Download Polycystic Ovary Syndrome

Polycystic Ovary Syndrome
DI WEN
M.D., Ph.D.,
Professor & Chairman
Department Of Obstetrics & Gynecology
Renji Hospital Affiliated to SJTU School of Medicine
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.
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Etiology & Pathopysiology
What we think we know.
“Vicious cycle”
Abnormal gonadotropin secretion
Excess LH and low, tonic FSH
Hypersecretion of androgens
Disrupts follicle maturation
Substrate for peripheral aromatization
Negative feedback on pituitary
Decreased FSH secreation
Insulin resistance, Elevated insulin levels
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Pathology
 Ovaries: enlarged and/or polycystic ovaries
 endometrium: Lack of ovulation for an
extended period of time may cause
excessive thickening of the endometrium
(the lining of the uterus).
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Pathology
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What Are the Symptoms of PCOS?
Irregular
or Lack of
Menses: Women will have
“spotty” periods (1 every
couple of months). Also, in
some women with PCOS they
simply cease having a menses
at all.
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Symptoms
Hirsutism
Excessive
body hair. In women with
PCOS dark, coarse hair
will appear on the face,
neck, chest, arms, and in
between the legs.
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Symptoms
Weight Problems :
Depending on the
woman, there could be
a decrease of weight
or a rapid fluctuation
of weight that settles
around the stomach
that will lead to
morbid obesity.
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Symptoms
Acne
:
Because
women with PCOS are
producing more male
hormone,
that
produces more sebum
( skin oils and old
tissue) and causes
blocked pores and
more acne around the
jawline, arms and
chest.
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Symptoms
 Alopecia or Female
Pattern Baldness :
This is caused by the
increase of male hormone
in the women's body.
Thinning or loss of hair is
usually contained to top of
the scalp, but in severe
cases loss of hair in front
or on the hairline has been
documented.
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Other Symptoms
“Dirty Skin” or Acanthosis
Nigricans : This condition
causes light brown to
black
rough
patches
around the neck and under
arms.
Migraines
:
Severe
headaches that cause light
sensitivity, nausea and
dizziness.
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Diagnosis
 BBT (basal body temperature)
 B ultrasound:
multiple small ovarian cysts
enlarged ovary
Endometrium biopsy(Curettage )
before menses reveal to proliferative glands
Determination of LH,FSH,E2,P,T,PRL，Ins，
(LH:FSH≧3:1)
Laparoscopy
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Treatment
If pregnancy is desired ------ cause
ovulation
anti-estrogens(clomiphene)
Gonadotropins
insulin-lowering agents
anti-androgens (agents that lower
androgen levels)
gonadotropin releasing hormone
agonists (GnRHa)
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Treatment
 If pregnancy is not desired
to reduce the risk of endometrial cancer ( birth
control pills)
cyclical progesterone (MPA, Provera)
insulin-lowering agents (metformin ,Glucophage)
anti-androgens.
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Long Term Effects: Infertility
Many women experience infertility while
having PCOS.
Many will have to go to an fertility doctor
to conceive.
To conceive women with PCOS have to
learn to monitor ovulation by taking their
Basal Body Temperature (BBT) and
examining cervical mucus.
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Long Term Effects: Heart Disease
There is new evidence that finds women
with PCOS are at a higher risk for
metabolic cardiovascular disease.
Both diseases are characterized by insulin
resistance, high blood pressure, and obesity.
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Thanks for Your Attention
DI WEN
M.D., Ph.D.
Professor & Chairman
Department of Obstetrics & Gynecology
Renji Hospital Affiliated to SJTU School of Medicine