Presented by

Sriloy Mohanty

B.N.Y.S

S-VYASA

Contents…Introduction

Definition

History

Epidemiology

Pathophysiology

Signs and symptoms

Causes

Risk factors

Complications

Aims of treatment

Treatment modalities

Natural treatment

Introduction

Polycystic ovarian syndrome is a condition in

which a woman’s levels of the sex hormones

are out of balance which leads to the growth

of ovarian cysts

Definition

PCOS is a syndrome of ovarian dysfunction along with cardinal features of LH

hypersecretion ,ovarian hyperandrogenism ,hyperinsulinemia,reduced fertility

History 1721

Antonio Vallisneri

“…Young peasant woman, married, moderately plump, infertile, with ovaries

larger than normal, like doves’ eggs, lumpy, shiny and whitish”

1935

Dr. Irving Stein and Dr. Michael Leventhal

Coined Stein-Leventhal disorder

1980

Linked to hyperinsulinemia and impaired glucose tolerance

2006

What causes PCOS?

Epidemiology

The most common endocrine disorder

in women of reproductive age ~ 2%-

8% of women

About 18% of women had PCOS, and

that 70% of them were previously

undiagnosed

Signs And Symptoms

Oligomenorrhea or Amenorrhea

Anovulation

Elevated Androgens

Hirsutism

Enlarged ovaries

Sub-fertility

Recurrent miscarriage

Hyperinsulinemic Insulin Resistance

Acanthosis niagricans

Obesity

Chronic pelvic pain

Sleep apnea

Causes

Unknown

Hormonal imbalances

genetics play a role

Genetic Predisposition

Aging

Pregnancy

Drugs

Lifestyle

Insulin

Resistance

Hyperinsulinemia

Altered Fat Metabolism

Altered Steroid Hormone Metabolism

PCOS: Acne, hirsutism,

hyperandrogenism infertility

Android

Obesity

↑ Lipid Storage

PATHOPHYSIOLOGY

Risk Factors

Genetic link

1st degree relatives of patients with

PCOS may be at high risk for diabetes

and glucose intolerance

Obesity (50%)

Increased insulin resistance (30%-35%)

Complication

Metabolic Syndrome 43% increase MS regardless of body weight

Insulin resistance Type II diabetes

○ 5x increase risk

Cardiovascular disease 2x increase risk

High cholesterol

High blood pressure

Cardiovascular risk in

PCOD Endothelium dysfunction (impaired NO

vasodilation)

Disorders of coagulation & fibrinolysis

Plasminogen activator inhibitor-1

Plasminogen activator activity

Fibrinogen levels

Activation of coagulation

Hypertension

Dyslipidemia

Pregnancy Complications

Spontaneous Abortions

Increased in high BMI/PCOS patients

Impaired Glucose Tolerance

Gestational Diabetes

Hypertension

Small for Gestational Age

Physical Examination

Vaginal ultrasound

Cysts

2-8 millimeter diameter

Often a “string of pearls”

Enlarged ovary

Thickened endometrium

Lack of menses

Blood Test Diagnosis ↑ Testosterone

↑ DHEA

↑ Androstenedione

↑ Prolactin

↓ Progesterone ↓ SHBG

LH:FSH 3:1 instead of 1:1

Thyroid-Stimulating hormone (TSH) Fasting insulin level Triglycerides Cholesterol

Aim Of Treatments

To reduce the the symptoms

To increases fertility

Reduce weight

Increase insulin resistance

Reduce cholesterol

Oral Contraceptives Combined-Oral Contraceptive (COC)

○ Decrease Androgen production

○ Break continuous estrogen

○ Decrease risk of endometrial cancer

○ Corrects abnormal bleeding

Progesterone○ 10-14 days a month

○ Regulates menstrual cycle

○ Prevents endometrial cancer

○ Does not improve androgen levels

Diabetes Medication Metformin (Glucophage, Glucophage XR)

○ Type II Diabetes Medication

○ Treats insulin resistance

○ Improves ovulation

○ May reduce androgen production

– even in non-obese women

Does it prevent endometrial cancer?

Is it safe for pregnant women?

Hirsutism Medication

Spironolactone (Aldactone)○ Blocks androgen effects

○ Reduces androgen production

○ Problems Diuretic

Heartburn

Headache

Fatigue

Prescription topical cream

Laparoscopic ovarian diathermy

Lasers burn holes in enlarged follicles

Stimulates ovulation by reducing LH and androgen hormones

Infertility treatment

Diet

Exercise

Insulin sensitizer

Ovulation induction

Clomiphene/letrozole

Gonadotropins

GnRH-agonist/gonadotropins

Ovarian drilling

Assisted Reproductive Technology (IVF)

Surgery Complications Scar tissue

Lasts a few months

80% ovulation rate

50% pregnancy rate

Only used if failed previous treatments

Natural Treatment

To reduce weight

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)

Diet

Hypocaloric diets insulin resistance

10-20% protein, ~50% carbohydrates

< 30% total fat, < 10% saturated fat

Cereal fiber

Substitute nonhydrogenated unsaturated fats for saturated and trans-fats

omega-3 fatty acids from fish, fish oil supplements, or plant sources

fruits, vegetables, nuts, and whole grains

refined grain products

Consume more foods

rich in complex

carbohydrates

monounsaturated fat

fiber with a ratio of omega-6 to

omega-3 fatty acids

Phytoestrogensshould be included in diet

Reduce

Total caloric intake

Saturated fat

Cholesterol

IAYT is found to be useful for people

with diabetes type 2

No mechanism related to insulin resistance