PCOS & Hirsuitism

Dr.Tarig Mahmoud AhmedMD SUDAN

HAIL UNIVERSITY KSA

Polycystic ovarian syndrome

PCOS is a syndrome of ovarian dysfunction along

with the cardinal features of hyperandrogenism and polycystic ovary morphology.

The aetiology of PCOS is not completely clear, but there is often a family history. It seems likely that a gene is important in its development.

Clinical features Oligomenorrhoea/amenorrhoea in up to 75

percent of patients, predominantly related to chronic anovulation.

Hirsutism. Subfertility in up to 75 per cent of women. Obesity in at least 40 per cent of patients. Recurrent miscarriage in 50–60 per cent of

women. Acanthosis nigricans (areas of increased velvety

skin pigmentation occur in the axillae and other flexures).

May be asymptomatic.

Rotterdam criteria for diagnosis of PCOS

Patients must have two out of the three features below:

amenorrhoea/oligomenorrhoea. clinical or biochemical

hyperandrogenism androgen excess (e.g. hirsutism).

polycystic ovaries on ultrasound.

Ultrasound picture of polycystic ovary.

The ultrasound criteria for the diagnosis of a polycystic ovary are eight or more subcapsular follicular cysts <10 mm in diameter and increased ovarian stroma.

Elevated serum LH levels and insulin resistance and are also common features.

Long-term consequences of PCOS

PCOS is associated with an increased risk of type 2 diabetes and cardiovascular events.

possible risk of sleep apnoea . Oligo- or amenorrhoea in women

with PCOS may predispose to endometrial hyperplasia and later carcinoma.

Management1) COCP: This should regulate

menstruation.2) Cyclical oral progesterone: used to

regulate menstruation.3) Metformin: This is beneficial in

patients with PCOS, those with hyperinsulinaemia and cardiovascular risk factors.

4) Clomiphene: used to induce ovulation where subfertility is a factor.

5) Lifestyle advice: Dietary modification and exercise is appropriate in these patients as they are at an increased risk of developing diabetes and cardiovascular disease later in life.

6) Weight reduction7) Ovarian electrocautery :8) Ovarian electrocautery should be

considered for selected anovulatory patients, especially those with a normal BMI, as an alternative to ovulation induction.

Treatment of Hirsutism

Eflornithine cream (Vaniqua™) applied topically;

Cyproterone acetate (Dianette™, anti-androgen contraceptive pill);

Metformin: improves parameters of insulin resistance, hyperandrogenemia, anovulation and acne in PCOS;

GnRH analogues : this regime should be reserved for women intolerant of other therapies.

Surgical treatments, e.g. laser or electrolysis.

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