PCOS -INDIAN STORY (IFS Good clinical practice recommendations) Dr. Sharda Jain , Dr. jyoti Agarwal Dr. Meenakshi Sharma

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PCOS is very common in India, affecting up to 2 in 5 adolescents and 1 in 5 adult women. Factors contributing to its high prevalence in India include urbanization, earlier menarche, genetic predisposition, and early malnutrition. Common symptoms include hirsutism in 44% of cases, acne in 20%, and glucose intolerance in 16.3% of women. PCOS is associated with increased risks of depression, diabetes, cardiovascular disease, non-alcoholic steatohepatitis, and obstructive sleep apnea. Diagnosis requires one biochemical and one clinical criterion. Lifestyle modifications like diet and exercise are the first line treatment, while bariatric surgery may be recommended for severe obesity.

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PCOS -INDIAN STORY
(IFS Good clinical practice recommendations)
INCIDENCE 20-40% PCOS...., as high as 2 in 5 adolescents and 1 in 5 adult women in India
suffer from PCOS
REASONS OF HIGH INCIDENCE IN INDIA
 Urbanisation leading to stress and less physical activity.
 Earlier age of menarche, increased insulin resistance and obesity in India due to bad
eating habits with genetic predisposition of Indian women for PCOS
 Early malnutrition also lead to PCOS
 Autosomal dominant genes Follistatin gene implicated in PCOD
PREVALENCE OF HIRSUTISM -44%
 Acne-20%
 Glucose intolerance 16.3%
 Obesity 37.5-62.5% in Indian women
ASSOCIATED COMORBIDITIES
 Depression-54%
 DM- 5-10 fold increased risk
 CVD Relative risk 1.53%
 NASH
 OSA
DIAGNOSIS
Indian women with ONE BIOCHEMICAL and One Clinical Criteria is diagnosed with PCOS
INVESTIGATION MUST TO DIAGNOSE PCOS
 Serum Testosterone
 OGTT
 Serum 17 OHP
 TSH
 Serum prolactin levels must be done

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LIFESTYLE MODIFICATION : FIRST LINE MANAGEMENT OF PCOS
*Low calorie diet *150 minutes / week of exercise should be recommended
* Routine screen for wt and BMI should be done
BARIATRIC SURGERY RECOMMENDED FOR BMI MORE THAN 50 KG/M2 AS FIRST
LINE AND MORE THAN 35 KG/M2 SECOND LINE THERAPY
Progesterone withdrawal bleeding recommended as first line therapy till menopause
Metformin and CPA not recommended in menstrual irregularity
HYPERANDROGENISM MANAGEMENT
 COC with antiandrogen progestin - CPA, drospirenone and desogestrel should
be given in PCOS
 CPA more beneficial in Indian setting
 Spironolactone and finasteride recommended as second line therapy in PCOS
hyperandrogenism but must be stopped 6 months prior to conception
 COC should be continued for long term but pause treatment for 3 months after one year in
patients having high risk of VTE
INFERTILITY
 CC is first line ovulation induction
 Second line gonadotropin induction or laparoscopic ovarian drilling
 IVF is third line for ovulation induction
METABOLIC SYNDROME COMPRISES OF
* Central Obesity *Diabetes * HTN * Dyslipidemia
METABOLIC SYNDROME IS DIAGNOSED IF PATIENT HAS 3 of 5 CRITERIA
 Fasting glucose more than 100
 BP more than 130/85
 TG > 150mg/dl
 HDL -C < 40 mg/dl
 waist circumference >35 inch or 88 cm
ENDOMETRIAL CANCER : Increased risk in PCOS
Regular withdrawal with progestin 3-4 times a year is suggested
Screen with TVS only in menstrual irregularities
DR. SHARDA JAIN DR. JYOTI AGARWAL DR. MEENAKSHI SHARMA

This document discusses the diagnosis and management of polycystic ovarian syndrome (PCOS) in adolescents. It provides information on the prevalence of PCOS in adolescents in India being near 18-20% according to some studies. The diagnostic criteria for PCOS have evolved over time from the NIH criteria in 1990 to the Rotterdam criteria in 2003 to current standards. Key diagnostic tests and evaluations discussed include assessing symptoms, signs of hyperandrogenism, menstrual history, ultrasound of the ovaries, and lab tests like testosterone, LH, and glucose levels. Management of PCOS focuses on treatment of symptoms and reducing risks of issues like obesity, insulin resistance, infertility and other long term health consequences.

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