OET Reading Part C – PCOS

Ms Adrian had a 26-year history of PCOS, characterized by oligomenorrhea or amenorrhea, hirsutism, hyperandrogenism, and polycystic ovaries, confirmed by several laboratory tests and ultrasound. Twenty years ago, her gynaecologist suggested lifestyle changes such as exercises, nutritional guidance, low doses of oral contraceptive pills, cosmetic therapy and laser therapy for hirsutism. With the use of oral contraceptive pills, she experienced an improvement in her menstrual cycles, although she continued to have mood swings, irritability, and severe headaches, which were extremely distressing. She was switched to several oral contraceptive pills, but all showed severe side effects. She discontinued all oral contraceptive pills after a few months of use.

7.2 What was one of the advantages of Ms Adrian’s taking the oral contraceptive pills?

1. Improvement in hirsutism.
2. Less side effects.
3. Less painful menstrual periods.
4. Improvement in menstrual cycles.

7.3 The primary reason Ms Adrian decided to stop increased use of contraceptive pills was:

1. Partial remission.
2. Complete remission.
3. Severe side effects.
4. Return of her menstrual cycles.

07.4 According to the first paragraph:

1. Ms Adrian started taking medication for PCOS immediately after she was diagnosed.
2. Ms Adrian started taking medication only after 6 years since she was diagnosed with PCOS.
3. Ms Adrian was diagnosed with PCOS by her gynaecologist.
4. Ms Adrian was diagnosed with PCOS 6 years prior to starting OCP suggested by her gynaecologist.

07.5 According to the first paragraph:

1. Ms Adrian could not carry on with all treatment options for long.
2. Ms Adrian was able to maintain consistency in trying treatment for her condition.
3. Ms Adrian commenced treatment after many years since she was diagnosed with PCOS.
4. Oral contraceptive pills could achieve a lasting solution for all her problems for a while.

07.6 Ms Adrian stopped the use of oral contraceptive pills because:

1. They had no effect on her conditions.
2. They had more side effects than expected.
3. They had more pros than cons.
4. They could not do very much to ease her distress.

07.7 According to the first paragraph:

1. Ms Adrian’s PCOS went undiagnosed for many years.
2. Ms Adrian got her PCOS reconfirmed with the same tests.
3. Ms Adrian developed related conditions after the diagnosis.
4. It is unlikely that Ms Adrian had oligomenorrhea and amenorrhea simultaneously.

In 2003, Ms Adrian presented for treatment of MDD (Major Depressive Disorder). Escitalopram—a selective serotonin reuptake inhibitor, not an oral contraceptive pill—was administered at 5 mg/d, with the dosage reaching 20 mg/d in 3 weeks. After 4 weeks of treatment, she experienced clinically significant depressive symptomatic relief. Remission was achieved in 8 weeks. Over the next 18 months, she continued to receive escitalopram and experienced a return of regular menstrual cycles and improvement in hirsutism. She reported transient mild nausea at the beginning of treatment; no other side effects were reported.

8.2 Which word means “a temporary absence of symptoms”?

1. Remission.
2. Relief.
3. Hirsutism.
4. Transiency.

08.5 Commencing on Escitalopram:

1. Saw unremarkable improvement in Ms Adrian’s overall conditions.
2. Saw great improvement in Ms Adrian’s overall condition.
3. Deteriorated her health for a few months.
4. Ended up in increasing its dosage infinitely.

08.6 When did Ms Adrian get the highest amount of relief from Escitalopram?

1. At the start of the treatment.
2. After 4 weeks of treatment.
3. In the 8th week.
4. Over the 18 months after the initial 8 weeks.

Remarkably, 2 months after antidepressant discontinuation, Ms Adrian started experiencing menstrual irregularity and hair growth. Ten months later, MDD recurred. During the next 4 years, she was on treatment with escitalopram at 20 mg/d and remained symptom-free. Meanwhile, she achieved notable menstrual cycle improvement and reduction in hirsutism. As Ms Adrian was feeling well, she stopped taking the medication on her own and her menstrual complaints immediately recurred. She restarted escitalopram in 4 months, and her PCOS symptoms remitted again. This was the longest regular menstrual cycle period she had ever had with no use of oral contraceptive pills. Last year, her ultrasounds continued to show polycystic ovaries.

09.6 What does Ms Adrian’s case suggest?

1. People like her can never achieve remission without medication.
2. Remission is possible with medication but they are short-lived.
3. Patients should stop relying on medication like escitalopram for a longer relief.
4. It is better for patients with PCOS not to stop medication.

09.7 Comparatively:

1. The antidepressant gave Ms Adrian more reliable relief from menstrual irregularity.
2. The contraceptive pills gave Ms Adrian longer relief from menstrual irregularity.
3. None of the medicines gave Ms Adrian long lasting relief from menstrual irregularity.
4. Ms Adrian should have considered antidepressants much earlier.

Women diagnosed with polycystic ovary syndrome may have an increased risk of attempting suicide, research suggests. PCOS is a common health condition thought to affect about 1 in 10 women in the UK, although many cases are undiagnosed. The condition can cause irregular periods, acne, obesity, and cysts in the ovaries among other symptoms, with the World Health Organization noting PCOS as a leading cause of infertility.

10.8 According to the paragraph:

1. The number of women in the UK with undiagnosed PCOS outnumbers those diagnosed.
2. 1 in 10 women in the UK have PCOS.
3. More than 1 in 10 women in the UK have PCOS.
4. More than 10% of British women have PCOS.

Now, a large study by researchers in Taiwan suggests people diagnosed with the condition have an increased risk of suicide attempts. Writing in the Annals of Internal Medicine, researchers from Taipei Veterans general hospital in Taiwan describe how they analysed nationwide data from 8,960 women and girls aged 12 to 64 diagnosed with PCOS, covering a period from 1997 to 2012. None of those included in the study had a history of suicide attempts.

11.1 What does the Taiwanese study indicate?

1. The study contradicts the opinions of researchers from Taipei.
2. The study does not conform with those conducted earlier.
3. There is no evidence for the presence of suicidal ideation in women diagnosed with PCOS.
4. The study participants did not admit to have attempted suicide.

After taking into account factors including psychiatric disorders, other health conditions and demographics, the team found those with PCOS had an 8.47-fold higher risk for suicide attempts than women without PCOS but who otherwise had similar characteristics. When the team broke down the findings by age, they found the risk of suicide attempts was 5.38 times higher for adolescents, 9.15 times higher for adults under 40, and 3.75 times higher for older adults, compared with controls.

The authors of the study suggest concerns over the impact of PCOS, including potential infertility and worries over body image, could be among the factors at play. “Body image concerns, including perceived obesity and acne, have been associated with suicide risk during adolescence, and these problems are common among adolescents with PCOS,” they write, adding that young adults may experience additional challenges such as unemployment, financial difficulties and relationship problems.

The drop in increased risk in older adults, the team suggest, could be linked to an improvement in the symptoms of PCOS with age. While the research has limitations, including that it cannot prove cause and effect and could not take into account all possible factors that may muddy the waters, it is not the first to suggest an association between PCOS and suicide. Dr Sophie Williams of the University of Derby, who was not involved in the new research, said a number of studies had revealed similar findings in recent years, while her own work had raised concerns around self-harm and suicidal ideation among women with PCOS. “We know that women with PCOS are more likely to have depression and anxiety – that’s been shown time and time again in a number of research papers,” she added.