Polycystic Ovary

Syndrome
Gabrielle Johnson,
Kimberly Lin,
Amanda Sheehan,
Leticia Fuentes

GNRS 564
 About the Disease
- Chronic disorder that involves multiple
fluid-filled benign cysts forming on the
ovaries.

- PCOS is due to reproductive hormone

abnormalities in which the ovaries produce
estrogen and excess testosterone but not
progesterone.

- The fluid filled cysts develop from mature

ovarian follicles.

- The high levels of testosterone can prevent

the release an egg each month during
ovulation.

- It is a syndrome rather than a disease and

involves hyperandrogenism and chronic
anovulation.
 About the Disease
- Extremely prevalent and probably
the most frequently encountered
endocrinopathy in women of the
reproductive age.

- Linked with a reproductive hormone

imbalance causing the growth of
small cysts on the womans ovaries.

- Cysts are not painful but they lead to

a womans period being altered and
make it difficult to get pregnant.

- Unknown factors as to what triggers

the hormones to over produce or
turn on.
 Pathophysiology / Cause of disease
PCOS is thought to be a very complicated disease with a tetrad of possible etiologies: genetics,
intrauterine exposure, environment/lifestyle, and obesity.

Genetics: 20-40% of female first-degree relatives of women with PCOS also have the syndrome,
suggesting that the disease is partially heritable and clusters in families. There is variance among
different races, but there is a notable higher presence in South Asian women, possibly to a mutation of
gene 7-hydroxysteroid-dehydrogenase type 6 (HSD17B6)

Intrauterine Exposure: Exposure of a fetus to testosterone in utero may lead to a higher prevalence of
developing PCOS later in life.

Environment/Lifestyle: Sedentary lifestyle is related to different metabolic dysfunction. Weight gain has
been found to have a correlation with irregular menstrual cycles, or insulin resistance.

Obesity: Similar points to environment/lifestyle, adipose dysfunction can lead to development of glucose
intolerance.
 Pathophysiology / Cause of disease
Hyperandrogenism: The characteristic feature of PCOS, which is exacerbated by an increase in
testosterone

Neuroendocrine Abnormalities: Increase in GnRH increase LH:FSH ratio

Insulin Resistance/T2DM: Metabolic abnormalities, including poor glucose tolerance and

hyperinsulinemia

Polycystic Ovaries: Present in only 20-30% of women, and are not true cysts but rather antral follicles
which have had slowed development
Hyperandrogenism
Hyperinsulinemia

Long-Term Morbidities:
Subfertility
Miscarriage
CVD
T2DM
Malignancies: hyperinsulinemia, hyperandrogenism, oligoanovulation
Psychiatric Disorders: correlated to anxiety, depression, binge-eating disorder, and bipolar
disorder
 What is the cause....
Excess insulin
Insulin is the hormone produced in the pancreas that allows cells to use sugar
(glucose) Glucose is your body's primary energy supply.
Excess insulin might also affect the ovaries by increasing androgen
production, which may interfere with the ovaries' ability to ovulate.

Inflammation
White blood cells produce substances to fight infection
PCOS have low-grade inflammation and this type of low-grade inflammation
stimulates polycystic ovaries to produce androgens

Hereditary
If your mother or sister has PCOS, you might have a greater chance of
having it
Signs and Symptoms
Clinical manifestations may include menstrual irregularities,
signs of androgen excess, polycystic ovaries, and obesity.

Menstrual Irregularities
Most common
Can last longer than 35 days, having less than
8 menstrual cycles a year, not menstruating for
4 months in a row
Androgen Excess
35
Elevated levels of male hormone
Excess facial and body hair (hirsutism), adult 25 22
acne or severe adolescent acne, and
male-pattern baldness (androgenic alopecia)
Polycystic ovaries 15
Polycystic ovaries become enlarged and
contain numerous small fluid-filled sacs which
surround the eggs.
Obesity
Abnormal rapid weight gain
 Diagnostic
The Rotterdam Consensus
(2003) defines PCOS as at
least two of the following
characteristics:
1. Clinical
hyperandrogenism
2. Oligo- or an-ovulation
3. Polycystic ovaries on
ultrasound
 Possible Diagnostic Tests & Procedures

