The document discusses polycystic ovary syndrome (PCOS), including its definition, prevalence, pathophysiology, clinical features, diagnosis, long-term complications, and treatment approaches including lifestyle modifications and pharmacologic options like oral contraceptives, clomiphene citrate, antiandrogens, and metformin.
The document discusses polycystic ovary syndrome (PCOS), including its definition, prevalence, pathophysiology, clinical features, diagnosis, long-term complications, and treatment approaches including lifestyle modifications and pharmacologic options like oral contraceptives, clomiphene citrate, antiandrogens, and metformin.
The document discusses polycystic ovary syndrome (PCOS), including its definition, prevalence, pathophysiology, clinical features, diagnosis, long-term complications, and treatment approaches including lifestyle modifications and pharmacologic options like oral contraceptives, clomiphene citrate, antiandrogens, and metformin.
The document discusses polycystic ovary syndrome (PCOS), including its definition, prevalence, pathophysiology, clinical features, diagnosis, long-term complications, and treatment approaches including lifestyle modifications and pharmacologic options like oral contraceptives, clomiphene citrate, antiandrogens, and metformin.
ovary syndrome Polycystic ovary syndrome (PCOS) Definition ❑ Polycystic ovary syndrome (PCOS) is the most common endocrinopathies affecting women in the reproductive age and associated with a broad range of clinical, hormonal, and metabolic derangement Prevalence ❑ The prevalence of PCOS among women of reproductive age in the general population has been estimated at 4% to 12 % ❑ The prevalence of PCOS appears to be higher from 37% to 90% in women with menstrual abnormalities and also is increased in the presence of certain diseases, like women with epilepsy Pathophysiology ❑ The pathogenesis of PCOS is thought to be complex and
multifactorial but is poorly understood.
❑ The heterogeneity of the syndrome may well reflect
multiple underlying mechanisms in which androgens and
insulin are two key endocrine mediators.
Clinical features of PCOS PCOS is characterized by ➢Ovulatory dysfunction: oligo-ovulation or anovulation, presenting clinically as a woman with irregular menstrual cycles usually oligomenorrhea or amenorrhea and associated with infertility ➢Hyperandrogenism present clinically as hirsutism, acne, and/or male pattern alopecia ➢Polycystic ovaries morphology which requires the presence of 12 or more follicles measuring 2-9 mm in diameter per ovary arranged peripherally around a dense corn of stroma or ovarian volume above 10 cc Diagnosis of PCOS Definition Diagnostic criteria A Phenotypes
NIH Requires the presence of 1. HA + OD
1990 1) Hyperandrogenism (HA) B and
2) Ovulatory dysfunction (OD) C Rotterdam Requires the presence of at least two of
2003 1) Hyperandrogenism B 1. HA + OD + 2) Ovulatory dysfunction C PCO 3) PCO morphology D 2. HA + OD 3. HA + PCO 4. PCO + OD AES Requires the presence of 1. HA + OD +
2006 1) Hyperandrogenism B and PCO
2)Ovarian dysfunction (ovulatory dysfunction C 2. HA + OD or PCO morphology D) 3. HA + PCO Long-term complication of PCOS
❑ Type II diabetes mellitus
❑ Metabolic syndrome ❑ Cardiovascular risk ❑ Endometrial hyperplasia and cancer Treatment of PCOS ❑ The treatment of PCOS consists mainly of controlling the symptoms of the syndrome in an attempt to achieve:
Short-term goals include improvement in symptoms like
menstrual irrgularity, hyperandrogenesim symptoms, treatment for infertility if required and reduction of weight, Long-term goals including reduction of diabetes, cardiovascular disease and endometrial hyperplasia risks Non-pharmacologic treatment ❑ Non pharmacologic measures are universally recommended; these include diet, exercise, and weight reduction ❑ Modest weight loss of less than 10% has been shown to increase the frequency of ovulation, improve conception, and reduce androgen level and insulin resistance in women with PCOS Pharmacologic treatment Today various classes of drugs being used in PCOS women with various benefit, these include: ❖ Combined oral contraceptives: recommended for women seeking for regularity in menstrual cycles and relief from hyperandrogenic symptoms, while not seeking fertility. ❖ Clomiphene citrate (CC): constitutes one of the first-line treatments for ovulation induction in anovulatory women with PCOS ❖ Antiandrogenic agents: which considered beneficial therapeutic options for hirsutism, acne, and other hyperandrogenism symptoms include: ➢ Cyproterone acetate ➢ Spironolactone ➢ Finasteride ❖ Insulin-sensitizing drugs: these agents are intended to correct the underlying metabolic defect of PCOS instead of simply treating the symptoms Metformin (Glucophage) ® ❑ Metformin is a biguanide currently used as an oral antihyperglycemic agent and is approved by FDA to manage type 2 diabetes mellitus. ❑ Metformin likely plays its role in women with PCOS through a variety of actions, including: ➢ Reducing insulin levels and improving insulin resistance so, altering the effect of insulin on ovarian androgen biosynthesis, theca cell proliferation. ➢ In addition, it inhibits human thecal cell androgen synthesis directly. Case study A 24 year old woman presented with a prolonged clinical history of fasting and exertional hypoglycaemia, and was subsequently diagnosed with an insulinoma. ❖ Concurrent symptoms ➢ oligomenorrhoea ➢ excessive facial hair Ovary ultrasound presentation ❖ Biochemically, ➢ hyperinsulinaemia was observed ➢a raised serum luteinizing hormone (LH), ➢raised testosterone and androstendione concentrations. ❖ Treatment Surgical removal of the insulinoma
