Polycystic Ovarian

Syndrome
KEPANITERAAN KLINIK ILMU OBSTETRI
& GINEKOLOGI
PROGRAM STUDI PROFESI DOKTER
UNIVERSITAS BATAM
2022
DEFINISI
Polycystic Ovarian Syndrome
“Polycystic ovarian syndrome (PCOS) atau sindrom ovarium
polikistik adalah suatu keadaan endokrinopati atau gangguan
hormonal di mana seorang perempuan mengalami gangguan
produksi dan metabolisme androgen serta morfologi ovarium
polikistik”

B.L. Hoffman, et al, editor. William’s Gynecology Textbook. 3th ed. New York: Mc Graw Hill; 2014
 Epidemiologi PCOS
PCOS biasanya terjadi pada perempuan usia produktif, berkisar antara 15

5-10% sampain30 tahun. Banyak kasus infertil terkait dengan sindroma ini.

PCOS adalah metabolisme sirkuit,

endokrin dan gangguan reproduksi yang
mempengaruhi sekitar 5-10% dari populasi
wanita di negara maju.
The American College of Nurse-Midwives

5-30%
menemukan bahwa antara 5-30% wanita
memiliki beberapa karakteristik PCOS yaitu,
sekitar 6,8 juta orang di Amerika Serikat

6,8 juta orang

Di USA

Hugar LA. Et al (2018). Polycystic Ovary Syndrome (PCOS)-A Mini Review. Open Access Journal of
Gynecology ISSN: 2474-9230.
 Etiologi PCOS

Polycystic Ovarian Syndrome (PCOS)

adalah sindrom yang secara genetik
.bersifat heterogen. Walaupun, etiologi

genetik dari PCOS masih belum diketahui

secara pasti, tetapi riwayat keluarga dari
penderita PCOS biasanya ditemukan.

Ndefo, U. A., Eaton, A., & Green, M. R. (2013). Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. P & T : a peer-reviewed journal for formulary management, 38(6), 336–355.
Patofisiologi
Resistensi Insulin
PCOS
GnRH

Pulsasi cepat Hiperinsulinemia

Menurunkan SHBG
↑ Kadar LH
↓ kadar ↑Produksi androgen ↑ kadar androgen
FSH di sel teka ovarium bebas
Hiperandrogen
Terhentinya
maturasi folikel
ovarium
Menganggu
Aromatase
Morfologi Polikistik
Ovarium Atresia Folikel Anovulasi
 Manifestasi Klinis PCOS
Gangguan Menstruasi
Menstruasi tidak teratur: Alopesia Androgenik
Oligomenore hingga
Amenorea.

Hirsutism Obesitas

Akne Peningkatan kadar LH

serum
 Diagnosis PCOS
Pada konsensus ASRM/ESHRE (Rotterdam)
tahun 2003 disepakati diagnosis PCOS
ditegakkan dengan adanya 2 dari 3 gejala yaitu 1. tanda klinis atau biokimia
hiperandrogenisme

2. Gangguan Ovulasi
Kronik

B.L. Hoffman, et al, editor. William’s Gynecology Textbook. 3th ed. New York: Mc Graw Hill; 2014

3. ditemukan adanya gambaran

morfologi ovarium polikistik pada
pemeriksaan Ultrasonografi.

Kriteria sonografi ovarium polikistik dari konferensi Rotterdam 2003 termasuk 12 kista kecil
(berdiameter 2 sampai 9 mm) atau peningkatan volume ovarium (>10 mL) atau keduanya .
 Tatalaksana PCOS
Edukasi
Menjelaskan pentingnya perubahan gaya
hidup untuk memperbaiki gangguan
hormonal dan efek jangka panjang akibat
PCOS. Pentingnya memberikan
penjelasan mengenai terapi PCOS dan
target terapi yang akan dicapai.
Modifikasi Gaya Hidup
Modifikasi gaya hidup merupakan terapi lini
pertama, yang mencakup intervensi diet dan
aktivitas fisik. Dengan melakukan modifikasi gaya
hidup, diharapkan dapat menurunkan kadar lemak
dalam tubuh serta meningkatkan sensitivitas
insulin..

