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Polycystic ovarian syndrome ( PCOS)

Polycystic ovarian syndrome ( PCOS), also known as PCOD ( polycystic ovarian disease) is one of the commonest causes of infertility. It is characterised by multiple small cysts in the ovaries. The ovary is enlarged; and it produces excessive amounts of androgen and estrogenic hormones. This condition is also called Polycystic Ovarian Syndrome (PCOS) or the Stein-Leventhal Syndrome. PCOS produces symptoms in 10% of women of reproductive age .It is the most frequent endocrine problem in women of reproductive age. Insulin resistance and elevated serum LH levels are also common features in PCOS. PCOS is associated with an increased risk of type 2 diabetes and cardiovascular events.

Signs and symptoms

  • • Menstrual disorders: patient typically presents with history of delayed cycles ie., oligomenorrhea (few menstrual periods) or amenorrhea (no menstrual periods)
  • • High levels of masculinizing hormones: leading to acne and hirsutism (male pattern of hair growth), hypermenorrhea (heavy and prolonged menstrual periods).
  • • Insulin resistance

The typical NECKLACE PATTERN OF CYSTS as seen on ultrasound.

CAUSE

Cause is uncertain with a strong genetic predisposition

Obesity plays a major role

CRITERIA FOR DIAGNOSIS

Since the 1990 NIH-sponsored conference on polycystic ovary syndrome (PCOS), it has become appreciated that the syndrome encompasses a broader spectrum of signs and symptoms of ovarian dysfunction than those defined by the original diagnostic criteria which had included oligoovulation ,signs of androgen excess (clinical or biochemical) and exclusion of other disorders that can result in menstrual irregularity and hyperandrogenism In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if any 2 out of 3 criteria are met, in the absence of other entities that might cause these findings[31][9][32]

  • 1. oligoovulation and/or anovulation
  • 2. excess androgen activity
  • 3. polycystic ovaries (by gynecologic ultrasound).

The 2003 Rotterdam consensus workshop concluded that PCOS is a syndrome of ovarian dysfunction along with the cardinal features hyperandrogenism and polycystic ovary (PCO) morphology. PCOS remains a syndrome and, as such, no single diagnostic criterion (such as hyperandrogenism or PCO) is sufficient for clinical diagnosis. It may manifest as : menstrual irregularities, signs of androgen excess, and obesity.

LH: FSH ratio in pcos

LH-FSH ratio refers to the relative values of two gonadotropin hormones produced by the pituitary gland in women. Luteinizing hormone (LH) and follicle stimulating hormone (FSH) stimulate ovulation by working in different ways. In pre-menopausal women, the normal ratio is 1:1 as measured on day three of the menstrual cycle. It used to be believed that an elevated LH-FSH ratio of greater than 2:1 or 3:1 was indicative of PCOS, but recently, researchers have discovered that many women with PCOS have normal levels. As many as half of all women with PCOS may not have high ratios

STANDARD DIAGNOSIS METHODS

  • 1. History of oligomenorrheic cycles,acne, obesity
  • 2. ultrasound
  • 3. laparoscopy
  • 4. elevated blood levels of androstenedione and testosterone .Elevated DHEA S ( dehydroepiandrosterone sulphate ) levels above 700-800 µg/dL are highly suggestive of adrenal dysfunction.

How to manage PCOS

Restore normal menses

restore fertility

treat acne

treat insulin resistance

TREATMENT

first and foremost is WEIGHT REDUCTION

Drugs like metformin,ocp combinations of ethinyl oestradiol and spironolactone derivative like drospirenone

Normal menses can occur by contraceptive pills

laparoscopic ovarian drilling” as shown above as treatment

They should be warned of developing endometrial carcinoma,type II diabetes mellitus and dyslipidemia