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Polycystic ovary syndrome


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Polycystic ovary syndrome

  1. 1. Polycystic Ovary Syndrome Krishna B. Singh, MD Department of Obstetrics & Gynecology LSU Health Sciences Center Shreveport, LA
  2. 2. PCOS: Learning Objectives After viewing this slide show, you’ll be able to understand that... -PCOS is a common endocrine disorder -Multifactorial, heterogeneous condition -Clinical manifestations affect menses, fertility -Multiple hormonal, biochemical changes -Long-term implications are important
  3. 3. PCO Syndrome: Topics       Historical review Incidence Clinical features Diagnosis Management Summary
  4. 4. PCOS: Literature Review     Sclerocystic ovaries were described by Chereau (1844); Pozzi (1894); Waldo (1895) Stein/Leventhal first described seven cases of infertility associated with enlarged polycystic ovaries (1935) The NIH Consensus Conference (1990) The Rotterdam PCOS Consensus Group (2003)
  5. 5. Incidence: PCO Syndrome    The incidence varies: 5-10% (~5% USA) About 25% normal women may have PCO by ultrasound criteria (BMJ 1986) Ultrasound findings don’t correlate with serum hormone levels
  6. 6. Features of PCO Syndrome     Symptoms present since puberty: Cyclic menses with luteal-phase progesterone deficiency; hirsutism; hyperandrogenemia; infertility; chronic anovulation/miscarriages Irregular menses in 25-75% women Obesity (60%); also non-obese women Hirsutism and/or acne (virilization rare)
  7. 7. Polycystic Ovarian Disease    PCO disease can be seen in women with pituitary neoplasms, hypo- or hyperthyroidism, diabetes, adrenal and pelvic neoplasms Rule out PCOD to diagnose PCO syndrome Long-term care is important. Studies have shown increased incidence of hypertension, hyperlipidemia and diabetes. Risk for CVD increased
  8. 8. PCO Syndrome: Facts/correlates    Genetic factors: autosomal or X-linked Positive correlations of androgen and insulin levels in some studies Ultrasound findings don’t correlate with serum hormone levels
  9. 9. Theories of PCO Syndrome     PCO syndrome is a multifactorial disorder Theories are based on data in selected women Brain and limbic system control the hypothalamuspituitary-ovarian axis needed for reproductive cycle initiation and maintenance Feedback CNS abnormality results in PCOS
  10. 10. CNS theories of PCO     Beta-endorphin theory: Higher plasma levels are found in women with PCO syndrome Progesterone deficiency/estrogen excess is the key component Hyperandrogenism also important in PCO women Hyperprolactinemia may cause breast symptoms, diminish libido, and alter moods in some women
  11. 11. More PCO Theories...    Rat PCO model: Persistent-estrus syndrome  Constant-light exposure; androgenized rat model; hypothalamic lesions  Other methods (DHEAS model) Monkey model: testosterone injections Human model: transvestites given androgens
  12. 12. Diagnosis of PCO Syndrome    History and physical examination important; selected laboratory and hormonal tests during several visits are needed for confirmation Both structured and descriptive notes are evaluated by the physician Follow-up visits arranged @ regular intervals
  13. 13. PCOS: Differential Diagnosis      Laboratory tests for confirmation: LH/FSH, T Baseline values: Chem-22 @ morning Baseline serum hormones @ morning Pelvic ultrasound in some cases required Consider PCOD versus PCO syndrome
  14. 14. PCOS: Key to Diagnosis      Rule out conditions which may require referral; focus on the presenting signs and symptoms Beware of misdiagnosis “on the fly” Beware of differential diagnosis History and physical exam; selected tests Know when to refer patients and where
  15. 15. PCOS: Management Options   Principal components: Confirm diagnosis and identify category; identify and manage concurrent illness; identify and manage patient needs There are numerous options for successful PCO management
  16. 16. PCOS: Treatment Options     General measures: diet, exercise, relaxation for stress management Contraception: OCP; DMPA Hormones/drugs: Provera; Parlodel; Clomiphene; hMG/hCG; IVF in selected women Newer drugs for treatment of obesity, hyperinsulinemia, hyperandogenemia and hirsutism
  17. 17. PCO Syndrome and Infertility   About 60% PCO patients will have ovulatory cycles and pregnancy on clomiphene alone About 50% PCO patients will respond to the combined clomiphene and dexamethasone within six months of treatment
  18. 18. PCO Syndrome: Summary    PCO syndrome remains an enigma despite many scientific studies done during the last three decades Theories of PCO abound; terminology used may be confusing and definitions are not standardized There are many treatment options
  19. 19. What This Means...    Polycystic ovary syndrome is a common disorder among reproductive age group of women; these women generally have irregular menstrual cycles PCO has many facets of clinical presentation PCO can be successfully managed and treated by conventional means