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MANAGEMENT OFHYPERANDROGENISM
ASSOCIATED WITHPOLYCYSTIC OVARY
SYNDROME
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HYPERANDROGENISM
Clinical manifestations: Hirsutism Acne
alopecia
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TREATMENT OF HIRSUTISM
Use of local cosmetic measures in conjunction withpharmacologic treatment will achieve a quick andoptimum response
Medical treatment Aims to reduce androgen levels Lower androgen production Augment androgen binding to specific plasma proteins Block androgen action at the level of the target tissue.
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ORAL CONTRACEPTIVES Estrogen component:
suppresses LH and ovarian androgen production Enhances hepatic production of SHBG, thus reducing free and
unbound fraction of plasma testosterone Drospirenone + ethinyl estradiol
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ANTI-ANDROGENS Cyprotenone acetate + ethinyl estradiol
Inhibits binding of testosterone to the androgen recetor
Spironolactone, flutamide, finasteride
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TREATMENT OF ACNE
RETINOIDS Elimination of microcomedones by preventing the
inflammatory stages Topical retinoid + antimicrobial
Target abnormal follicle keratinization P. acnes proliferation Inflammation Increased sebum production
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ORAL CONTRACEPTIVES Increase hepatic synthesis of SHBG, decreases free serum
testosterone Inhibit FSH and LH production, decreases ovarian androgen
synthesis OCP + dropirenone
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ANTI-ANDROGENS Cyprotenone acetate + ethinyl estradiol Spironolactone
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TREATMENT OF ALOPECIA
TOPICAL MINOXIDIL Efficacy can be assessed 6-12months of treatment
ANTIANDROGENS Not FDA approved
HAIR SURGERY
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MANAGEMENT OF
INFERTILITY ASSOCIATEDWITH POLYCYSTIC OVARYSYNDROME
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LIFESTYLE MODIFICATIONS
Obesity adversely affects reproduction and isassociated with anovulation and pregnancy loss
Obesity adversely affects reproduction and is
associated with late pregnancy complications Obesity is associated with diminished response to
clomiphene citrate treatment or laparoscopicovarian drilling
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Obesity is associated with diminished response togonadotropin therapy
BMI 20-25kg/m2 Weight loss Diet and exercise
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CLOMIPHENE CITRATE
Induction of ovulation in most anovulatory womenwith PCOS
Patient selection: body weight/body mass index,
female, age and the presence of other infertilityfactors Ovulation rate: 75-80% Conception rate: 22% per cycle Limited to the minimum effective dose and to no
more than 6 ovulatory
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INSULIN-SENSITIZING AGENTS
Less effective than CC in inducing ovulation Metformin + CC provides more benefit than using CC alone
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Gonadotropins Laparoscopic ovarian drilling 2nd line intervention
Starting dose: 37.5-75IU/day Human menopausal gonadotropins Urinary FSH Recombinant FSH
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Strict cycle cancellation should be agreed uponwith the patient before ovulation induction therapyto avoid potential higher order multiple
pregnancies and ovarian stimulation syndrome
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Laparoscopic Ovarian Drilling No risk of hyperstimulation syndrome or higher order multiple
pregnancy Indications:
Cc resistance develops Those who require gonadotopin treatment but who cannot be
monitored PCOS women who require laparoscopic assesment
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ASSISTED REPRODUCTIONTECHNIQUES
Intrauterine insemination Indications:
Women with PCOS and an associated male factor Women with PCOS who failed to conceive after maximum of 6
successful induction of ovulation
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In-Vitro Fertlilization Indications:
Tubal damage Endometriosis Male factor infertility
GnRH agonist + GnRH antagonist redces the risk of OHSS Metformin prior to or during IVF decreases the risk of OHSS
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