Polycystic Ovarian Disease
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Transcript of Polycystic Ovarian Disease
POLYCYSTIC OVARIAN DISEASE: THE RISING TREND
Dr Nupur GuptaConsultant & Unit Head, Dept of Obstetrics & Gynecology
WHAT IS PCOS?
A health problem that can affect a woman’s • Menstrual cycle,• Ability to have children• Hormones• Heart• Blood Vessels &• Appearance
INCIDENCE
• Affects 5 to 10% of females
• 20 to 30% have ultrasound appearance
Most common hormonal
disorder in women of
reproductive age
CAUSE: HORMONAL IMBALANCE
• Not completely understood
• Family History (genetic – 50%, 40% if sister,
10% if mother)
• Hyperinsulinaemia
• The ovaries make more androgens than
normal
SYMPTOMS
Vary from woman to woman
• Irregular menstrual cycles (amenorrhoea
25%, oligomenorrhoea 85%,
hypomenorrhoea)
• Difficulty in conception 50%
• Weight gain 40%
• Unwanted hair growth
• Acne
DIAGNOSIS
• CLINICAL
• ULTRASOUND – multiple tiny ovarian cysts
(STRING OF PEARLS)
• BIOCHEMICAL (blood tests) – hormones (LH
FSH, Testosterone, DHEAS, Glucose tolerance
test)
• ASSOCIATED TESTS - thyroid, prolactin, lipid
profile
PCOD & INSULIN RESISTANCE
• High insulin levels – high androgens
• Hyperinsulinemia
• Insulin resistance
PCOD & HYPERANDROGENISM
SERUM TESTOSTERONE & DHEAS
• Acne, oily skin, seborrhoea
• Hirsutism – upper lip, side bran, chin, chest,
abdomen, back & inner thigh
• Thinning of hair, Male pattern baldness
• Irregular or absent ovulation
• Dark patches of skin (neck, armpit & groin)
PCOD & WEIGHT GAIN
• Increase in abdominal fat as in males
• Apple figure (waist hip ratio)
• Rise in BMI
LONGTERM SIDE EFFECTS
• Metabolic Syndrome (risk of type 2
diabetes, hypertension, hyperlipidaemia,
heart disease)
• Increased risk of sleep apnoea
• Increased risk of endometrial hyperplasia &
uterine cancer
• Increased risk of depression
MANAGEMENT
• Lifestyle modification
• Drug therapy – hormones, insulin sensitisers
• Symptomatic treatment for acne, hair
growth, menstrual dysfunction
• Surgical management
COUNSELING IN PCOD
• Regarding endocrine problems
• Metabolic problems
• Fertility
• Risk of multiple pregnancy & its
complications
• Long term sequealae
TREATMENT GOALS
Depends on age & need
• Adolescent
• Newly married, not planning conception
• Married planning conception
• Secondary infertility
• Family complete
• Perimenopausal & Menopausal
PCOS DIETARY GOALS
Consume More Foods
• Rich in
carbohydrates (50%)
• MUFA
• Fiber
• Omega 3
• Low Glycemic Index
Reduce
• Total Caloric intake
• Saturated Fats
(<10%)
• Cholesterol
WEIGHT LOSS & MENSTRUAL CYCLES
If 7% weight loss & 30 to 60 min of moderate physical activity
• Spontaneous menses
Free androgen Free insulin Free testosterone
SHBG
WEIGHT LOSS & FERTILITY
• In overweight anovulatory women
• Weight loss 6 Kg
• Resumption of ovulation 92%
• Pregnancy rate 85%
• Decrease in insulin & testosterone levels
Early diagnosis and treatment helps
prevent long-term complications, such
as infertility, metabolic syndrome, obesity,
diabetes & heart disease.
IS THERE A CURE FOR PCOS? CAN IT BE PREVENTED?