POLYCYSTIC OVARIAN

SYNDROME
Definition and Prevelance
Syndrome of ovarian
dysfunction along with the
cardinal features of
hyperandrogenism and
polycystic ovary morphology.
Polycystic ovarian syndrome
affects arond 5-10 percent of
women of reproductive age.
PCOS is associated with
cardiovascular disease, non-
insulin dependent diabetes
mellitus (NIDDM), endometrial
hyperplasia and endometrial
and breast carcinoma
Aetiology
Remains
unclear
Genetic
causes
Insulin resistance-
resulting
hyperinsulinaemia
Increased LH
stimulation
Disordered ovarian
cytochrome P450
activity
Clinical
Features
Oligomenorrhoea
/amenorrhoea
65-75 percent
Ovarian
dysfunction with
irregular ovulation
Hirsutism
production of
terminal hair in a
male pattern
Subfertility
Infertility
due to irregular
ovulation
Obesity
40 percent-
clinically obese
Recurrent
miscarriage
50-60 per cent of
women - >3 early
pregnancy losses.
Symptoms of
metabolic
condition
Insulin
resistance,
dyslipidemia
Hirsutism
Obesity and hirustism
Acne - found in patients
whose sebaceous glands
respond to the higher free -
circulating testosterone
OVARIAN ABNORMALITIES
ASSOCIATED MEDICAL CONDITIONS
Increased risk of developing Type 2 Diabetes and
Gestational diabetes
Low HDL and high triglycerides
Sleep apnea
Nonalcoholic steatohepatitis
Metabolic syndrome43% of PCOS patients (2 fold
higher than age-matched population)
Elevated CRP and heart disease
Advanced atherosclerosis

Diagnosis and Differential Diagnosis
No single test is diagnostic of PCOS .
It is often a diagnosis of exclusion.

Diagnosis Laboratory test
Hypothyroidism TSH
Hyperprolactinemia Prolactin
Late-onset CAH 17-hydroxyprogesterone
Ovarian tumor Total testosterone
Hyperthecosis Total testosterone
Adrenal tumor DHEA-S
Cushings syndrome 24-hour urine free cortisol
DIAGNOSTIC CRITERIA
Menstrual irregularity due to anovulation or
oligo-ovulation
Evidence of clinical or biochemical
hyperandrogenism
Hirsutism, acne, male pattern baldness
High serum androgen levels
Exclusion of other causes (CAH, tumors,
hyperprolactinemia)

Investigations Findings
Elevated testosterone levels.
Decreased sex hormone binding globulin (SHBG) levels.
Elevated LH levels.
Elevated LH:FSH ratio.
Increased fasting insulin levels.
Ultrasound:
8 or more subcapsular follicular cysts > 1 0 mm in diameter
increased ovarian stroma.
thickening of the ovarian capsule.
Polycystic ovary showing dense stroma and multiple
follicles/cysts.
Treatment
There is no treatment for PCOS
Treatment should be directed at the
symptoms.
Oligomenorrhoea/amenorrhoea
Oligomenorrhoeic women with PCOS tend to have infrequent
but heavy bleeds.
to induce regular menstruation
to protect the endometrium
Cyclical progesterone
10 days in each month
(e.g.medroxyprogesteron
e acetate 10 mg daily for
10 days).
Oral contraceptive pill
An alternative
treatment for women
who do not wish to
conceive
Hirsutism
Treatments aimed at reducing testosterone levels
Eflornithine cream.
applied topically
Cyproterone acetate
Form of - contraceptive pill Dianette (consists of cyproterone
acetate 2 mg and 35 mcg of ethinylestradiol)
50-100 mg daily
(reverse sequential regimen) give it for the first 10 days of each
month, initially in combination with oestrogen, and then followed
by oestrogen alone for a further 11 days
Others
Metformin
GnRH analogues with low-dose HRT
Surgical : Removing or destroying hair follicles - laser or
electrolysis
Subfertility
Clomiphene citrate
Gonadotrophin
therapy
Metformin-has been
shown to improve
reproductive
performance
Obesity
Weight reduction has many benefits for the patient but
usually proves very difficult
The usual array of dietary modifications (with or without
drugs such as orlistat) may be considered.
Long-term
Lifestyle advice (such as dietary modification
and increasing exercise) is appropriate.
Surveillance for diabetes, hypertension and
dyslipidemia especially if positive family
history and overweight
Monitor endometrium

Thank you