Basics of Polycystic ovarian disease , diagnostic criteria, investigations , the harmful effects of plastics component-Bisphenol A has been described for medical professionals.

1. Dr.S.Sethupathy,M.D.,Ph.D.,
Professor and Head,
Department of Biochemistry,
Rajah Muthiah Medical College,
Annamalai University.

2.  It is an endocrine, reproductive and
metabolic disorder.
 4-12 % are affected, common cause for
infertility
Characterized by
 Irregular menstrual cycles
 Hyperandrogenism/ Hirsutism
 Obesity
 Polycystic ovaries
 Insulin resistance

3.  Infertility
 Type2 diabetes (15-20%)
 Hypercholesterolemia
 Hypertension
 CVD
 Thyroid disease
 Endometrial cancer

5.  Follicular phase
 One ovarian follicle matures by FSH
 Maturing follicle releases estrogen which causes
release of LH from pituitary( positive feed back)
 Ovulation ( 14th day) – LH peak initiate ovulation-
egg released from dominant follicle
 Luteal phase
 Ruptured follicle becomes corpus luteum and
secretes estrogen and progesterone
 High levels of them inhibit FSH and LH release-
negative feed back

10.  LH induces theca and granulosa cells to
secrete progesterone
 Theca externa releases proteolytic enzymes
which cause thinning of outer membrane.
 Rapid vascularization and prostaglandins
cause plasma leak into follicle and its
swelling
 Both factors cause rupture of follicle and
release of ovum

11.  FSH stimulate granulosa cells - estradiol
by aromatase during the follicular
phase .
 After ovulation- the granulosa cells
become granulosa lutein cells
 Produce progesterone -to maintain a
potential pregnancy –
 It causes a thick cervical mucus to
inhibit sperm entry into the uterus.


12.  Thecal cells from the stromal layer
surrounding the granulosa cells and oocyte.
 Thecal cells are not capable of producing
estrogen but do produce androgens in
response to LH
 They are converted into estrogen by FSH
induced aromatase in the neighboring
granulosa cells of selected growing follicles.

15.  Oligo-ovulation – cycles longer than 36 days
and less than 8 times a year
 Menstrual dysfunction, anovulation
 Signs of hyperandrogenism.
 Hirsutism
 Infertility
 Obesity
 Diabetes
 Obstructive sleep apnea
 Metabolic syndrome

16.  Guidelines from the NHLBI and AHA, metabolic
syndrome is diagnosed when a patient has at
least 3 of the following 5 conditions:
1) Fasting glucose ≥100 mg/dL (or on drugs)
2) Blood pressure ≥130/85 mm Hg (or on drugs)
3) Triglycerides ≥150 mg/dL (or on drugs)
4) HDL-C <40 mg/dL in men or <50 mg/dL in
women
5) Waist circumference ≥102 cm (40 in) in men or
≥88 cm (35 in) in women;
If Asian American, ≥90 cm (35 in) in men or
80 cm (32 in) in women

18.  Virilizing signs
 Acanthosis nigricans
 Hypertension
 Enlarged ovaries- evaluate for an ovarian
mass
 Exclude - adrenal or ovarian tumors, thyroid
dysfunction, congenital adrenal hyperplasia,
hyperprolactinemia, acromegaly, and Cushing
syndrome.

19.  Severe acne or hirsutism or both
 Frontotemporal balding
 Deepening of the voice
 A decrease in breast size
 Clitorial hypertrophy
 Increased muscle mass
 Amenorrhoea / Oligomenorrhoea

24.  Absent (0): Not detectable on close inspection
 Present (1): Clearly present on close visual
inspection, not visible to the casual observer,
extent not measurable
 Mild (2): Limited to the base of the skull, usually
does not extend to the lateral margins of the
neck
 Moderate (3): Extends to the lateral margins of
the neck but not visible anteriorly
 Severe (4): Visible anteriorly
 Severe (5): Circumferential

27.  Girls whose oligomenorrhea persists 2-3
years past menarche – look for ovarian or
adrenal dysfunction.
 First-line monotherapy- metformin
 or combination therapy with oral
contraceptive agents and antiandrogen
agents.

30.  Plasma glucose –F and PP
 Lipid profile
 Insulin – F - > 12 mIU significant
 Insulin – PP - > 25 mIU significant
 TSH – hypothyroidism
 FSH/LH ratio- normal- FSH > 3-4 LH Reversal
of ratio significant
 Total testosterone > 3.6 ng/ml significant
 USG- volume of one ovary more than 10 cc
with “ string of pearl appearance”

31.  Androstenedione increased in ovarian
pathology
 Very high Prolactin due to pituitary tumour
 17 hydroxy progesterone increased in late
onset CAH
 Dehydroepiandrosterone –SO4 (DHEAS)
elevated in adrenal pathology
 Dihydro testosterone – indicates peripheral
conversion of testosterone

34.  BMI negatively correlates with
estrogen level
 Glyphosate – a broad spectrum
herbicide
 Inhibitor of cyp450 enzymes,
aromatase.
 Affects gut bacteria and increase
the risk for celiac disease,
Autism, Parkinson’s disease ,
cancer, PCOS

35.  Complex carbohydrates and Whole grains-
fiber, B comp vitamins, trace minerals
 Fruits- fibers, antioxidants,
 Legumes- proteins, macronutrients, pinitol
 Pinitol improves insulin resistance.
 Whole foods - whole grains , fruits,
vegetables, meats, fish, seaweeds and
spices.
 75% of the diet should be whole foods.

