This document provides guidance on diagnosing and managing polycystic ovarian syndrome (PCOS) in adolescents. Key points include:
- Adult PCOS diagnostic criteria are not applicable to adolescents due to normal irregular periods and cystic ovaries during puberty.
- Recommended diagnostic approach involves assessing for unexplained hyperandrogenism and ovarian dysfunction after ruling out other conditions.
- Management involves lifestyle changes like weight loss, exercise and diet, as well as symptom-focused treatments like birth control pills, anti-androgens and insulin-sensitizing agents.
- The goals are to alleviate current symptoms, decrease future health risks of PCOS like infertility, metabolic syndrome and diabetes. Care must be taken to
Optimal protocols for Ovulation induction (Assisted Reproductive technologies)Anu Test Tube Baby Centre
Presentation given in Tirupati, India in 2018 on Ovulation Induction for assisted reproductive technologies. Dealing with infertility using Intra uterine insemination (IUI) and In vitro fertilization (IVF)
PANEL DISCUSSION
MANAGEMENT OF PCOS - WOMB to TOMB
MODERATOR : Sharda Jain
PANELISTS : Dr.Chitra setia
Dr Puneet Arora
Dr. Ila Gupta
Dr. Rupam Arora
Dr. Archana Sharma
Dr. Sangeeta Gupta
Dermatologists
Dr. V.K. Upadhyay
Dr. S. Kandhari
When other treatments are unsuccessful, women suffering from PCOS can get pregnant with IVF. However, they need to find a high-quality clinic. The success rate of IVF in PCOS is about 70%, which is excellent for women with PCOS who want to conceive.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Optimal protocols for Ovulation induction (Assisted Reproductive technologies)Anu Test Tube Baby Centre
Presentation given in Tirupati, India in 2018 on Ovulation Induction for assisted reproductive technologies. Dealing with infertility using Intra uterine insemination (IUI) and In vitro fertilization (IVF)
PANEL DISCUSSION
MANAGEMENT OF PCOS - WOMB to TOMB
MODERATOR : Sharda Jain
PANELISTS : Dr.Chitra setia
Dr Puneet Arora
Dr. Ila Gupta
Dr. Rupam Arora
Dr. Archana Sharma
Dr. Sangeeta Gupta
Dermatologists
Dr. V.K. Upadhyay
Dr. S. Kandhari
When other treatments are unsuccessful, women suffering from PCOS can get pregnant with IVF. However, they need to find a high-quality clinic. The success rate of IVF in PCOS is about 70%, which is excellent for women with PCOS who want to conceive.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The loss of pregnancy at any stage - devastating experience, both patient and physician.
Recurrent miscarriage is defined as the occurrence of three or more consecutive spontaneous abortion before 20wks of gestation.
Ectopic, molar and biochemical pregnancies not included.
The Role of laparoscopy in the era of ARTDrRokeyaBegum
The advancement of new perspectives in assisted reproductive technology (ART) through the use of modern infertility evaluation technique Stillclinician needs to reassess how infertility should be best treated.
Recently the focus of treatment for infertility has shifted from systematic correction of each identified factor.
Challenges - In management of infertilityDrRokeyaBegum
Over fertility is a problem of Bangladesh.Still infertility is an issue 1 in 7 couples have difficulties to conceive.
Inability to create a desired pregnancy that culminates in the Birth of child is likely to create a life crisis for women and their partners.
Predictive Factors influencing pregnancy rate after intrauterine inseminationDrRokeyaBegum
Intrauterine insemination (IUI) is an assisted reproduction procedure that involves the deposition of a processed semen sample in the upper uterine cavity.This is non invasive and cost effective first line therapy for infertile couple.IUI can be done easily in simple setups.
Postpartum haemorrhage (PPH) is commonly defined as a blood loss of 500 ml or more within 24 hours after birth.
It affects about 5% of all women giving birth around the world.
Globally, nearly one quarter of all maternal deaths are associated with PPH. In most low-income countries, it is the main cause of maternal mortality.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
4. The classic syndrome originally was described by
stein and leventhal as the association of amenorrhoea
with polycystic ovaries and variably hirsutism and
obesity.