Diagnostic Tests include:

- Physical exam
- Pelvic exam
- Blood tests
- Karyotype
- Ultrasound
- CT/MRI
Treatment - Pharmacotherapy
Medications for management of
PCOS:

Oral contraceptive
Antiandrogens
Hypoglycemic agents
Selective estrogen receptor
modulators (ovulation inducer)
Topical hair-removal agents
Topical acne agents
Treatment - Lifestyle Modifications
Lifestyle modifications are considered
the first-line treatment for women with
PCOS

- Diet
- Increased fiber
- decreased refined carbohydrates
- Smaller, more frequent meals
- Less saturated/trans/hydrogenated
fats
- Exercise
- Weight loss
- Smoking cessation
Patient/Family Education - Nutrition for PCOS
Avoid
- High GI foods
- Dairy
- Saturated/ trans/
hydrogenated fats

Include
- Green leafy vegetables
- Fruit
- Lean meat
- More fiber
- Frequent small meals
 Patient/Family Education - Immediate & Long term
Is there a Cure?
Symptoms may begin in puberty and last until menopause
The insulin resistance, diabetes risk, and heart disease risk last throughout life
NO CURE but CAN be treated
May be considered an autoimmune disorder, and has links to hypothyroidism

Prevention:
Currently no prevention of PCOS
Treatment for polycystic ovary disease can prevent complications such as uterine
cancer
Due to increased risk of heart disease with PCOS, it is important that you:
Avoid smoking
Maintain a healthy exercise regimen
Follow a healthy diet
 Patient/Family Education - Immediate & Long term
Fertility options:
It is a common misconception that women with PCOS cannot become pregnant

Studies show that overweight or obese women with PCOS, infertility, or both, are
more likely to become pregnant if they lose weight before beginning infertility
treatment.

First-line medications for ovulation induction: letrozole or clomiphene citrate

IVF
 Q&A
What disease characteristic is known to lead to an ability for a woman to get
pregnant?
What is one of the 3 main causes listed of PCOS?
Which hormone is elevated in PCOS?
Are there definitive diagnostic tests for PCOS?
What are some nutrition tips for someone suffering from PCOS?
What is the first-line treatment for PCOS?
What are two serious health problems that can develop if polycystic ovary
syndrome goes untreated?
 Q & A Answers
What disease characteristic is known to lead to an ability for a woman to get
pregnant? The painless cysts on their ovaries
What is one of the 3 main causes listed of PCOS? Inflammation, excess of
insulin (due to insulin resistance), and hereditary causes
Which hormone is elevated in PCOS? Androgen
Are there definitive diagnostic tests for PCOS? No
What are some nutrition tips for someone suffering from PCOS? Whole grains
instead of refined carbohydrates; eat small meals more frequently to manage
insulin resistance, incorporate more fiber
What is the first-line treatment for PCOS? Lifestyle modifications - diet,
exercise, weight loss
What are two serious health problems that can develop if polycystic ovary
syndrome goes untreated? Diabetes and heart disease
 References
Badawy, A., & Elnashar, A. (2011). Treatment options for polycystic ovary syndrome. International
Journal of Womens Health, 3, 2535. http://doi.org/10.2147/IJWH.S11304

Legro, R.S., & Dodson, W.C. (2016). Benefit of delayed fertility therapy with preconception weight loss
over immediate therapy in obese women with PCOS. The Journal of Clinical Endocrinology & Metabolism,
101, 26582666. doi: 10.1210/jc.2016-1659

Lewis, S. M., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. (n.d.). Medical-

surgical nursing: Assessment and management of clinical problems.

Polycystic ovarian syndrome (n.d.). Medscape. Retrieved from

http://emedicine.medscape.com/article/256806-overview

https://www.ncbi.nlm.nih.gov/pubmed/14711538

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871972/
 References continued...
http://www.pathophys.org/pcos/

http://press.endocrine.org/doi/full/10.1210/jcem.84.6.5803