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Polycystic Ovary Syndrome Ding Ding M.D., Ph.D. Department of Obstetrics & Gynecology
Ob/Gyn Hospital
Fudan Unoversity
PCOS 2
Introduction Definition: polycystic ovary syndrome (PCOS) is
a generic description for a broad spectrum of clinical and morphological findings in women with an endocrine dysfunction, specifically abnormal androgen production and metabolism.
PCOS was first identified by Stein and Leventhal in 1935 so that it can also be known as Stein – Leventhal Syndrome.
PCOS 3
Genetic Predisposition
Aging
Pregnancy
Drugs
Lifestyle
Insulin Resistance
Insulin Resistance
HyperinsulinemiaHyperinsulinemia
Altered Fat MetabolismAltered Fat Metabolism
Altered Steroid Hormone MetabolismAltered Steroid Hormone Metabolism
PCOS: Acne, hirsutism, Hyperandrogenism, infertility
PCOS: Acne, hirsutism, Hyperandrogenism, infertility
Adapted from Cristello F et al, Gynecological Endocrinology, 2005.
Android Obesity
Android Obesity
↑ Lipid Storage↑ Lipid Storage
PCOS 4
Pathology Ovaries:bilateral enlarged and/or polycystic o
varies
endometrium: Lack of ovulation for an extended period of time may cause excessive thickening of the endometrium (the lining of the uterus).
PCOS 5
What Are the Symptoms of PCOS? Oligomenorrhea:
Reduction in frequency of menses
Between 35 days and 6 months.
PCOS 6
Symptoms Hirsutism : Excessive bo
dy hair. In women with PCOS dark, coarse hair will appear on the face, neck, chest, intergluteal, axillary and pubic area.
PCOS 7
Symptoms Obesity
PCOS 8
Symptoms
Acne : Because women with PCOS are producing more androgen, that produces more sebum ( skin oils and old tissue) and causes blocked pores and more acne around the jawline, arms and chest.
PCOS 9
Other Symptoms “Dirty Skin” or Acanth
osis Nigricans : This condition causes light brown to black rough patches around the neck and under arms.
PCOS 10
Diagnosis BBT (basal body temperature) Ultrasound:
multiple small ovarian follicles
enlarged ovaries Endometrium biopsy(Curettage )
before menses reveal to proliferative glands
Elevated free testosterone LH:FSH 3:1≧ 10-30% hyperprolactinmia hyperinsulinmia Laparoscopy
PCOS 11Balen AH et al4
PCOS 12
Polycystic Ovary
PCOS 13
PCOS: Metabolic Disorder Insulin Resistance
High association with PCOS 10% have Type 2 Diabetes 30%-35% have Impaired Glucose Tolerance (IGT)
Obesity 50% of PCOS patients are obese
Amplifies biochemical and clinical abnormalities of PCOS
PCOS 14
PCOS: Long-term Risks Cancer
Chronic anovulatory, persistently elevated estrogen levels, uninterrupted by progesterone, PCOS women found an increased risk of endometrial cancer
The risk of ovarian cancer is also increased two-to three fold
Cardiovascular Disease PCOS is characterized by endothelial dysfunction and resi
stance to vasodilating action of insulin Increased risk of myocardial infarction in PCOS women t
han age-matched controls
PCOS 15
Sleep Apnea Increased Sleep Disordered Breathing (SDB) and
daytime sleepiness in PCOS vs. controls
Depression Higher prevalence in PCOS patients, associated with
higher body mass index (BMI, P=0.05) and greater insulin resistance (P=0.02)
PCOS: Metabolic Disorder
PCOS 16
Pregnancy Complications Spontaneous Abortions
Increased in high BMI/PCOS patients
Impaired Glucose Tolerance
Gestational Diabetes
Hypertension
Small for Gestational Age
Wang JX et al, Human Reproduction, 2001.
Turhan NO et al, International Journal of Gynecology & Obstetrics, 2003.
Bjercke S et al, Gynecologic and Obstetric Investigation, 2002.
Weerakiet S et al, Gynecological Endocrinology, 2004.
Sir-Petermann T et al, Human Reproduction, 2005.
PCOS 17
Treatment: Weight Loss
calorie-restricted diets Exercise a 5% reduction in body mass was still able to
restore ovulation Six month weight-loss program for overweight
anovulatory women Lost an average of 6.3 kg (13.9 lbs) Decreased fasting insulin and testosterone levels 92% resumed ovulation (12/13) 85% became pregnant (11/13) Clark AM et al, Human Reproduction, 1995.
PCOS 18
Treatment Fertility Treatment
If pregnancy is desired ------ induce ovulation
Clomiphene Citrate Anti insuline resistance-Metformin 1000-1500mg/d
anti-androgens
Laparoscopic ovarian drilling (LOD): reduce ovarian sourced androgen
IVF
PCOS 19
Laparoscopic Ovarian Drilling Lasers burn holes in
enlarged follicles Stimulates ovulation
by reducing LH and androgen
Improve local microcirculation
Mayo Clinic 2006
PCOS 20
If pregnancy is not desired
to reduce the risk of endometrial cancer ( birth control pills)
OC: Diane-35: reduce LH and androgencyclical progesterone (Medroxyprgesterone)Anti insuline resistance-Metformin 1000-1500mg
/d, GlucophageAnti-androgens
Treatment
PCOS 21
Case presentation 22 y.o. college student, do not want to conceive Obese, oligomenorrhea, LMP: 3 months ago Hirsutism at face, axillary and pubic area Face acne Testosterone is mildly elevated DHEAS is normal LH 35mIU/ml, FSH 9 mIU/ml
Examination? Diagnosis? Treatment?
Ding Ding M.D., Ph.D. Department of Obstetrics & Gynecology
Ob/Gyn Hospital
Fudan Unoversity
Thanks for Your Attention