Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects individuals with ovaries, typically during their reproductive years. PCOS is characterized by a combination of symptoms, and its exact cause is not fully understood.

1. Presentation of Obstetrics and Gynecology
Polycystic Ovary Syndrome (PCOS)
Presented by: Dr.Saima Mustafa (pt)

2. POLYCYSTIC OVARY SYNDROME (PCOS)
❖It is a hormonal imbalance that occurs when your ovaries (the
organ that produces and releases eggs) create excess
hormones called androgens.
❖This causes your reproductive hormones to become
imbalanced.
❖As a result, people with PCOS often have irregular menstrual
cycles, missed periods and unpredictable ovulation.
❖Small follicle cysts (fluid-filled sacs with immature eggs) may
be visible on your ovaries on ultrasound due to lack of
ovulation (anovulation).

3. ❖However, despite the name "polycystic," you don’t need to have cysts on your
ovaries to have PCOS.
❖The ovarian cysts aren’t dangerous or painful.
❖PCOS is one of the most common causes of infertility in women and people assigned
female at birth (AFAB).
❖It can also increase your risk of other health conditions.
❖Your healthcare provider can treat PCOS based on your symptoms and if you wish
to become pregnant.

4. What age does PCOS start?
❖Women and people AFAB can get PCOS any time after puberty.
❖Most women are diagnosed in their 20s or 30s when they’re trying to get
pregnant.
❖A higher chance of getting PCOS if you have obesity or if other people in
your biological family have PCOS.

5. How Common is PCOS
❖PCOS is very common — up to 15% of women and people AFAB of reproductive age have PCOS
Signs and symptoms of PCOS
❖Irregular periods: Abnormal menstruation involves missing periods or not having a period at all. It may also
involve heavy bleeding during periods.
❖Abnormal hair growth: You may grow excess facial hair or experience heavy hair growth on your arms, chest
and abdomen (hirsutism). This affects up to 70% of people with PCOS.
❖Acne: PCOS can cause acne, especially on your back, chest and face. This acne may continue past your teenage
years and may be difficult to treat.
❖Obesity: Between 40% and 80% of people with PCOS have obesity and have trouble maintaining a weight that’s
healthy for them.

6. ❖Darkening of the skin: You may get patches of dark skin, especially in the folds of your neck, armpits, groin
(between the legs) and under your breasts. This is known as acanthosis nigricans.
❖Cysts: Many people with PCOS have ovaries that appear larger or with many follicles (egg sac cysts) on
ultrasound.
❖Skin tags: Skin tags are little flaps of extra skin. They’re often found in your armpits or on your neck.
❖Thinning hair: People with PCOS may lose patches of hair on their head or start to bald.
❖Infertility: PCOS is the most common cause of infertility in people AFAB. Not ovulating regularly or frequently
can result in not being able to conceive.

7. ●Can I have PCOS but not have any symptoms?
●Yes, it’s possible to have PCOS and not have any symptoms.
●Many people don’t even realize they have the condition until they have trouble
getting pregnant or are gaining weight for unknown reasons.
●It’s also possible to have mild PCOS, where the symptoms aren’t severe enough for
you to notice.

8. Cause of PCOS
❖The exact cause of PCOS is unknown. There’s evidence that genetics play a role.
Several other factors, most importantly obesity, also play a role in causing PCOS:
❖Higher levels of male hormones called androgens: High androgen levels prevent
your ovaries from releasing eggs, which causes irregular menstrual cycles.
❖Irregular ovulation can also cause small, fluid-filled sacs to develop on your
ovaries.
❖High androgen also causes acne and excess hair growth in women and people
AFAB.

9. ●Insulin resistance: An increase in insulin levels causes your ovaries to make
and release male hormones (androgens). Increased male hormones suppress
ovulation and contribute to other symptoms of PCOS.
❖Low-grade inflammation: People with PCOS tend to have chronic low-grade
inflammation. Your healthcare provider can perform blood tests that measure
levels of C-reactive protein (CRP) and white blood cells, which can indicate the
level of inflammation in your body.

10. PCOS and miscarriage
● Having PCOS may increase your risk for certain pregnancy complications,
although most women and people AFAB with PCOS are able to successfully
carry a pregnancy.
● Other complications of PCOS related to pregnancy include increased risk of:
● Gestational diabetes, preeclampsia and high blood pressure.
● Preterm birth (birth before 37 weeks of pregnancy) or C-section delivery due
to obesity, diabetes or high blood pressure.

11. Diagnoses Of polycystic ovary syndrome (PCOS
● In most cases, your healthcare provider can diagnose PCOS after an examination and
discussing your symptoms.
● They may order blood tests or perform an ultrasound to help with the diagnosis.
● Talk to you about your symptoms and medical history.
● Take your weight and blood pressure.
● Perform a physical exam, looking specifically for excess facial hair, hair loss, acne,
discolored skin and skin tags.
● Perform a pelvic exam to look for other causes of abnormal bleeding.
● Order blood tests to check hormone levels and glucose levels.
● Perform a pelvic ultrasound to look at your ovaries, check the thickness of your uterine
lining and look for other causes of abnormal bleeding.

