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Pcod

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Pcod

  1. 1. Presented by Sriloy Mohanty B.N.Y.S S-VYASA
  2. 2. Contents… Introduction Definition History Epidemiology Pathophysiology Signs and symptoms Causes Risk factors Complications Aims of treatment Treatment modalities Natural treatment
  3. 3. Introduction Polycystic ovarian syndrome is a condition in which a woman’s levels of the sex hormones are out of balance which leads to the growth of ovarian cysts
  4. 4. Definition PCOS is a syndrome of ovarian dysfunction along with cardinal features of LH hypersecretion ,ovarian hyperandrogenism ,hyperinsulinemia,reduced fertility
  5. 5. History  1721  Antonio Vallisneri  “…Young peasant woman, married, moderately plump, infertile, with ovaries larger than normal, like doves’ eggs, lumpy, shiny and whitish”  1935  Dr. Irving Stein and Dr. Michael Leventhal  Coined Stein-Leventhal disorder  1980  Linked to hyperinsulinemia and impaired glucose tolerance  2006  What causes PCOS?
  6. 6. Epidemiology  The most common endocrine disorder in women of reproductive age ~ 2%- 8% of women  About 18% of women had PCOS, and that 70% of them were previously undiagnosed
  7. 7. Signs And Symptoms  Oligomenorrhea or Amenorrhea  Anovulation  Elevated Androgens  Hirsutism  Enlarged ovaries  Sub-fertility  Recurrent miscarriage  Hyperinsulinemic Insulin Resistance  Acanthosis niagricans  Obesity  Chronic pelvic pain  Sleep apnea
  8. 8. Causes  Unknown  Hormonal imbalances  genetics play a role
  9. 9. Genetic Predisposition Aging Pregnancy Drugs Lifestyle Insulin Resistance Hyperinsulinemia Altered Fat Metabolism Altered Steroid Hormone Metabolism PCOS: Acne, hirsutism, hyperandrogenism infertility Android Obesity ↑ Lipid Storage PATHOPHYSIOLOGY
  10. 10. Risk Factors  Genetic link  1st degree relatives of patients with PCOS may be at high risk for diabetes and glucose intolerance  Obesity (50%)  Increased insulin resistance (30%-35%)
  11. 11. Complication Metabolic Syndrome  43% increase MS regardless of body weight Insulin resistance  Type II diabetes ○ 5x increase risk Cardiovascular disease  2x increase risk  High cholesterol  High blood pressure
  12. 12. Cardiovascular risk in PCOD  Endothelium dysfunction (impaired NO vasodilation)  Disorders of coagulation & fibrinolysis  Plasminogen activator inhibitor-1  Plasminogen activator activity  Fibrinogen levels  Activation of coagulation  Hypertension  Dyslipidemia
  13. 13. Pregnancy Complications  Spontaneous Abortions  Increased in high BMI/PCOS patients  Impaired Glucose Tolerance  Gestational Diabetes  Hypertension  Small for Gestational Age
  14. 14. Physical Examination  Vaginal ultrasound  Cysts  2-8 millimeter diameter  Often a “string of pearls”  Enlarged ovary  Thickened endometrium  Lack of menses
  15. 15. Blood Test Diagnosis  ↑ Testosterone  ↑ DHEA  ↑ Androstenedione  ↑ Prolactin  ↓ Progesterone  ↓ SHBG  LH:FSH  3:1 instead of 1:1  Thyroid-Stimulating hormone (TSH)  Fasting insulin level  Triglycerides  Cholesterol
  16. 16. Aim Of Treatments  To reduce the the symptoms  To increases fertility  Reduce weight  Increase insulin resistance  Reduce cholesterol
  17. 17. Oral Contraceptives  Combined-Oral Contraceptive (COC) ○ Decrease Androgen production ○ Break continuous estrogen ○ Decrease risk of endometrial cancer ○ Corrects abnormal bleeding  Progesterone ○ 10-14 days a month ○ Regulates menstrual cycle ○ Prevents endometrial cancer ○ Does not improve androgen levels
  18. 18. Diabetes Medication  Metformin (Glucophage, Glucophage XR) ○ Type II Diabetes Medication ○ Treats insulin resistance ○ Improves ovulation ○ May reduce androgen production – even in non-obese women Does it prevent endometrial cancer? Is it safe for pregnant women?
  19. 19. Hirsutism Medication  Spironolactone (Aldactone) ○ Blocks androgen effects ○ Reduces androgen production ○ Problems  Diuretic  Heartburn  Headache  Fatigue  Prescription topical cream
  20. 20. Laparoscopic ovarian diathermy  Lasers burn holes in enlarged follicles  Stimulates ovulation by reducing LH and androgen hormones
  21. 21. Infertility treatment  Diet  Exercise  Insulin sensitizer  Ovulation induction  Clomiphene/letrozole  Gonadotropins  GnRH-agonist/gonadotropins  Ovarian drilling  Assisted Reproductive Technology (IVF)
  22. 22. Surgery Complications  Scar tissue  Lasts a few months  80% ovulation rate  50% pregnancy rate  Only used if failed previous treatments
  23. 23. Natural Treatment  To reduce weight  Six month weight-loss program for overweight anovulatory women ○ Lost an average of 6.3 kg (13.9 lbs) ○ Decreased fasting insulin and testosterone levels ○ 92% resumed ovulation (12/13) ○ 85% became pregnant (11/13)
  24. 24. Diet  Hypocaloric diets insulin resistance  10-20% protein, ~50% carbohydrates  < 30% total fat, < 10% saturated fat  Cereal fiber  Substitute nonhydrogenated unsaturated fats for saturated and trans-fats  omega-3 fatty acids from fish, fish oil supplements, or plant sources  fruits, vegetables, nuts, and whole grains  refined grain products
  25. 25. Consume more foods  rich in complex  carbohydrates  monounsaturated fat  fiber with a ratio of omega-6 to  omega-3 fatty acids  Phytoestrogens should be included in diet Reduce  Total caloric intake  Saturated fat  Cholesterol
  26. 26.  IAYT is found to be useful for people with diabetes type 2  No mechanism related to insulin resistance

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