This document discusses polycystic ovary syndrome (PCOS), a hormonal disorder common among women of reproductive age. PCOS is caused by abnormal ovarian function and high androgen levels. Its symptoms include irregular periods, excess body and facial hair, and cysts on the ovaries. Early diagnosis and treatment, especially weight loss, can reduce risks of diabetes and heart disease. The document discusses various treatment options for PCOS, including lifestyle changes, oral contraceptives, metformin, and clomiphene. It also covers diagnosis of PCOS through physical exams, blood tests, and pelvic ultrasounds.

1. Dr.Aqsa Rabbani
Speaker

2. PCOS
Pregnant Patients
Incontinence
Menopause
Osetoporosis

3. Polycystic ovary syndrome (PCOS) is a
hormonal disorder common among women of
reproductive age. Women with PCOS may
have infrequent or prolonged menstrual
periods or excess male hormone (androgen)
levels. The ovaries may develop numerous
small collections of fluid (follicles) and fail to
regularly release eggs.
The exact cause of PCOS is unknown. Early
diagnosis and treatment along with weight
loss may reduce the risk of long-term
complications such as type 2 diabetes and
heart disease
Polycystic Ovarian Syndrome

4. Symptoms
• Signs and symptoms of PCOS often develop around the time of the first menstrual period during
puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain.
• Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two
of these signs:
• Irregular periods. Infrequent, irregular or prolonged menstrual cycles are the most common sign
of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between
periods and abnormally heavy periods.
• Excess androgen. Elevated levels of male hormones may result in physical signs, such as excess
facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
• Polycystic ovaries. Your ovaries might be enlarged and contain follicles that surround the eggs. As
a result, the ovaries might fail to function regularly.

6. Polycystic Ovarian Syndrome
Definintion: PCOS is a disorder of chronically abnormal ovarian
function and hyperandrogenism (abnormally elevated androgen levels).
It is also called the Stein- Leventhal syndrome.
Causes:
Gonadotropin secretion leads to insulin resistance and
hyperinsulinemia as well as excessive androgen production.
Complications:
Include the development of diabetes, metabolic
syndrome, increased cardiovascular risk factors (HTN, early markers of
Atherosclerosis)

7. • Obstructive sleep, infertility, endometrial hyperplasia in 30% to 50%
and increased risk of endometrial carcinoma.
Treatment
Lifestyle Changes Oral
Contraceptives
Metformin Thiazolidinediones Spironoleactone Clomiphene
Weight loss of 5%
to 10% can reduce
insulin and
androgen levels
and restore
regular menstrual
cycles.
Reduce androgen
production and
reduce risk of
endometrial
hyperplasia and
cancer.
Glucophage also
improves
ovulation leading
to more cycle
regularity.
Minimum dose is
500mg three
times daily.
Improve ovulation and
increase the
pregnancy rate in
women with PCOS.
Decreases incidence
of hirsutism by 40%
to 88%.
Dose is 50 to 100mg
twice daily for 6 to
12 months
Initial therapy
of choice for
infertility.

8. Diagnosis
There's no test to definitively diagnose PCOS, including menstrual periods
and weight changes. A physical exam will include checking for signs of
excess hair growth, insulin resistance and acne.
A pelvic exam. The doctor visually and manually inspects your
reproductive organs for masses, growths or other abnormalities.
Blood tests. Your blood may be analyzed to measure hormone levels. This
testing can exclude possible causes of menstrual abnormalities or
androgen excess that mimics PCOS. You might have additional blood
testing to measure glucose tolerance and fasting cholesterol and
triglyceride levels.
An ultrasound. Your doctor checks the appearance of your ovaries and the
thickness of the lining of your uterus. A wandlike device (transducer) is
placed in your vagina (transvaginal ultrasound). The transducer emits
sound waves that are translated into images on a computer screen.

9. Pelvic exam & Transvignal Ultrasound

11. Drugs use in Pregnant Patients
Fetal development:
Weeks 1 to 2, During the first days after fertilization , the zygote
forms in the fallopian tube. Over the next few days, division of the zygote eventually
results in the formation of the blastocyst, which travels through the tube into uterus.
Weeks 3 to 8, during this time that the placenta becomes fully functional and
organogenesis ocgens.
Weeks 9 to 38 (fetal period), at the ninth week, the embryo is referred to as a fetus.
https://www.nhs.uk/pregnancy/

14. Incontinence
What happens normally?
The brain and the bladder control urinary function.
The bladder stores urine until you are ready to empty
it. The muscles in the lower part of the pelvis hold the
bladder in place. Normally, the smooth muscle of the
bladder is relaxed. This holds the urine in the bladder.
The neck (end) of the bladder is closed. The sphincter
muscles are closed around the urethra. The urethra is
the tube that carries urine out of the body. When the
sphincter muscles keep the urethra closed, urine
doesn't leak.
Once you are ready to urinate, the brain sends a signal
to the bladder. Then the bladder muscles contract.
This forces the urine out through the urethra, the tube
that carries urine from the body. The sphincters open
up when the bladder contracts.