(J.obstet gynecol 1935)
5. It is now recognized that PCOS represents a
spectrum of disease characterized primarily by the
following features.
6. Etiology
Multifactorial disease with full clinical expression being
the result of synergistic pathological interaction of :
1. Genetic,
2. Epigenetic
3. Environmental factor.
7. Genetic link
1. Familial genetic disorder related to a single gene defect.
2. 16 loci for PCOS (Jones and Goodarzi Fertil steril 2016)
3. Gene polymorphism
4. Familial clustering of PCOS common.
- First degree relatives of patients with PCOS may be at high risk for diabetes and
glucose intolerance.
- Inherited cell dysfunction
- Mother and sister of PCOS
8.
9. Criteria for Diagnosis of PCOS
PCOS definition
NIH 1990
Patient demonstrates
both:
1. Clinical and/or
biochemical signsof
hyperandrogenism
2. Oligo- orchronic
anovulation
Rotterdam
criteria 2003
(ESHRE/ASRM)
Two of the following
three manifestations:
1.Irregular or absent
ovulation
2.Hyperandrogenism
(clinical or
biochemical)
3 PCO on USG
AES Criteria
2006
Patient demonstrates
both:
1. Hirsutism and/or
hyperandrogenemia
2. Oligo-anovulation
and/or polycystic
ovaries
Azziz et al. JCEM 2006; 91: 4237-45
Exclude other etiologies of androgen excess – Late onset congenital
adrenal hyperplasia, Androgen secreting tumours, Cushing’s
syndrome
10. Can we use these criteria to diagnose PCOS
in Adolescence?
Normal Adolescents
- Oligomenorrhoea
- Amenorrhoea
- Acne
- Multicystic” ovaries
NO
11. Adolescence
From Latin adolescere meaning to grow up
1.Transitional stage of physical and psychological
development from puberty to adult hood.
2.Adolescent young people between the age of 10 -19 years.
13. PCOS patient presents during
adolescents
30% menstrual irregularities
60% adrogen excess
84% over weight
9% IGT or T2 DM
14. Obesity
Typical obesity of PCOS is described as centripetal or apple type
of fat distributions center of body as apposed to thighs and legs.
Waist circumference > 88cm marker of central / visceral obesity
Body weight primary factor affecting quality of life.
15. Why adult criteria not applicable to young PCOS.
Anovulation
85% of cycles anovulatory in first year of menstruation.
59% of cycle anovulatory in third year.
25% of the cycle still anovulatory by the 6th year.
Normal adolescent
PCOM at USG
2 years after Menarche – 40%
3 years 35%
4 years 33.3%
16. Abnormal menstrual patterns painting out anovulation in adolescents.
Secondary amenorrhea > 90 days
Oligomenorrhoea
Postmenercheal
1st year > 90 days < 4 periods/yr
2nd year > 60 days < 6 periods/yr
3-5 yrs > 45 days < 8 periods/yr
>6yrs > 35-40 days < 9 periods/yr
Menorrhagia bleeding <21 days or> 7 days and one pad per 1-2 hours.
17. Adolescent have functional ovarian cysts
High ovarian volume occurs in adolescence.
Transabdominal sonography is inaccurate
Clinical evidence of androgen excess (especially acne) is common
during puberty as resolves over time.
18. Metabolic features
Insulin resistance
- Increase insulin level due to high growth hormone leading to
obesities
- BMI > 24.
- Hyperpulsatile GnRh secretion.
- Decrease SHBG increase the androgen level.
Return to normal at the end of normal puberty but remain elevated
in PCOS.
19. How to evaluate hyper androgenemia in the adolescent girl.
Hirsutism – good marker
Alopecia – from the bolding and anterior hair line recession
seen only in more severe cases of androgen excess.
Acne and seborrhea.
Sexual hair growth is commonly graded by
semiquantitative Ferriman-Gallway (F-G score)
21. Recommendation:
Clinical:
1. Isolated mild hirsutism – in early post menarched year may be development.
2. Moderate to severe hirsutism constitutes clinical evidence of hirsutism.
3. Girls with acne that is persistent and poorly responsive to topical dermatologic
therapy should be evaluated for the presence of hyper androgenaemia before
initiation of any medical therapy.
