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Presentation on The Diagnosis of Polycystic Ovary Syndrome (PCOS)

Dr. Laxmi Shrikhandge, Nagpur, India present on The Diagnosis of Polycystic Ovary Syndrome (PCOS)

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Dr. Laxmi Shrikhande
MD,FICOG,FICMU
• Director-Shrikhande Fertility Clinic,Nagpur
• President MenopauseSociety,Nagpur
• NationalCorrespondingEditor-TheJournalof Obstetrics& Gynecologyof India
• SeniorVice President FOGSI 2012
• Vice Chairperson IndianCollegeOB /GY
• GoverningCouncilmemberICOG2012-2017
• GoverningCouncilMemberISAR 2014-2019
• GoverningCouncilMemberIAGEfor3 terms
• Patron-VidarbhaChapterISOPARB
• Chairperson-HIV/AIDS Committee,FOGSI (2007-09)
• Received Best Committee Awardof FOGSI
• ReceivedBharat excellenceAwardforwomen’s health
• President NagpurOB/GYSociety 2005-06
• Associatememberof RCOG
• Memberof EuropeanSociety of HumanReproduction
• Visited96 FOGSI Societies as invitedfaculty
• Delivered 6 orationsand296 guest lectures
• Publications-ThirteenNational& sevenInternational
• PresentedPapers in FIGO,AICOG,SAFOG,AICC-RCOG conferences
• Conductedadolescenthealth program for more than15,000 adolescent girls
PCOS & Adolescence
DR LAXMI SHRIKHANDE
DIRECTOR-SHRIKHANDE FERTILITY CLINIC,
NAGPUR
PCOS
PCOS is one condition where people always
like to agree to disagree.
Over the years these disagreements have
continued.
The criteria for diagnosis keep on changing.
Management guidelines keep on changing
Latest Guidelines 2018
International evidence-based guideline for the assessment
and management of polycystic ovary syndrome 2018
By ESHRE &ASRM
Released in July 2018 during ESHRE congress at Barcelona
New Guidelines
designed to provide clear information to assist clinical decision
making and support optimal patient care
Is the culmination of the work of over 3000 health
professionals and consumers internationally
How you will diagnose PCOS in adolescent
girl

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Presentation on The Diagnosis of Polycystic Ovary Syndrome (PCOS)

  • 1. Dr. Laxmi Shrikhande MD,FICOG,FICMU • Director-Shrikhande Fertility Clinic,Nagpur • President MenopauseSociety,Nagpur • NationalCorrespondingEditor-TheJournalof Obstetrics& Gynecologyof India • SeniorVice President FOGSI 2012 • Vice Chairperson IndianCollegeOB /GY • GoverningCouncilmemberICOG2012-2017 • GoverningCouncilMemberISAR 2014-2019 • GoverningCouncilMemberIAGEfor3 terms • Patron-VidarbhaChapterISOPARB • Chairperson-HIV/AIDS Committee,FOGSI (2007-09) • Received Best Committee Awardof FOGSI • ReceivedBharat excellenceAwardforwomen’s health • President NagpurOB/GYSociety 2005-06 • Associatememberof RCOG • Memberof EuropeanSociety of HumanReproduction • Visited96 FOGSI Societies as invitedfaculty • Delivered 6 orationsand296 guest lectures • Publications-ThirteenNational& sevenInternational • PresentedPapers in FIGO,AICOG,SAFOG,AICC-RCOG conferences • Conductedadolescenthealth program for more than15,000 adolescent girls
  • 2. PCOS & Adolescence DR LAXMI SHRIKHANDE DIRECTOR-SHRIKHANDE FERTILITY CLINIC, NAGPUR
  • 3. PCOS PCOS is one condition where people always like to agree to disagree. Over the years these disagreements have continued. The criteria for diagnosis keep on changing. Management guidelines keep on changing
  • 4. Latest Guidelines 2018 International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018 By ESHRE &ASRM Released in July 2018 during ESHRE congress at Barcelona
  • 5. New Guidelines designed to provide clear information to assist clinical decision making and support optimal patient care Is the culmination of the work of over 3000 health professionals and consumers internationally
  • 6. How you will diagnose PCOS in adolescent girl
  • 7. Criteria for diagnosis of PCOS  NIH (1990) – include all of the following 1. Hyperandrogenism &/or hyperandrogenaemia 2. Oligo-ovulation 3. Exclusion of related disorders  ESHRE/ASRM (Rotterdam 2003)- two of the following 1. Oligo or anovulation 2. Clinical &/or biochemical signs of Hyperandrogenism 3. Polycystic ovaries  Androgen Excess Society (2006) - include all of the following 1. Hirsutism &/or hyperandrogenaemia 2. Oligo – anovulation &/or polycystic ovaries 3. Exclusion of androgen excess or related disorder
  • 8. Diagnostic Criteria Irregular menstrual cycles Clinical hyperandrogenism Biochemical hyperandrogenism Ultrasound and polycystic ovarian morphology (PCOM) Ethnic variation Anti-müllerian hormone (AMH)
  • 9. Ethnic variation Consider ethnic variation in PCOS including: relatively mild phenotypes in Caucasians. higher BMI in Caucasians, especially North America and Australia. more severe hirsutism in Middle Eastern, Hispanic and Mediterranean women. increased central adiposity, insulin resistance, diabetes, metabolic risks and acanthosis nigricans in South East Asians and Indigenous Australians. lower BMI and milder hirsutism in East Asians. higher BMI and metabolic features in Africa
  • 10. What do we mean by lifestyle interventions? Healthy lifestyle behaviours (healthy eating and regular physical activity) should be recommended in all women with PCOS including those with excess weight too achieve and/or maintain healthy weight and to optimise health, and quality of life across the life course.
  • 11. Lifestyle Intervention Behavioural strategies Dietary intervention Exercise intervention Obesity and weight assessment
  • 13. Goal setting for this weight loss ? SMART Specific, Measurable, Achievable, Realistic and Timely
  • 14. How much weight loss ? Achievable goals such as 5% to 10% weight loss in those with excess weight yields significant clinical improvements and  is considered successful weight reduction within six months
  • 15. How to loose weight? DIET Which diet plan is best ? How much calorie deficit should be prescribed?
  • 16. Immediate / Acute Issues- ◦ Hirsutism ◦ Obesity ◦ Regulation of menses Long term issues- ◦ Insulin Resistance ◦ Cardiovascular risk ◦ Obstructive sleep apnea ◦ Malignancy risk
  • 17. • Combined OCPs containing ---estrogen and Progesterone given cyclically help in controlling menstrual problem , hirsutism, acne, and extra weight. • Estrogen salt used is- --- Ethinylestradiol in the dose 0f 20/ 30 ug / day. • Progeserones used are of many types and they have variable effect on Acne, weight , hirsutism, -to be considered when prescribing OCPs.
  • 19. PCOS - Late sequelae • Diabetes mellitus x7 • Hypertension x4 • Low HDL/high LDL • Endometrial Cancer
  • 20. Practical measures Articles in news papers and magazines TV shows Adolescent health programmes in schools and colleges Medical conferences to educate doctors, paramedics PCOS associations in every country with regular activities Good blogs by experts Research
  • 21. • Frequently seen in adolescence • Early diagnosis is important because of the potential long-term consequences
  • 22. Dr. Laxmi Shrikhande Shrikhande Fertility Clinic Ph-8805577600 / 8805677600 shrikhandedrlaxmi@gmail.com
  • 23. 'Spiritual blossoming' simply means blossoming in life in all dimensions. Being happy, at ease with yourself and with everybody around you. Sri Sri Ravi Shankar The Art of Living