Polycystic Ovarian Syndrome (PCOS)

Table of Contents

• PCOS Polycystic Ovary Syndrome
  • Polycystic ovarian syndrome
  • Aetiology
    • Clinical features:
  • PCOS SYMPTOMS
    • POLYCYSTIC OVARY SYNDROMS (PCOS)
  • Diagnosis
  • Management
  • Hirsutism
    • THANK YOU

PCOS Polycystic Ovary Syndrome

By dr Mona Ahmed
assisted professor
Elmareefa university
SMSB

Polycystic ovarian syndrome

PCOS is a syndrome of :

• ovarian dysfunction
• with features of hyperandrogenism.
• and polycystic ovary morphology .

Clinical manifestations

• Menstrual irregularities.
• Signs of androgen excess (e.g. hirsutism).
• Obesity.
• Elevated serum LH levels.
• Insulin resistance .
• Increased risk of type 2 DM and CVD events.

Affects around 5–10% of women of reproductive age.

The prevalence of PCOS on ultrasound is 25 %.

Aetiology

• Aetiology is not completely clear.
• There is often a family history (gene is important in its development).

Clinical features:

• Oligomenorrhoea/amenorrhoea up to 75% (due to chronic anovulation).
• Hirsutism.
• Subfertility (75 %).
• Obesity (40 %).
• Recurrent miscarriage in around (50–60 %).
• Acanthosis nigricans (areas of increased velvety skin pigmentation occur in the axillae and other flexures).
• May be symptomatic.

PCOS SYMPTOMS

• HAIR LOSS
• HIRSUTISM
• PELVIC PAIN
• INFERTILITY
• OVERWEIGHT
• IRREGULAR PERIODS
• FATIGUE
• HIGH TESTOSTERONE LEVELS
• ACNE

POLYCYSTIC OVARY SYNDROMS (PCOS)

Diagnosis

Patients must have two out of the three features below:

• Amenorrhoea/oligomenorrhoea.
• Clinical or biochemical hyperandrogenism.
• Polycystic ovaries on ultrasound.
  • The ultrasound criteria for the diagnosis of a polycystic ovary are:
    1. Eight or more subcapsular follicular cysts <10 mm in diameter.
    2. Increased ovarian stroma.

While these findings support a diagnosis of PCOS, they are not by themselves sufficient to identify the syndrome.

Management

• Weight reduction.
• Lifestyle advice:
  • Dietary modification and exercise because these patients are at an increased risk of developing DM and CVS.
• Medications:
  • COCP:
    • Regulate menstruation.
  • Cyclical oral progesterone:
    • Regulate menstruation.
  • Metformin:
    • In patients with PCOS with hyperinsulinemia and cardiovascular risk factors.
  • Clomiphene:
    • To induce ovulation where subfertility is a factor.

Hirsutism

• Medical treatment:
  • Eflornithine cream topically.
  • Cyproterone acetate.
  • Dinetter anti-androgen contraceptive pill).
  • Metformin:
    • improves insulin resistance,
    • Hyperandrogenaemia.
    • anovulation.
    • and acne .
  • GnRH analogues with low-dose HRT: Reserved for women intolerant of other therapies.
• Surgical treatments, e.g. laser or electrolysis.
• Physical methods: shaving.

THANK YOU