Biochemical hyperandrogenic:
Measurement of total and free testosterone.
22. Precaution
1.Best assessed in early morning.
2.Early follicular phase.
3.Oral pill interface with the assessment of androgen.
4.After discontinuation wait for 6 weeks.
23. Total testosterone level
The normal upper limit for semen total testosterone in woman is
approximately 60ngm/dl (2.0nmol/L).
Free testosterone level an elevation in serum or plasma free
testosterone is the single most sensitive test to establish the
presence of hyper androgenemia.
24. Evidence of Oligo anovulation
It is difficult to differentiation of adolescent with physiological
anovulation from those with true ovulatory dysfunction in PCOS.
25. Recommendation
1.Menstrual interval persistently shorter than 20 days or greater
than 45 days in individuals two or more years after menerche
are evidence of oligo-anovulation.
2.A menstrual interval greater than 90 days is unusual even in
first year after menerche – Require further investigations.
3.Lack of onset of menes by the age of 15 years or by more than
2-3 years after thelarche regardless of chronological age.
26. Evaluation of polycystic ovarian morphology in an adolescent
(PCOM)
1. No compelling criteria to define PCOM have been established for adolescent
- ovarian volume
- follicle count
2. Multifollicular pattern which is defined by the presence of large follicle distributed throughout the
ovary does not have relation with hyper androgenaemia is more common in adolescent and should not
considered a pathological finding.
3. Regular menstruation with hyper androgenaemia – may show PCOM.
4. Abdominal US is Adolescent particularly obese girl may yield inadequate information.
5. AMH should not be used as diagnostic criteria for PCOS in adolescent.
6. Till now ovarian image can be deferred during the diagnostic evaluation of PCOS.
27. What are the other disease mimcs PCOS
1. Hypothyroidism
2. Hyper prolactineamia
3. Nonclassical CAH
4. Androgen secreting neoplasm
- ovary
- Adrenal
1. Cushing’s syndrome
2. Acromegaly
3. Gluco corticoid resistance
4. Drug – sodium valproate
The incidence is less
29. Hyper prolactinaemia causes PCOS phenotype
Hyper prolactinaemia
1. Central neurotransmitter dysregulation.
2. Positive feed back of estrogen
3. Drug OCPS, Antipsychotic
4 Other
- Pituitary cause
- Hypothyroidism
- Physiological
PCOS – causes mild hyper prolactnaemia
30. Congenital Adrenal Hyperplasia(CAH)
Mainly nonclassical form – phenotypical like PCOS
Premature pubarche
Peripubertal onset
Consanguinity
Virilisation
Total testosterone > 1.5ngm/L
31. 17 OH progesterone measurement in follicular phase
Due to 21 hydroxylase deficiency.
Less than 2ngm/ml - No NC CAH
More than10ngm/ml- NC CAH
2-8 ngm/ml – ACTH stimulation test
< 10ngm/nl – rule out
>15ngm/nl – NC CAH
34. Following investigations has to be done.
1. TSH and prolactin
2. Serum 17OH progesterone
3. Serum testosterone more than 2ngm/ml
4. DHEA
5. Imaging of abdomen to rule out Androgenic tumour.
35. Once the diagnosis of PCOS has been established
identify the other risk factors.
- Early development of type-2 DM
- Metabolic syndrome
- Sleep disordered
- Breathing difficulty
- Cardiovascular risk sequence
- Endometrial carcinoma
36. Family evaluation
There is a high frequency of PCOS and metabolic syndrome
among immediate relatives of individual with PCOS.
37. Management of adolescent girls with PCOS
• Psychological support
• Life style change
- Weight loss and exercise
- Healthy approach to eat
• Symptom oriented treatment
• Anti androgens and Insulin sensitizing agent
39. Weight loss of only 5% of total body weight is associated with
- Decreased insulin and LH level
- Increased SHBG and decreased free androgen
- Improved menstrual function
- Reduced hirsutism and acne
- Lower testosterone level
40. Metformin
1.Reduced insulin level by direct inhibition of hepatic glucose
output.