15. Urinary incontinence is not a disease. It is a symptom of many
conditions. Causes may differ for men and women. But it is not
hereditary. And it is not just a normal part of aging. These are the
four types of urinary incontinence:
Stress Urinary Incontinence (SUI)
With SUI, weak pelvic muscles let urine escape. It is one of the most
common types of urinary incontinence. It is common in older
women. It is less common in men.
SUI happens when the pelvic floor muscles have stretched. Physical
activity puts pressure on the bladder. Then the bladder leaks.
Leaking my happen with exercise, walking, bending, lifting, or even
sneezing and coughing. It can be a few drops of urine to a
tablespoon or more. SUI can be mild, moderate or severe.

16. Overactive Bladder (OAB)
OAB is another common type of urinary incontinence. It is also called
"urgency" incontinence. OAB affects more than 30% of men and 40% of
women in the U.S. It affects people's lives. They may restrict activities. They
may fear they will suddenly have to urinate when they aren't near a bathroom.
They may not even be able to get a good night's sleep. Some people have both
SUI and OAB and this is known as mixed incontinence.
With OAB, your brain tells your bladder to empty - even when it isn't full. Or
the bladder muscles are too active. They contract (squeeze) to pass urine
before your bladder is full. This causes the urge (need) to urinate.
The main symptom of OAB is the sudden urge to urinate. You can't control or
ignore this "gotta go" feeling. Another symptom is having to urinate many
times during the day and night.
OAB is more likely in men with prostate problems and in women after
menopause. It is caused by many things. Even diet can affect OAB. There are a
number of treatments. They include life style changes, drugs that relax the
bladder muscle, or surgery. Some people have both SUI and OAB.

17. Mixed Incontinence (SUI and OAB)
• Some people leak urine with activity (SUI) and often feel the urge to urinate (OAB). This is mixed
incontinence. The person has both SUI and OAB.
Overflow Incontinence
• With overflow incontinence, the body makes more urine than the bladder can hold or the bladder
is full and cannot empty thereby causing it to leak urine. In addition, there may be something
blocking the flow or the bladder muscle may not contract (squeeze) as it should.
• One symptom is frequent urinating of a small amount. Another symptom is a constant drip, called
"dribbling."
• This type of urinary incontinences is rare in women. It is more common in men who have prostate
problems or have had prostate surgery.

19. Menopause is the time that marks the end of your menstrual cycles.
It's diagnosed after you've gone 12 months without a menstrual
period. Menopause can happen in your 40s or 50s.
Menopause is a natural biological process. But the physical
symptoms, such as hot flashes, and emotional symptoms of
menopause may disrupt your sleep, lower your energy or affect
emotional health. There are many effective treatments available,
from lifestyle adjustments to hormone therapy
Menopause

21. Treatment
• Follicle-stimulating hormone (FSH) and estrogen (estradiol),
because your FSH levels increase and estradiol levels decrease
as menopause occurs
• Thyroid-stimulating hormone (TSH), because an underactive
thyroid (hypothyroidism) can cause symptoms similar to those
of menopause
• Hormone therapy
• Non-Hormonal Therapy
• Lifestyle changes
• Herbal therapies/phytoestrogens

22. Osteoporosis
• Osteoporosis causes bones to become weak and brittle — so
brittle that a fall or even mild stresses such as bending over or
coughing can cause a fracture. Osteoporosis-related fractures
most commonly occur in the hip, wrist or spine.
• Bone is living tissue that is constantly being broken down and
replaced. Osteoporosis occurs when the creation of new bone
doesn't keep up with the loss of old bone.
• Osteoporosis affects men and women of all races. But white and
Asian women, especially older women who are past menopause,
are at highest risk. Medications, healthy diet and weight-bearing
exercise can help prevent bone loss or strengthen already weak
bones.

25. Treatment

27. Thank you
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