o m b i na si
o nt r as e p si K
Diet Pil K
p a d
i PCOS s
a terap
ecara
n ya siklus
sebesar 73% perempuan PCOS mengalami obesitas si P K K ti m bu l
Fung e rangsang gi sekresi LH,
sedangkan non obes mencapai 12%.28 Sehingga t u k m
umum un ratur, menguran e n, dan
penanganan pertama pada perempuan PCOS dengan ya n g t e i a n dr og
haid n gi produks ar SHBG
Indeks Massa Tubuh (IMT) ≥ 25 kg/m2 adalah penurunan men g u r a
n in g k a tkan kad
berat badan dan pada perempuan. disarankan untuk me
mengurangi asupan kalori dan berolahraga sebagai terapi
lini pertama PCOS
 Klomifen Sitrat
Klomifen sitrat adalah terapi lini pertama pada induksi ovulasi pada
siklus anovulasi. Klomifen sitrat bekerja dengan cara mengikat
reseptor estrogen di hipotalamus sehingga terjadi umpan balik positif
estrogen terhadap hipotalamus. Blokade reseptor estrogen ini akan
meningkatkan produksi GnRH dari hipotalamus yang kemudian akan
menstimulasi perkembangan folikel.
Metformin
Metformin menghambat glukoneogenesis dan meningkatkan
pengambilan glukosa oleh jaringan perifer serta menurunkan
oksidasi lemak. Dengan demikian, hiperinsulinemia dapat
ditekan sehingga terjadi penurunan kadar androgen. Metformin
hanya direkomendasikan pada wanita PCOS dengan DM tipe 2
jika terapi modifikasi gaya hidup tidak berhasil.
Thiazolidindion
Tiazolodindion bekerja sebagai insulin sensitizing agent melalui dua
mekanisme: (1) Mekanisme langsung yaitu dengan meningkatkan
ambilan asam lemak pada jaringan adipose sehingga massa jaringan
adiposa akan meningkat dan menyelamatkan jaringan lain yang
sensitif terhadap insulin seperti sel beta pankreas, hepar dan otot
rangka dari efek buruk asam lemak. (2) Mekanisme tidak langsung
yaitu dengan meningkatkan ekspresi adiponektin dan menurunkan
ekpresi 11b-hidroksisteroid dehidrogenase tipe 1.
Aromatase Inhibitor
Aromatase inhibitor menekan biosintesis estrogen dengan cara
menghambat proses aromatisasi androgen menjadi estrogen sehingga
menurunkan respon umpan balik negatif hipotalamus-hipofisis. Kadar
androgen intraovarium akan meningkat dan memicu sekresi FSH
sehingga pemilihan dan pematangan folikel dominan akan terjadi.
 Komplikasi PCOS
PCOS tidak hanya berefek pada sistem reproduksi, tetapi juga berefek ke seluruh area tubuh.
Abnormalitas metabolik yang berhubungan dengan PCOS seperti resistensi insulin memiliki
efek jangka panjang yang cukup serius seperti risiko DM Tipe 2 dan gangguan kardiovaskuler

Infertilitas, komplikasi kehamilan, kanker,

hiperplasia endometrium.

DM Tipe 2, Resiko Penyakit Kardiovaskular:

Hipertensi, Dislipidemia, Sindrom metabolik,

Royal College of Obstetricians and Gynaecologists. Green top Guideline No.33: Long-term Consequences
of Polycystic Ovary Syndrome. London: RCOG Press; 2014. Tersedia pada
https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_33.pdf.
.
 Prognosis PCOS

Prognosis PCOS. (Polycystic Ovarian Syndrome) sangat

dipengaruhi oleh komplikasi karena banyaknya
kemungkinan komplikasi jangka panjang yang dapat
terjadi pada penyakit ini.

Royal College of Obstetricians and Gynaecologists. Green top Guideline No.33: Long-term Consequences of Polycystic Ovary Syndrome. London: RCOG
Press; 2014. Tersedia pada https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_33.pdf.
f
THANK YOU
 Tatalaksana PCOS

EDUKASI DIET 2018 2019 2020

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POGI. (2016). Konsensus Tatalaksana Sindrom Ovarium Polikistik. Himpunan Endokrinologi Reproduksi dan Fertilitas Indonesia.
Legro, R. S., Arslanian, S. A., Ehrmann, D. A., Hoeger, K. M., Murad, M. H., Pasquali, R., Welt, C. K., & Endocrine Society (2013). Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical
practice guideline. The Journal of clinical endocrinology and metabolism, 98(12), 4565–4592. https://doi.org/10.1210/jc.2013-2350
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 Manifestasi Klinis PCOS
Gangguan Menstruasi
Menstruasi tidak teratur:
Oligomenorea hingga Alopesia Androgenik
Amenorea.

Hirsutisme Obesitas

Akne Peningkatan kadar LH

serum

B.L. Hoffman, et al, editor. William’s Gynecology Textbook. 3th ed. New York: Mc Graw Hill; 2014
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Reputation. You can simply impress your audience and add a unique zing and
appeal to your Presentations.

Get a modern PowerPoint Presentation that is beautifully designed.

Column
Style

You can simply impress your audience and add a unique zing and appeal to
your Presentations. Easy to change colors, photos and Text.
You can simply impress your audience and add a unique zing and appeal to your Presentations.
I hope and I believe that this Template will your Time, Money and Reputation. Get a modern
PowerPoint Presentation that is beautifully designed. Easy to change colors, photos and Text. I
hope and I believe that this Template will your Time, Money and Reputation. You can simply
impress your audience and add a unique zing and appeal to your Presentations. You can simply
impress your audience and add a unique zing and appeal to your Presentations. I hope and I
believe that this Template will your Time, Money and Reputation.

You can simply impress your audience and add a unique zing and appeal to your Presentations.
I hope and I believe that this Template will your Time, Money and Reputation.
Fully Editable Shapes
Fully Editable Shapes
 Fully Editable Icon Sets: A

You can Resize without

losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com
 Fully Editable Icon Sets: B

You can Resize without

losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com
 Fully Editable Icon Sets: C

You can Resize without

losing quality
You can Change Fill
Color &
Line Color

FREE
PPT
TEMPLATES
www.allppt.com