37.  MUFA-olive and canola oil, avocados, cashew,
peanuts and sesame seeds.
 Omega3 fatty acis – Alpha linoleic acid (ALA)-
flax seeds, canola, walnuts, and chia seeds.
 Eicosa petanoic acid(EPA) and docosa
hexaenioc acid (DHA) reduce risk of heart
disease
 Found in salmon, trout, tuna, sardines,
mackerel and fish oil capsules.
 Omega 6 – sunflower oil, sesame oil ,olive oil

38.  Refined carbohydrates – cause spikes in BG
 Processed foods- poor quality fats, many
artificial flavours which are not good for
health
 Trans fats- margarine (Dalda) -raise LDL and
lower HDL, promote inflammation and
increase the risk for CVD
 Non organically grown foods and meat may
contain glyphosate

39.  Vitamin D
 Chromium
 N-acetyl cysteine
 Inositol
 Fish oil capsules
 Magnesium
 B comp vitamins
 Antioxidants

40.  Exercise
 Insulin sensitizing agents-
metformin
 Fertility treatment- clomiphene
citrate , gonadotropins
 Oral contraceptives
 Ovarian drilling
 Acne treatment
 Herbal treatment- eg: cinnamon
bark, liquorice etc

41.  AMH is secreted by the granulosa
cells of ovarian follicles.
 AMH -protein hormone related
to inhibin and activin
 It is increased in PCOS
 Its level indicates ovarian reserve.

42.  Bisphenol A (BPA) - starting material for the
synthesis of plastics, polycarbonates and epoxy
resins, polysulfones
 BPA-based plastic - clear and tough- made into
consumer goods, such as plastic water bottles,
sports equipment, CDs, and DVDs.
 Epoxy resins containing BPA -used to line water
pipes, as coatings on the inside of many food
and beverage cans
 For making thermal paper- used in sales
receipts.

43.  4 million tonnes of BPA chemical-used for
manufacturing polycarbonate plastic
 One of the highest volume of chemicals
produced worldwide.
 Estrogen-mimicking, hormone-like
properties
 U.S. Food and Drug Administration (FDA)
has ended its authorization of the use of
BPA in baby bottles and infant formula
packaging

44.  Proposed mechanisms for BPA exposure to
increase the risk of obesity
 BPA-induced thyroid dysfunction
 Activation of the PPAR-gamma receptor, and
disruption of neural circuits that regulate feeding
behavior.
 BPA works by imitating the natural hormone 17B-
estradiol.
 BPA alter glucose and lipid metabolism in animal
studies.
 BPA exposure modifies insulin sensitivity and
insulin release without affecting weight

45.  BPA is a thyroid-disrupting
chemical
 Affect pregnant women, neonates
and small children.
 A 2009 review summarized BPA
adverse effects on thyroid
hormone action.

46.  Exposure to BPA in the uterus and
during childhood
 Cause poor behavioral outcomes
 Higher levels of anxiety, depression,
hyperactivity, and aggression in
children.
 Effects on fetal and infant brain
development and behavior.

47.  Lower sperm quality.
 miscarriage is associated with
BPA levels
 Decreased male sexual
function

49.  Microbial degradation
 The fungus Cunninghamella elegans degrade
synthetic phenolic compounds like bisphenol
A.
 Plant degradation
 Portulaca oleracea efficiently removes
bisphenol A

50.  Photodegradation
 Main method of natural
weathering in the environment,
via the Photo Fries rearrangement.
 It occurs at wavelengths less than
300 nm.
 Combustion
 Oxidation of BPA by Ozone

51.  Those who'd dined out the day before
- higher urine levels of phthalates,
versus people who'd had all meals at
home.
 Old-fashioned home-cooked meals
reduce health risks.
 Phthalates are added to plastics to
make them more flexible and difficult
to break.

53.  Table mushroom has anti-aromatase
properties
 Chinese women who consumed greater than
10 grams of fresh mushrooms or greater than
4 grams of dried mushrooms per day had an
approximately 50% lower incidence of breast
cancer.
 Chinese women who consumed mushrooms
and green tea had a 90% lower incidence of
breast cancer.

54. Thank you