IN THIS PRESENTATION I

1. Presented by
Sriloy Mohanty
B.N.Y.S
S-VYASA

2. Contents…
Introduction
Definition
History
Epidemiology
Pathophysiology
Signs and symptoms
Causes
Risk factors
Complications
Aims of treatment
Treatment modalities
Natural treatment

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. Definition
PCOS is a syndrome of ovarian dysfunction
along with cardinal features of LH
hypersecretion ,ovarian hyperandrogenism
,hyperinsulinemia,reduced fertility

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. 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. 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. Causes
 Unknown
 Hormonal imbalances
 genetics play a role

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. 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. 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. 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. Pregnancy Complications
 Spontaneous Abortions
 Increased in high BMI/PCOS patients
 Impaired Glucose Tolerance
 Gestational Diabetes
 Hypertension
 Small for Gestational Age

14. Physical Examination
 Vaginal ultrasound
 Cysts
 2-8 millimeter diameter
 Often a “string of pearls”
 Enlarged ovary
 Thickened endometrium
 Lack of menses

16. 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

17. Aim Of Treatments
 To reduce the the symptoms
 To increases fertility
 Reduce weight
 Increase insulin resistance
 Reduce cholesterol

18. 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

19. 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?

20. Hirsutism Medication
 Spironolactone (Aldactone)
○ Blocks androgen effects
○ Reduces androgen production
○ Problems
 Diuretic
 Heartburn
 Headache
 Fatigue
 Prescription topical cream

21. Laparoscopic ovarian diathermy
 Lasers burn holes
in enlarged follicles
 Stimulates
ovulation by
reducing LH and
androgen
hormones

22. Infertility treatment
 Diet
 Exercise
 Insulin sensitizer
 Ovulation induction
 Clomiphene/letrozole
 Gonadotropins
 GnRH-agonist/gonadotropins
 Ovarian drilling
 Assisted Reproductive Technology (IVF)

23. Surgery Complications
 Scar tissue
 Lasts a few months
 80% ovulation rate
 50% pregnancy rate
 Only used if failed
previous treatments

24. 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)

25. 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

26. 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

27.  IAYT is found to be useful for people
with diabetes type 2
 No mechanism related to insulin resistance