2. Introduction
PCOS was described first in 1935 by Stein &
Leventhal.
(PCOS) is a set of symptoms due to elevated
androgens in females.
“PCOS is a syndrome manifested by
amenorrhea, hirsutism and obesity associated
with enlarged polycystic ovaries.”
It is the most common cause of infertility in
women which is frequently seen in adolescence.
3. Etiology
• The cause of PCOS isn't well understood, but may
involve a combination of genetic and environmental
factors.
• Diagnosis is done on the basis of presence of any
two criterias out of three.
1. Anovulation (80%) (ovaries do not release an oocyte during a
menstrual cycle)
2. Hyperandrogenism
3. Polycystic ovaries (20-30%)
DDx: these etologies are to be excluded. (thyroid dysfunction,
hyperprolactentinaemia, cushing syndrome, CAH
(congenital adrenal hyperplasia)
4. • Women with oligo ovulatory infertility
• Obesity and/or insulin resistance
• Type 1 , type 2 or gestational diabetes mellitus
• A history of premature adrenarche
• First-degree relatives with PCOS, it may be a
manifestation of a complex
genetic disorder.
• Women using antiepileptic drugs.
High risk groups
5. Clinical features
• Increasing obesity(abdominal-50%)
• Menstrual abnormalities (70%): oligomenorrhea,
amenorrhea, infertility & DUB (Dysfunctional uterine
bleeding).
• Hirsutism (presence of body hair pattern like male & acnes
present in about 70% (most important features)
• Virilism (increasing androgen cause development of male
sexual characters), it's very rare.
• Hair-An syndrome : hyperandrogenism, insulin resistance
and acanthosis nigricans, internal examination reveals
bilateral enlarged cystic ovaries. Mayn't be revealed due to
obesity
6. Investigation
• Transvaginal Sonography is useful specially in obese
patients. ovaries are enlarged in volume (>10cm³),
increased number(>12) of peripherally arranged cysts (2-
9) are seen.
• Serum values
LH level elevated and/or the ratio LH:FSH is >2:1
Raised estradiol & estrone : estronrle is markedly elevated.
SHBG level is reduced.
Raised serum testosterone (>150ng/dL)
• Insulin resistant (IR): Raised fasting insulin levels
>25μIU/mL
8. Sequelae (symptoms) of PCOS
Short term
• Obesity
• Menstrual disorders
• Anovulation, infertility
• Miscarriage
• Abnormal lipid profile
• Androgen excess
Acne
Hirsutism
Alopecia (Hair loss)
• Insulin resistance
Acanthosis nigricans
Glucose intolerance
• Long term
• Diabetes mellitus
• Endometrial cancer
• Hypertension
• Cardiovascular disease
• Atherosclerosis
• Obstruction sleep
apnea
• Dyslipidemia
(Dyslipidemia is an
abnormal amount of
lipids )
9. Management
The primary treatments for PCOS include: lifestyle changes
and medications to correct biochemical abnormalities.
Goals of treatment may be considered under four
categories:
• Lowering of insulin resistance levels
• Restoration of fertility
• Treatment of hirsutism or acne
• Restoration of regular menstruation, and prevention of
endometrial hyperplasia and endometrial cancer.
11. Management
*endometrial hyperplasia
Combined oral contraceptives to prevent hyperplasia &
abnormal bleeding.
3. Patient desires pregnancy
• Improve metabolic syndrome to prevent chronic
anovulation, which is most common cause of infertility.
• Ovulation induction is achieved by clomiphene citrate
following correction of other biochemical abnormalities.
• Insulin sensitizers: women with PCOS & hyperinsulinemia
with BMI>25, ovulate satisfactorily when clomiphene is
combined metformin.
12. Management
4. Surgery: laproscopic ovarian drilling (LOD) is done for
cases found resistant to medical therapy.
It has replaced with the conventional wedge resection of
the ovaries.
Bariatric surgery may be indicated in some PCOS women
who're morbidly obese.
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