Polycystic Ovarian Syndrome

1. Polycystic Ovarian Syndrome
(PCOS)

2. STRUCTURE OF OVARY

3. The Ovary: Functions
1. Oogenesis - production of oocytes
2. Steroidogenesis - hormone production
estrogens
- estrone (E1), estradiol (E2), estriol (E3)
- growth/maturation of sex organs
- female secondary sex characteristics
- literally “estrus-generating”
progesterone
- prepares uterus for implantation
- prepares mammary glands for lactation
- literally a “promoter of gestation” (progestegen)
progesterone
estrogens

5.  1st described by Irving Stein
and Michael Leventhal as a
triad of amenorrhea, obesity
and hirsutism (1935)
 “Syndrome O” –
Ovarian confusion –
Ovulation disruption –
Over‐nourishment –
Overproduction of insulin

6. PCOS: Etiology
 Neuroendocrine derangement: ↑LH relative to FSH
 Hyperinsulinemia: defect in insulin action or secretion
 Decrease binding proteins (ie.,SHBG, IGFBP‐I)
 Increase unbound androgens
 Reduce HDL [good] cholesterol
 Risk for PCOS (Legroet al.,1999; Dunaif, et al. 1997)Insulin resistance:
~50%
 NIDDM: 8%
 Acanthosisnigricans
 Androgen excess: ovarian and adrenal
 Worse with hyperinsulinemia
 Hirsutism: 80% PCOS
 Acne: 20% PCOS
 Androgenic alopecia: 10% PCOS

7. The theories proposed to explain the pathophysiology
of PCOS could be divided into four categories:
a) Single defect in action and secretion of insulin, causing
hyperinsulinemia and IR.
b) Primary neuroendocrine defect, leading to increased pulse
frequency and amplitude of LH.
c) Defect in androgen synthesis, resulting in increased
production of ovarian androgens.
d) Alteration in cortisol metabolism, resulting in increased
production of adrenal androgens.

11. DIAGNOSIS OF PCOS
 Physical exam – To check the blood pressure, body mass index (BMI), and
waist size.
 Skin for extra hair on your face, chest or back, acne, or skin
discoloration and hair loss.
 Blood Test- To check the level of insulin, testosterone, and LH hormone.
 Ultrasound- This is done to detect to ovaries are enlarged or swollen with
multiple cysts.

12. TREATMENTS
Lifestyle modification: may help attenuate all symptoms of PCOS and
reduce the long-term risk of infertility, CVD and T2DM
Estrogen and progestin oral contraceptive (OCP) therapy: treatment of
acne, hirsutism and irregular menstrual cycles
Anti-androgens (e.g. spironolactone, finasteride, flutamide): treatment of
acne and hirsutism
Metformin: treatment of glucose intolerance, hyperinsulinemia, and
anovulation. Reducing circulating insulin levels may secondarily reduce
ovarian androgen synthesis
Clomiphene citrate: for inducing ovulation.
Gonadotropin therapy: recombinant FSH and hCG can be used to induce
ovulation in cases where treatment with clomiphene citrate and metformin
has been unsuccessful.

13. Life style management
of Weight Reduction
• 50% treatment of PCOS is simply – weight
control.
• Even if one loses 5-10 kg - the effect is
tremendous .
Experience