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 (PC
OS) is a generic description for a broad spe
ctrum of clinical and morphological finding
s 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 kno
wn 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 ext

ended period of time may cause excessive t
hickening 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 bod
y hair. In women with PCO
S dark, coarse hair will app
ear on the face, neck, chest,
arms, and in between the le
gs.

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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 wome
n with PCOS are prod
ucing more male horm
one, that produces mor
e sebum ( skin oils and
old tissue) and causes
blocked pores and mor
e acne around the jawl
ine, 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 Acanthosi
s Nigricans : This conditio
n causes light brown to bla
ck rough patches around t
he neck and under arms.
Migraines : Severe headac
hes that cause light sensitiv
ity, 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 cont

rol 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