2.Suppress appetite and enhance weight reduction.
3.Metformin is used as an adjuvant to
- Management of obesity
- Insulin resistant metabolic abnormalities
41. Dose
lean – 850mg/daily
over weight and obese 1.5-2.5gm daily
43. Combination OCPS
First line treatment
OCP induced menstrual period with a higher degree of reliability than other
form of treatment.
44. Combinations of OCPS
Progesterone
Inhibits endometrial proliferation
Prevent hyperplasia
Estrogen
Inhibits the activity of the H-P-O. axis
Reducing ovarian androgen production
Increase level of SHBG
Decrease gene of unbound testosterone
OCP will normalize androgen level within
18-21 days
45. Combinations OCPS
After three months – The efficacy of treatment is assessed by evaluation
- clinical symptoms
- Androgen level
How long
Till patient is gynecologically nature – 5 years post menercheal.
or loss of substantial amount of excess weight
At that point withholding treatment for a few months
-To allow recovery of suppression of H-P-O
-Persistent of abnormalities
47. Progesterone
- Menstrual irregularity can be controlled with cycle progesterone alone
GnRh agonist
Cannot tolerate OCP
Progesterone not sufficient
Not use before the case of 16 yrs
Pt receive GnRn agonist therapy also should be treated with
low dose estradiol and progesterone add back therapy
Bone mineral density should be monitored during therapy
48. Hyper adrogenism
This is manifested in 2/5 of cases by
Hirsutism
Equivalent cutaneous findings
Acene vulgaris
Alopecia
Seborrhoea
Hyperhidrosis
Hidradenitis suppurative
49. Hirsutism treated
Cosmetic and dermatological measure
Medical endocrine therapy
Cosmetic and physical measures
Shaving
Eflornithine cream (vanique) is a tropical agent that is FDA approved for the
removed of unwanted facial hair in women.
50. Laser therapy
Removes hair permanently by thermal destruction of dermal papilla.
Reduce hair density by 30% or move with 3-4 treatment cycle
Medical therapy
Reduced productions of androgen
Increase SHBG
Block androgen action at largest organs.
51. OCP
1. Suppress ovarian androgen production
2. Increase sex hormone binding globulin (SHBG) level
3. Decrease DHEA sulfate.
4. Transformation of vellus to terminal-reduced.
OCP
1. Arrest progression of hirsutism
Reduced the shaving by about half
1. Improve acne – with in 3 months
52. Androgen level has to be checked after 3 months of therapy.
Anti androgen
Suboptimal response after 6 months
Inhibits the androgen induced transformation of vellus to terminal hair.
Individual variation antiandrogen therapy reduces hirsutism by one third on average.
Antiandrogen should be prescribed with an OCP
Cause menstrual disturbance
Potential teratogen for fetus.
53. Anti androgen
1. Cyproterone acetate -progesterone with anti androgenic effect.
2. Spironolactone – Safe and potent
Starting with l00mg twice day until maximum effect than
reduce the dose to 50mg twice day
Causes fatigue and hyper kalamia
Laboratory test
Electrolytes
Liver function
- one to two week after initiation of Spironolactone
54. Flutamide
250mg TDS for 3 months
Gradually lowering the dose
Hepatocellular toxicity
Finasteride
5 reductase inhibitor
55. Acne
- Antibiotics and topical therapies
Tetracycline, erythromycin and minocycline
Used in conjunction with anti androgen treatment
Topical non steroidal anti androgen
Oncogenomic acetate
Benzoyl peroxide.
Alopecia
- 2% minoxidil BD with anti androgen treatment
56. Over diagnosis of PCOS
Unnecessary psychological distress of having a
diagnosis associated with future subfertility.
58. Long term health hazard
Infertility
Metabolic syndrome
Obesity
Diabetes
Heart disease
59.
60. Take home message
1. The overlap between normal pubertal development and characteristic
features of PCOS.
2. Other diagnosis associated with irregular menses hyper adrogenaemia need
to excluded from diagnosis.
3. Even in the absence of definitive diagnosis
- Alleviation of current symptoms
- Decrease the risk
for subsequent associated co-morbidities