Information about PCOS i.e. polycystic ovarian syndrome.
It is not same as the PCOD.
This presentation contain data about causes, treatments, etiology, diagnosis, symptoms and pathophysiology of PCOS
(👑VVIP ISHAAN ) Russian Call Girls Service Navi Mumbai🖕9920874524🖕Independent...
PCOS (polycystic ovarian syndrome)
1.
2. INTRODUCTION
• PCOS was described first in 1935 by Stein & Leventhal.
• It is the most common cause of infertility in women
which is frequently seen in adolescence.
• “PCOS is a syndrome manifested by amenorrhea,
hirsutism and obesity associated with enlarged polycystic
ovaries.”
• It is a heterogenous disorder characterized by excess
androgen production by the ovaries that interferes with
the reproductive, endocrine & metabolic functions.
• Consequences- Increased risk for metabolic syndrome,
type 2 diabetes mellitus, cardiovascular disease &
endometrial carcinoma
3. INCIDENCE
• Most common endocrine disorder affecting 5-10% women of reproductive
age (15-45 years).
• Incidence is increasing fast with change in life style & stress.
• Most frequent (20%) cause of infertility in women.
• Strongly associated with Insulin Resistance that creates risk for Diabetes,
Cardiovascular disorders & Hypertension.
4. ETIOLOGY
• The cause of polycystic ovary syndrome isn't well understood, but
may involve a combination of genetic and environmental factors.
• Symptoms include menstrual irregularity, excess hair growth, acne
and obesity.
• There are four types of PCOS:
• Insulin-resistant PCOS
• Pill-induced PCOS
• Inflammatory PCOS
• Hidden PCOS
5. • Insulin resistance PCOS- most common type.This is caused by smoking,
sugar, pollution and trans fat. In this, high levels of insulin prevent ovulation
and trigger the ovaries to create testosterone
• Pill induced PCOS- second most common type. It gets developed due to the
birth control pills which suppress ovulation.
• Inflammatory PCOS- ovulation is prevented, hormones get imbalanced and
androgens are produced. Inflammation is caused due to stress, toxins of
environment and gluten.
• Hidden PCOS- simpler form, once the cause is addressed then it takes about
three to four months to get resolved. Causes of Hidden PCOS:Thyroid
disease, deficiency of iodine (ovaries need iodine), vegetarian diet ( it makes
you zinc deficient and the ovaries need zinc) and artificial sweeteners.
6. DIAGNOSIS
• There's no test to definitively diagnose PCOS.
• Doctor have to know about all the signs and symptoms the person noticed, period
problems, weight changes, family’s medical history, including whether her mother or sister
has PCOS or problems getting pregnant as PCOS tends to run in families.
• One may diagnose PCOS if patient have at least two of these symptoms:
• Irregular periods.
• Higher levels of androgen (male hormones) shown in blood tests or through symptoms like
acne, male-pattern balding, or extra hair growth on your face, chin, or body.
• Cysts in your ovaries in an ultrasound exam.
7. • Physical Exam- A doctor may check patient’s
blood pressure, BMI, and waist size. She may
also look at her skin to check for extra hair
growth, acne, and discolored skin.
• Pelvic exam:Your doctor will look at and feel
areas of your body including the vagina, cervix,
uterus, fallopian tubes, ovaries, and rectum,
checking for anything unusual.
8. • Pelvic ultrasound (sonogram):The doctor will check for cysts in ovaries and how
thick the endometrium is in the uterus. It may be thicker than normal if periods are
irregular. Ovaries may be 1½ to 3 times larger than normal when one have PCOS.
• enlarged ovaries with multiple small follicles
• Peripheral location of follicles:-string of pearl appearance
• 12 or more follicles measuring 2-9 mm
• Hyperechoic central stroma
• Irregular ovarian outline
9. Blood tests
• FSH- affects ability to get pregnant. its level might be lower than normal, or even
normal, if patient have PCOS.
• LH- encourages ovulation. It could be higher than normal.
• * normal LH/FSH ratio is 1.5:1, but in PCOS it become up to 3:1
• Testosterone- higher in women with PCOS.
• Estrogens- level may be normal or high if patient have PCOS.
• SHBG- may be lower than normal.
• Androstenedione- may be at a higher-than-normal level.
• hCG-This is a hormone test that can check to see if you’re pregnant.
• Anti-Mullerian hormone (AMH): check how well ovaries are working and to help
estimate how far off menopause may be.The levels would be higher with PCOS.
• TSH- to check thyroid function
• Free cortisol & creatinine levels- rule out Cushing syndrome
• 17-hydroxyprogestrone- to rule out congenital adrenal hyperplasia
• Dehydroepiandrosterone sulfate (DHEAS) –marker for adrenal hyperandrogenism;
elevated in PCOS
10. PATHOPHYSIOLOGY
• Female with PCOS have HA-IR-AN syndrome.
• hyperandrogenism (HA)
• insulin resistance (IR)
• acanthosis nigricans (AN).
15. LONGTERM COMPLICATIONS
• Metabolic syndrome
• Acanthosis nigricans
• Type 2 Diabetes Mellitus- due to insulin resistance
and hyperglycemia.
• Heart diseases- due to disbalanced lipid profiles.
• Hypertension
• Dyslipidemia
• Endometrial cancer- due to increased estrogen and
decreased progesterone.
• Breast cancer- due to increased estrogen.
• Recurrent pregnancy loss- due to decreased
progesterone.
• Ovarian failure after surgery- ovarian insufficiency
16. Metabolic Syndrome
• Results from the interaction of insulin
resistance with obesity and age
• Co-occurrence of metabolic risk
factors for type 2 diabetes &
cardiovascular disease, including
abdominal obesity, hyperglycemia,
elevated triglycerides, low HDL
cholesterol, and hypertension.
• Approximately 25 %of adolescents
with PCOS have metabolic syndrome
17. • Acanthosis nigricans skin patches occur
when epidermal skin cells begin to
reproduce rapidly.This abnormal skin cell
growth is most commonly triggered by
high levels of insulin in the blood. In rare
cases, the increase in skin cells may be
caused by medications, cancer, or other
medical conditions
23. • no fertility desired
Monophasic antiandrogenic OCP
– Orthocyclen (norgestimate)
– Desogen or Orthocept (desogestrel)
–Yasmin
• Fertility issues
– Metformin
–Thiazolidinediones
• Insulin resistance
• – Metformin
• • Function
• – Lowers hepatic glucose production by reducing
gluconeogenesis
• – Increases peripheral glucose uptake by skeletal
muscle and adipose tissue
• – Reduces intestinal glucose absorption
• • Outcomes
• – Estimated 31% reduction in development of type II
DM over mean period 3 years
• –Taken during pregnancy, reduction in gestational
diabetes and major fetal complications
27. Laparoscopic Ovarian Drilling (LOD)
• It is second line therapy in case of CC (clomiphene
citrate) failure or resistance or who have
completed six ovulatory cycles without
pregnancy.
• Also known as ovarian diathermy.
• It is done following the rule of four- using 40-
watt current for 4 sec and making four punctures
on each ovary.
