Polycystic Ovary Syndrome
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Transcript of Polycystic Ovary Syndrome
Polycystic Ovary Syndrome
Krishna B. Singh, MDDepartment of Obstetrics & GynecologyLSU Health Sciences CenterShreveport, LA
PCOS: Learning Objectives
After viewing this slide show, you’ll be able to understand that...
-PCOS is a common endocrine disorder-Multifactorial, heterogeneous condition-Clinical manifestations affect menses,
fertility-Multiple hormonal, biochemical
changes-Long-term implications are important
PCO Syndrome: Topics
Historical review Incidence Clinical features Diagnosis Management Summary
PCOS: Literature Review
Sclerocystic ovaries were described by Chereau (1844); Pozzi (1894); Waldo (1895)
Stein/Leventhal first described seven cases of infertility associated with enlarged polycystic ovaries (1935)
The NIH Consensus Conference (1990) The Rotterdam PCOS Consensus Group (2003)
Incidence: PCO Syndrome
The incidence varies: 5-10% (~5% USA) About 25% normal women may have
PCO by ultrasound criteria (BMJ 1986) Ultrasound findings don’t correlate with
serum hormone levels
Features of PCO Syndrome
Symptoms present since puberty: Cyclic menses with luteal-phase progesterone deficiency; hirsutism; hyperandrogenemia; infertility; chronic anovulation/miscarriages
Irregular menses in 25-75% women Obesity (60%); also non-obese women Hirsutism and/or acne (virilization rare)
Polycystic Ovarian Disease
PCO disease can be seen in women with pituitary neoplasms, hypo- or hyperthyroidism, diabetes, adrenal and pelvic neoplasms
Rule out PCOD to diagnose PCO syndrome Long-term care is important. Studies have
shown increased incidence of hypertension, hyperlipidemia and diabetes. Risk for CVD increased
PCO Syndrome: Facts/correlates
Genetic factors: autosomal or X-linked Positive correlations of androgen and
insulin levels in some studies Ultrasound findings don’t correlate with
serum hormone levels
Theories of PCO Syndrome PCO syndrome is a multifactorial disorder Theories are based on data in selected women Brain and limbic system control the
hypothalamus-pituitary-ovarian axis needed for reproductive cycle initiation and maintenance
Feedback CNS abnormality results in PCOS
CNS theories of PCO Beta-endorphin theory: Higher plasma levels
are found in women with PCO syndrome Progesterone deficiency/estrogen excess is
the key component Hyperandrogenism also important in PCO
women Hyperprolactinemia may cause breast
symptoms, diminish libido, and alter moods in some women
More PCO Theories... Rat PCO model: Persistent-estrus syndrome
Constant-light exposure; androgenized rat model; hypothalamic lesions
Other methods (DHEAS model) Monkey model: testosterone injections Human model: transvestites given
androgens
Diagnosis of PCO Syndrome
History and physical examination important; selected laboratory and hormonal tests during several visits are needed for confirmation
Both structured and descriptive notes are evaluated by the physician
Follow-up visits arranged @ regular intervals
PCOS: Differential Diagnosis Laboratory tests for confirmation:
LH/FSH, T Baseline values: Chem-22 @ morning Baseline serum hormones @ morning Pelvic ultrasound in some cases required Consider PCOD versus PCO syndrome
PCOS: Key to Diagnosis Rule out conditions which may require
referral; focus on the presenting signs and symptoms
Beware of misdiagnosis “on the fly” Beware of differential diagnosis History and physical exam; selected tests Know when to refer patients and where
PCOS: Management Options
Principal components: Confirm diagnosis and identify category; identify and manage concurrent illness; identify and manage patient needs
There are numerous options for successful PCO management
PCOS: Treatment Options General measures: diet, exercise, relaxation
for stress management Contraception: OCP; DMPA Hormones/drugs: Provera; Parlodel;
Clomiphene; hMG/hCG; IVF in selected women
Newer drugs for treatment of obesity, hyperinsulinemia, hyperandogenemia and hirsutism
PCO Syndrome and Infertility
About 60% PCO patients will have ovulatory cycles and pregnancy on clomiphene alone
About 50% PCO patients will respond to the combined clomiphene and dexamethasone within six months of treatment
PCO Syndrome: Summary
PCO syndrome remains an enigma despite many scientific studies done during the last three decades
Theories of PCO abound; terminology used may be confusing and definitions are not standardized
There are many treatment options
What This Means... Polycystic ovary syndrome is a common
disorder among reproductive age group of women; these women generally have irregular menstrual cycles
PCO has many facets of clinical presentation PCO can be successfully managed and treated
by conventional means