Download Polycystic Ovary Syndrome

Polycystic Ovary Syndrome
Ding Ding
M.D., Ph.D.
Department of Obstetrics & Gynecology
Ob/Gyn Hospital
Fudan Unoversity
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
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Genetic Predisposition
Aging
Pregnancy
Drugs
Lifestyle
Android
Obesity
Insulin
Resistance
↑ Lipid Storage
Hyperinsulinemia
Altered Fat Metabolism
Altered Steroid Hormone Metabolism
PCOS: Acne, hirsutism,
Hyperandrogenism, infertility
PCOS
Adapted from Cristello F et al, Gynecological Endocrinology, 2005.
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Pathology

Ovaries:bilateral 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).
PCOS
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What Are the Symptoms of PCOS?

Oligomenorrhea:

Reduction in frequency of
menses
Between 35 days and 6 months.

PCOS
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Symptoms

PCOS
Hirsutism : Excessive
body hair. In women with
PCOS dark, coarse hair
will appear on the face,
neck, chest, intergluteal,
axillary and pubic area.
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Symptoms

PCOS
Obesity
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Symptoms

PCOS
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.
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Other Symptoms

PCOS
“Dirty
Skin”
or
Acanthosis Nigricans :
This condition causes
light brown to black
rough patches around
the neck and under
arms.
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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
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PCOS
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Balen AH et al4
Polycystic Ovary
PCOS
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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
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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
resistance to vasodilating action of insulin

Increased risk of myocardial infarction in PCOS women
than age-matched controls
PCOS
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PCOS: Metabolic Disorder

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
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Pregnancy Complications

Spontaneous Abortions

Increased in high BMI/PCOS patients
Wang JX et al, Human Reproduction, 2001.

Impaired Glucose Tolerance
Turhan NO et al, International Journal of Gynecology & Obstetrics, 2003.

Gestational Diabetes

Hypertension

Small for Gestational Age
Bjercke S et al, Gynecologic and Obstetric Investigation, 2002.
Weerakiet S et al, Gynecological Endocrinology, 2004.
PCOS
Sir-Petermann T et al, Human Reproduction, 2005.
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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
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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
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Laparoscopic Ovarian Drilling



Lasers burn holes in
enlarged follicles
Stimulates ovulation
by reducing LH and
androgen
Improve local
microcirculation
PCOS
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Mayo Clinic 2006
Treatment
 If pregnancy is not desired
to reduce the risk of endometrial cancer ( birth
control pills)
OC: Diane-35: reduce LH and androgen
cyclical progesterone (Medroxyprgesterone)
Anti insuline resistance-Metformin 10001500mg/d, Glucophage
Anti-androgens
PCOS
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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?

PCOS
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Thanks for Your Attention
Ding Ding
M.D., Ph.D.
Department of Obstetrics & Gynecology
Ob/Gyn Hospital
Fudan Unoversity