12. ● Three Major symptoms to diagnose PCOS?
● Irregular or missed periods. Some people with PCOS have very heavy bleeding
when they do have a period.
● Signs of excess androgens such as acne or excessive hair growth. Or a blood test
confirming high androgen levels.
● Enlarged ovaries or polycystic appearance of ovaries on ultrasound. Many people
don’t develop cysts.

13. ● Women with PCOS can develop serious health problems, especially if they are
overweight:
● Diabetes—more than half of women with PCOS develop type 2 diabetes by age 40
● Gestational diabetes (diabetes when pregnant)—which puts the pregnancy and baby at
risk and can lead to type 2 diabetes later in life for both mother and child
● Heart disease—women with PCOS are at higher risk, and risk increases with age
● High blood pressure—which can damage the heart, brain, and kidneys
● High LDL (“bad”) cholesterol and low HDL (“good”) cholesterol—increasing the risk for
heart disease
● Sleep apnea—a disorder that causes breathing to stop during sleep and raises the risk
for heart disease and type 2 diabetes
● Stroke—plaque (cholesterol and white blood cells) clogging blood vessels can lead to
blood clots that in turn can cause a stroke
● PCOS is also linked to depression and anxiety, though the connection is not fully
understood.

14. ● Treatment for PCOS
● depends on a number of factors.
● These may include your age, how severe your symptoms are, and your overall health.
● The type of treatment may also depend on whether you want to become pregnant in
the future.
● Change in diet and activity. A healthy diet and more physical activity can help you lose
weight and reduce your symptoms. They can also help your body use insulin more
efficiently, lower blood glucose levels, and may help you ovulate.

15. Medications
● To regulate your periods, your health care provider might recommend:
● Combination birth control pills. Pills that contain both estrogen and progestin decrease
androgen production and regulate estrogen. Regulating your hormones can lower your risk of
endometrial cancer and correct irregular bleeding, excess hair growth and acne.
● Progestin therapy. Taking progestin for 10 to 14 days every 1 to 2 months can regulate your
periods and protect against endometrial cancer. This progestin therapy doesn't improve
androgen levels and won't prevent pregnancy. Clomiphene. This oral anti-estrogen medication
is taken during the first part of your menstrual cycle.
● Letrozole (Femara). This breast cancer treatment can work to stimulate the ovaries.

16. ● Metformin. This medicine for type 2 diabetes that you take by mouth improves
insulin resistance and lowers insulin levels. If you have prediabetes, metformin can
slow the progression to type 2 diabetes and help with weight loss.
● Gonadotropins. These hormone medications are given by injection.
● Birth control pills. These pills decrease androgen production that can cause excessive
hair growth and acne.
● Hair removal. Electrolysis and laser hair removal are two options for removing hair.
Acne treatments. Medications, including pills and topical creams or gels, may help
improve acne. Talk to your health care provider about options.

17. Physical therapy management
● to decrease the main symptoms of PCOS by addressing hormonal imbalances, obesity, and seeking to
improve the quality of life for these women.
High Intensity Interval Training (HIIT)
● A popular style of fitness training that consists of a series of exercises being performed at a fast paced to elicit both
an aerobic and anaerobic response. training for PCOS include improvements of glycemic control, “improvements in
aerobic capacity, insulin sensitivity, menstrual regulation and hormonal profiles." HIIT has also been shown to
decrease stress, anxiety, and depression level.
● workout for PCOS would include:
● -Warm Up such as walking, jogging, biking to a 50-65% of heart rate’s max.
● - 2-3 rounds of 2 minutes of exercises performed at a high speed with low to moderate weight varying in difficulty
and heart rate max as low as 65%-90%

18. ● Example:
● Round 1: Squats and shoulder presses for 2 minutes
● Round 2: Mountain climbers and high knees for 2 minutes
● Round 3: Side lunges and triceps dips for 2 minutes
● Cool down such as walking, active stretching to lower heart rate max

19. Aerobic training
● can include running, walking, and bike riding.Aerobic training can help to alleviate the severity of
PCOS symptoms.
● Performing an aerobic activity that will increase your heart rate to sixty to seventy percent can
chow improvements in autonomic and inflammatory functions
Resistance Training
● The “increase in muscle strength by making muscles work against a weight or force” and is another
effective way to help improve and decrease PCOS symptoms.
● RT has been shown to reduce testosterone levels, waist circumference and increase functional
capacity.

20. Modalities
TENS is a treatment that utilizes low-voltage electric current to relieve lower back pain and menstrual cramps Women
with PCOS often complain of pelvic or lower abdominal discomfort related to menstruation and low back pain. With
TENS, electrical pulses can reduce pain and provide short-term pain relief.
Hot pack/Heat Therapy:
hot packs, and heat treatments can relax tense muscles, increase blood flow, and alleviate pain. Heat exposure reduces
inflammation, which controls PCOS flare-ups. Most HT participants had improved menstrual function and substantially
lower serum testosterone levels.
Electroacupuncture is a technique for treating conditions by putting an electrical current through a needle.
Acupuncture can help people lose weight; this may be a particularly appealing option for those with PCOS because it
may also help with other symptoms such as stress, irregular menstrual cycles, and infertility.