.

Lesson 3 • Insulin-Sensitizing Pharmacotherapy

Positions metformin, inositols, and thiazolidinediones within the metabolic treatment algorithm for PCOS. Compares efficacy, safety, and patient selection criteria for each agent.

Lesson 4 • Behavioral Change and Weight Management

Applies motivational interviewing and cognitive-behavioral techniques to support sustained lifestyle modification. Integrates multidisciplinary team roles including dietitians and psychologists.

Lesson 1 • PCOS During Pregnancy

Identifies elevated risks of gestational diabetes, preeclampsia, and preterm birth in PCOS pregnancies. Guides preconception optimization and antenatal surveillance protocols.

Lesson 2 • Diagnosing PCOS in Adolescents

Applies age-specific diagnostic criteria that account for physiologic anovulation and normal pubertal development. Avoids premature labeling while identifying true PCOS risk.

Lesson 3 • Managing PCOS in Adolescents

Prioritizes lifestyle intervention and COC therapy for symptom management in adolescent PCOS. Addresses psychosocial impact and body image concerns in this age group.

Lesson 4 • Perimenopause and Menopause in PCOS

Tracks phenotypic changes as androgen levels decline and metabolic risk persists into menopause. Guides hormone therapy decisions and long-term cardiovascular surveillance.

Lesson 1 • PCOS with Concurrent Thyroid Disease

Manages the bidirectional interaction between thyroid dysfunction and PCOS hormonal and metabolic parameters. Sequences treatment to address thyroid status before optimizing PCOS therapy.

Lesson 2 • Managing Clomiphene-Resistant PCOS

Defines clomiphene resistance and applies a structured escalation pathway through letrozole, metformin, and gonadotropins. Identifies surgical candidacy for laparoscopic ovarian drilling.

Lesson 3 • Atypical and Lean PCOS Presentations

Recognizes diagnostic and management challenges in normal-weight PCOS patients with predominant hyperandrogenism. Adjusts metabolic screening and treatment intensity accordingly.

Lesson 4 • Integrating Multidisciplinary Care Plans

Coordinates endocrinology, gynecology, nutrition, mental health, and dermatology into a unified PCOS care plan. Applies shared decision-making frameworks to align patient goals with clinical priorities.