This document provides information on polycystic ovarian syndrome (PCOS), including its frequency, structural changes to the ovaries, normal androgen metabolism in females, pathogenesis, clinical presentation, diagnosis, and treatment. Key points are that PCOS is characterized by enlarged ovaries with multiple small cysts and high androgen levels, it develops due to increased LH and decreased FSH levels, and treatment involves weight loss, ovulation induction drugs, oral contraceptives, and anti-androgen medications.
AMENORRHEA
Ludmila Barbakadze
Ivane Javakhishvili Tbilisi State University Assistant Professor Medical Doctor at Archil Khomassuridze Institute of Reproductology ,Tbilisi , Georgia.
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
There is general inconsistency in the nomenclature used to describe abnormal uterine bleeding (AUB) classification system for AUB, which has been approved by the International Federation of Gynecology and Obstetrics (FIGO) Executive Board as a FIGO PALM-COEIN classification system.
Explains the inflammatory process of endometrium,its causes and its two clinical variants as acute and chronic endometritis.
Describes the pathology of its two types with histologic perspective.
AMENORRHEA
Ludmila Barbakadze
Ivane Javakhishvili Tbilisi State University Assistant Professor Medical Doctor at Archil Khomassuridze Institute of Reproductology ,Tbilisi , Georgia.
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
There is general inconsistency in the nomenclature used to describe abnormal uterine bleeding (AUB) classification system for AUB, which has been approved by the International Federation of Gynecology and Obstetrics (FIGO) Executive Board as a FIGO PALM-COEIN classification system.
Explains the inflammatory process of endometrium,its causes and its two clinical variants as acute and chronic endometritis.
Describes the pathology of its two types with histologic perspective.
This presentation briefly discuss the polycystic ovary syndrome in terms of pathogenesis, features and management. Then, It moves on to discuss the various guidelines laid down by Endocrine Society in 2013 for the management of patients with polycystic ovary syndrome.
Polycystic ovary syndrome (PCOS) is the most common hormone abnormality of reproductive-age women, the most common cause of infertility in women and an important harbinger of metabolic disorders such as diabetes and heart disease.
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.
2. Polycystic ovarian syndrome PCOS is also known as Stein-Levental syndrome Frequency: Approximately 1% of female population suffers from PCOS 30% among patients of gynecological endocrinologist 75% of infertility with endocrine genesis
3. Polycystic ovarian syndrome Structural changes of the ovaries: Ovaries are enlarged in size 2-6 times on both sides Hyperplasia of stroma and theca cells Presence of big amount of follicles with cystic changes and atresia
4. Polycystic ovarian syndrome Structural changes of the ovaries: The average diameter of the follicle is 5-8 mm Follicles form the “necklace” of ovarian Ovarian capsule is thick
5. Polycystic ovarian syndrome Normal metabolism of androgens in females Androgens are synthesized in ovaries in follicles Peak of synthesis of androgens in ovaries comes when follicle is 5-8 mm in size Ovarian androgens (testosterone, andrestendion) are converted into estrogens (estradiol, estron)
6. Polycystic ovarian syndrome The enzyme Cytochrome P450c17 is responsible for conversion of estrogens into androgens The synthesis of this enzyme is regulated by follicle-stimulating hormone (FSH) produced by pituitary
7. Polycystic ovarian syndrome Pathogenesis Develops in puberty age Probable reasons are genetic, viral infections, obesity etc Hypothalamic gonadotropine-releasing hormone (GRH) is increased Consequently, level of luteinizing hormone (LH) increases, FSH decreases
8. Polycystic ovarian syndrome High level of LH provokes cystic atresia of follicles Low level of FSH causes deficiency of enzyme P450c17 Androgens are not converted to estrogens enough -> hyperandrogenia and lack of ovarian estrogens
10. Polycystic ovarian syndrome Patients with PCOS have more or less manifesting resistance to insulin (defect of insulin receptors) Blood level of glucose increases Obesity appears Compensatory, levels of insulin and insulin-like growth factor-1 are increased That substances cause high synthesis of androgens and estrogens by fat tissue Process does not depend from pituitary
12. Polycystic ovarian syndrome Clinical flow The average age of menarche is normal but Menstrual abnormalities (oligo- and amenorrhea) since the menarche No ovulation Primary infertility Hyperplasia of endometrius (no phases of cycle, “fat estrogens” are present)
13. Polycystic ovarian syndrome “Female type” of obesity (circumference of waist/ circumference of hips <0.85) Breasts are developed enough but 30% of patients have mastopathia Hirsutism Changes of glucose profile
16. Polycystic ovarian syndrome Diagnostics: Infertility (primary) Obesity + hirsutism Oligo- and amenorrhea High level of glucose Monophasal basal temperature, no ovulation Ovaries are enlarged on BOTH sided LH is increased, LH/FSH >2,5