Polycystic ovarian syndrome (PCOS) is a leading cause of female infertility and is the most common endocrine disorder in reproductive-aged women, affecting millions globally. Key features include hyperandrogenism, menstrual irregularities, and ultrasound findings of multiple ovarian follicles. Management focuses on lifestyle changes, insulin resistance treatment, and various medical therapies, with specific treatments for infertility and hirsutism tailored to individual needs.

1. POLYCYSTIC OVARIAN
SYNDROME
Presentation : AHMED ABDUL MALIK
(3rd year)

2. SYNDROME
First described by STEIN & LEVENHAL (1935)
LEADING CAUSE OF FEMALE INFERTILITY

3. EPIDEMIOLOGY
Most common endocrine abnormality in reproductive aged women
WHO Pcos affects 116 MILLION Women WORLD WIDE in 2012
Studies of Pcos in INDIA reported up to 36% prevalence in adolescents

4. Clinical Presentation Sign & Symptoms

5. ETIOLOGY
Neuroendocrine derangement: increased LH
Hormonal Imbalance
Hormonal
(FSH:LH/2:1)
(FSH:LH/1:3)
Hyperinsulinemia: Defect in Insulin Action or Secretion
Androgen Excess: Ovarian and Adrenal

6. Hallmark of PCOS

7. Follicle
oocyte
Granulosa
cells
Theca
cellsAnterior
pituitary
GnRH
LH
FSH
Desmolasae/
7a-Hydroxylase
Androgen
Estrodil
PCOS: LH HIRSUTISM
Androgen ADIPOSE ESTRONE
ESTRONE
OVARYNORMAL OVARY

8. Normal menstrual cycle PCOS
LH (fluctuate)
Ovulation
Corpus Leuteum
Progesterone

9. Criteria of PCOS
(I)Rotterdam criteria:
2/3 Need to be met
1)Hyperandrogenism: Clinical- Acne
Hirsutism
Biochemical-increased testosterone,DHEA,…
2) menstrual irregularities: Amenorrhea/Anovulation
3)USG Feature of PCOS:>12 Follicles,Ovaian vol.10cc

10. (II) ANDROGEN EXCESS PCOS SOCIETY:
1)Hyperandrogenism: Clinical- Acne
Hirsutism
Biochemical-increased testosterone,DHEA,..
2)Ovarian dysfunction:

11. DIFFRENTIAL DIAGNOSIS

12. RISK FACTORS
Obesity >88cm (35inchs)
Waist
Hyperandrogenism

14. MANAGEMENT OF PCOS
OBESITY Wt-Reduction
IRREGULAR PERIODS- OC Pills low dose with progesterone(*NOTE* but It will cure only irregular periods.
It's Not for Pcod Women desire to be pregnant
INSULIN RESISTANCE: Metformin
ANOVULATORY INFERTILTY: Ovulation induction
HIRSUTISUM: Low dose oc pills & Progestil,..
FOR FERTILITY
 Clomiphene citrate: 1st line of treatment for INFERTILITY
 Induction Ovulation
 IN-VITRO FERTILIZATON
 Intra cytoplasmic sperm injection
 OVARIAN DRILLING

15. Conclusion
It is an endocrine disorder with EXCESS ANDROGEN
CONTROAL THIS - Increased LH & ESTROGEN Level
TREATMENT GOALS
EDUCATE –Patient About
LIFE STYLE MODIFICATION : Low calories diets
: Regular walk for 25-30min daily
REGULAR LAB TEST FOR: Hyperlipidemia,Diabetis,…
LONG TERM HEALTH RISK: DIET,EXERCISE,MEDICATION
EFFECTIVE THERAPY FOR: Hirsutism,Infertility,cycle regulation.