PCOS is quite common hormonal disorder seen in all age groups. It is almost a century old disease. It affects all systems of the body.

1. Dr.Suresh Babu Chaduvula
Professor
NRIIMS, Vizag

2.  Heterogeneous condition
 Affects entire body and affects general
health
 Most common hormonal abnormality.
 Chronic disease and affects all age groups.
 Previously it was a disease and presently it is
a syndrome [ symptom complex ].

3.  Stein and Levinthal in 1935 USA.
 Wedge resection for amenorrhea
 Hirsutism and amenorrhea association

4. Rotterdam Criteria:
1. Oligomenorrhea and / or Anovulation
2. Hyperandrogenism and / or
Hyperandrogenemia
3. Polycystic ovaries [ ultrasonography ]
Two out of three criteria is must.
Drawback: Insulin resistance is not included

5.  Overall – 10%
 Asian women – 30%

6.  Unknown
 Multifactorial
 Genetic – either maternal or paternal or both
 Mode of inheritance – Dominant variety and
single gene affected
 Environmental – obesity and stress
 Interaction between genes and environment

7.  It is still an enigma
 Principal feature – Hyperinsulinemia and Insulin
resistance [ IR ]
 Pulsatile LH secretion and LH peak does not
occur
 LH is chronically elevated
 LH stimulates theca walls and produce Androgens
 Androgens converted to estrone [ E 1] in adipose
tissue – Hyperestronism
 Estrone has negative feedback on FSH.
 Androgens will stop maturing follicles, will not
become atretic but undergo cystic degeneration.

8.  Decreased SHBG by the liver
 Hyper-androgenism and Anovulation vicious
cycles will continue

9.  Affects Adolescents, reproductive age group and
post menopausal women
 Adolescents – Hirsutism, Menstrual irregularities
 Reproductive age group – Infertility
 Post menopausal women – Diabetes,
cerebrovascular disease and endometrial cancer.
 Menstrual irregularities:
Oligomenorrhea – less than 6 menses per year.
Irregular bleeding

10.  Infertility – Anovulation
 Obesity – 30-70% - because of Hyper-insulinemia
 Hirsutism – SHBG decreased and increased
androgens
 Skin Manifestations – Acne, seborrhea, balding,
acanthosis nigricans, Hidradenitis suppurativa
 Depression – infertility and mood swings
 Sleep apnea – Obstructive Sleep Apnea Syndrome
[OSAS]
 “HA-IR-AN” Syndrome – Hyper androgenism,
Insulin resistance and Acanthosis Nigricans

11.  Cushing’s syndrome
 Ovarian or Adrenal androgen producing
tumor
 Hypothyroidism
 Hyper-prolactinemia

13.  Ultrasonography – Transvaginal
“Necklace or String of Pearls” appearance
- cysts are located in periphery of ovary in
cortex –
Criteria –
1. 10 or more follicles
2. Each follicle 2-10 mm
3. Ovarian volume of > 10cm cubed

15.  Elevated LH
 Elevated LH: FSH ratio
 Decreased SHBG
 Elevated Androgens
 Elevated Prolactin
 Abnormal GTT
 AMH - Higher levels – marker for ovarian
insufficiency
 Dyslipidemia
 HOMA index > 5

16.  HOMA [ homeostatic model assessment ]
index of Insulin resistance
 F.Glucose X F. Insulin/405 - > 5 - IR and < 3 –
normal
 Androgens:
1. S. Testosterone levels
2. Androstenidione
3. Dehydroepiandrosterone sulfate
4. Free Androgen index-Total testosterone/
SHBG X 100
5. 17-OH progesterone

17.  Laparoscopy
 Thyroid function tests
 Prolactin levels
 24 hour urinary free cortisol

18.  No Prophylactic treatment or cure for PCOS
 Only symptomatic treatment
 Depends on age and clinical presentation
 1. Life style changes – Exercise , yoga,
meditation – for possible weight reduction
 Drugs:
1. Cyclical progestin
2. Combined OCPs
3. Ovulation induction – Clomiphene citrate /
Inj.
GNRH, Corifollitropin

19.  4. Metformin – insulin sensitizer
 5. Troglitazone or Rezulin
 Ovarian drilling by Laparoscopy
 Corticosteroids – only to suppress adrenal
androgens
 Anti-androgens: [ Diane ]
 1. Spiranolactone
 2. Flutamide
 3. Cyproterone acetate
 4. Finasteride

20.  Non-hormonal treatment
 1. Myo-inositol – Improves insulin receptor
activity and ovulation
 2. Vitamin D
 N- acetylcysteine

21.  Natural remedies:
 1. Flax seeds
 2. Cinnamon
 3. Green tea
 4. Spearmint tea
 5. Fish oil

22.  Type II Diabetes mellitus
 Hypertension
 Dyslipidemia
 Cerebrovascular accidents
 Non alcoholic fatty liver disease
 Autoimmune thyroiditis
 Depression/ Anxiety
 Endometrial cancer

23.  Self limiting disorder
 As age advances PCOS will resolve and
ovulation will occur
We learned a lot still miles
to go.

24.  American Journal of Obstetrics & Gynecology
29: 181, 1935
 Current concepts, pathogenesis and clinical
care of PCOS
 Lancet 2: 1375, 1985

25. Thank you all