Polycystic ovarian syndrome

(PCOS）
 OVERVIEW: PCOS

• 1 st described by Stein and Leventhal as a

triad of amenorrhea, obesity and
hirsutism (1935)
• It is one of the leading causes offemale
infertility
 Definition

• Definition :Polycystic ovarian syndrome is a

common endocrine disfunction typified by
oligo-ovulation or anovulation, signs of
androgen excess, and multiple small ovarian
cysts
 Incidence

• PCOS is the most common disorder of

reproductive-aged women

• PCOS appears to equally affect all races and

nationalities
 Etiology
• Genetic basis
• Environment causes
– Life style
– Exercise
– Diet
– Androgen exposure, et. al
•
 PCO
Polycystic is
>12 follicles
per ovary less
than 10mm in
diameter,
ovary itself is
enlarged
1. Facial Hirsutism in PCOS
 2. Menstrual Dysfunction

• Oligo or amenorrhea
–Menstrual irregularity
typically begins in the
peripubertal period
 3. INFERTILITY

• Inherent ovarian disorder—studies

show reduced rated of conception
despite therapy with clomid
 4. Obesity

• Prevalence of obesity varies from 30-75%

• 2/3 of patients with PCOS who are not obese
have excessive body fat and central adiposity
• Obese patients can be hirsute and/or have
menstrual irregularities without having PCOS
 5. Insulin Resistance

• > 80% are hyperinsulinemic and have insulin

resistance (independent of obesity)
 Treatment

• Goals of PCOS Treatment

– Restoration a normal cycle and fertility
– Lowering of insulin levels
– Treatment of hirsutism, acne
– Prenvention of endometrial cancer
– Prevention of DM,CVD and metabolic syndrome
• Metformin
– Dosage: 1500-2550 mg per day
– Clinically significant responses not regularly
observed at doses less than 1000 mg per day
• Treat with cyclic progestin to reduce endometrial hyperplasia
if regular menses not attained
• 10 mg for 7 to 10 days every one to
three months
 Infertility
• Weight loss—reduction in serum testosterone concentration
and resumption of ovulation
• Clomid: 80% will ovulate, 50% will conceive
• Metformin
– will restore ovulation and menses in > 50% of
patients
– added to clomid, improves ovulatory rates
• CC/FSH/hCG
• Laparoscopic surgery: wedge resections, laparoscopic ovarian
laser electrocautery
• IVF
Thankyou