Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder common among women of reproductive age. It is characterized by oligo-ovulation or anovulation, clinical or biochemical signs of hyperandrogenism, and polycystic ovaries. Diagnosis involves assessing these criteria through medical history, physical exam, and lab tests or imaging. Treatment options depend on a patient's symptoms and goals, and may include lifestyle changes, medication to control hormones or insulin resistance, and occasionally surgery. Left untreated, PCOS can increase long-term health risks like diabetes, endometrial cancer, and cardiovascular diseases.

1. POLYCYSTIC OVARIAN
SYNDROME
1
By
PRANAV KOHLI

2. OUTLINE
2
• Differential diagnosis
• Investigations
• Treatment
• Complications
• Conclusion

3. DIAGNOSTIC CRITERIA
3
• Controversies on what constitute PCOS 3
• It is a diagnosis of exclusion1,2,3
• NIH, 1990: includes both of
• Oligo-ovulation
• Hyperandrogenism and/or
hyperandrogenaemia (with exclusion of
related disorders)

4. DIAGNOSTIC CRITERIA
4
• ESHRE/ASRM (Rotterdam criteria)
2003: to include 2 out of the following 3
• Oligo- or anovulation
• Clinical and/or biochemical
signs of hyperandrogenism
• Polycystic ovaries
• RCOG recommends the use of Rotterdam
criteria 1

5. DIAGNOSTIC CRITERIA
5
Other available criteria:
• AE-PCOS, 2009
• Hyperandrogenism: hirsutism
and/or hyperandrogenaemia, and
• Ovarian dysfunction: oligo-anovulation
and/or polycystic ovaries, and
• Exclusion of the other androgen-excess or
related disorders

6. DIFFERENTIAL DIAGNOSIS
6
• Hyperthyroidism
• Hypothyroidism
• Hyperprolactinaemia
• Hypogonadotropic hypogonadism
• Primary ovarian failure
• Acromegaly
• Late onset CAH
• Androgen secreting ovarian tumour
• Androgen secreting adrenal tumour
• Cushing syndrome
• Exogenous androgen use

7. INVESTIGATIONS
7
Biochemical tests
• FSH, LH
• Testosterone – total and free, FAI
• Thyroid function tests
• Serum prolactin
• Blood sugar test (2hr GTT)
• Fasting insulin level
• Fasting lipid profile
• DHEAS
• 17α hydroxyprogesterone
• Cortisol

8. INVESTIGATIONS
Radiological tests
• Ultrasound scan
• CT scan
• MRI scan
Histology
• Endometrial biopsy
8

9. • No universal treatment for PCOS is
available
• Treatment is individualized, based on:
• Woman’s goal
• Severity of symptoms
• Modalities include:
• Conservative
• Medical
• Surgical
9
TREATMENT

10. TREATMENT
10
Conservative
• Fairly regular cycle intervals (8 to 12
menses per year)
• Mild hyperandrogenism
• Encourage weight loss
• Diet modification
• Exercise
• Periodic screening for dyslipidemia and
diabetes mellitus

11. TREATMENT
11
Medical management aims to
• Lower insulin levels
• Restore regular menstruation
• Restore fertility
• Treat hirsutism or acne,
• Prevent endometrial hyperplasia and
endometrial cancer.

12. MEDICAL TREATMENT
Restoration of ovulation/menstruation
• Combined Oral Contraceptive Pills
• Suppress gonadotropin release
• Reduce androgen levels
• Induce regular menstrual cycles
• Cyclic progestogens
• When COCP is contraindicated (e.g. MPA)
• Intrauterine progestogen device (IUS or
implants) 2
• Insulin sensitizing agents 2

13. MEDICAL TREATMENT
13
Insulin resistance / hyperinsulinaemia
• Metformin (NICE, 2004) 2
• improves peripheral insulin sensitivity by
reducing hepatic glucose production
• increases target tissue sensitivity to insulin
• decreases androgen levels
• helps spontaneous ovulation
• Thiazolidinedione 3
• improves entry of glucose into muscle and fat
• suppresses hepatic gluconeogenesis.

14. MEDICAL TREATMENT
14
Treatment of infertility
• Clomiphene citrate
• Tamoxifen
• Clomiphene+Metformin
• Gonadotropin alone or with hCG
• Assisted Reproductive Technology

15. MEDICAL TREATMENT
15
Treatment of hirsutism
• COCP
• Lowers androgen level
• Oestrogen component increases SHBG
• Eflornithine hydrochloride
• GnRH agonists
• Antiandrogens (e.g. spironolactone,
cyprotene acetate, flutamide)
• 5α reductase inhibitor (e.g. finasteride)
• Hair removal – depilation, epilation

16. MEDICAL TREATMENT
16
Treatment of acne
• COCP
• Topical Retinoids
• Topical Benzoyl Peroxide
• Topical and Systemic Antibiotics
• Isotretinoin

17. MEDICAL TREATMENT
17
Alternative medicine 2
• Acupuncture
• Helps menstrual regulation
• Decreases body weight
• Reduces headache
• Improves mood
• Myo-inositol
• Promotes proper insulin
utilization
• Balances ovarian hormone
functions
• Regularises menstrual cycle
• Improves fertility

18. SURGICAL TREATMENT
• Ovarian wedge resection (rarely done)
• Oophorectomy (rarely done)
• When fertility is not desired and symptoms
are severe
• Laparoscopic ovarian drilling (laser,
electrocautery, multiple biopsy)
• For clomiphene resistants
• Mechanism unclear
• May be due to destruction of androgen
producing stroma 3

19. COMPLICATIONS
3
1
Short term Long term
Obesity Diabetes mellitus
Infertility Endometrial cancer
Irregular menses Hypertension
Abnormal lipid levels Cardiovascular
diseases
Hirsutism Depression
Acne Sleep apnoea
Glucose intolerance Reduces health-
related quality of life
Acanthosis nigricans

20. SUMMARY
20
• PCOS is a clinical disorder associated
with hormonal and menstrual
abnormalities
• It may be associated with short and long
term complications
• Diagnosis involves clinical, laboratory
and radiological methods
• Treatment depends on the need of the
patient and severity of symptoms
• Treatment can be conservative, medical
or surgical

21. THANK YOU
21