Polycystic Ovary

DR.NIGAR SADAF Gynaecology & Obstetric Department

Ziauddin University and Hospitals

POLYCYSTIC OVARIAN SYNDROME

This syndrome was first described by Stein and Leventhal in 1935 and is characterized by hirsuitism, obesity, infertility and oligomenorrhoea.

The hirsuitism found in association with PCOS is due to hyperandrogenism.

Polycystic ovary syndrome has an unknown aeitology.

Ovaries, adrenal glands, pituitary and thyroid glands have all been investigated for their contributory role in its development.

There is no clear cut evidence of direct involvement of hypothalamus, pituitary and adrenal glands in the development of polycystic ovary syndrome

The ovarian dysfunction may be due to increased follicle number, theca cell hyperplasia or dysregulation of P 450C 17 alpha enzyme involved in theca cell androgen biosynthesis.

PCOS is associated with a number of alterations in the hormonal levels, which are best expressed in follicular phase of the menstrual cycle.

The hormonal changes include; LH: FSH ratio of 3:1 The baseline estrogen level is increased Hyper prolactinaemia Testosterone is only slightly raised

To make the diagnosis of PCOS on ultrasound at least 3 of the following 4 features should be present.

Peripheral distribution of follicles 10 or more follicles typically 2-8 mm in

diameter. Increased stroma Increased ovarian volume

6-7% of the population The prevalance of PCOS may differ

according to ethnic background; for example, in women of South Asian origin, PCOS presents at a younger age, has more severe symptoms and a higher prevalance.

Diagnosis of PCOS can only be made when other aetiologies have been excluded (thyroid dysfunction, congenital adrenal hyperplasia, hyperprolactinemia, androgen secreting tumors and Cushing syndrome).

Following criteria being diagnostic of the condition:

Polycystic ovaries (either 12 or more peripheral follicles or increased ovarian volume (greater than 10 cm5)

Oligo or anovulation Clinical and/or biochemical signs of

hyperandrogenism

HOW SHOULD WOMEN BE COUNSELLED?

Women diagnosed with PCOS should be inform of the possible long-term risks to health that are associated with their condition. They should be advised regarding weight control exercise.

Metabolic consequences of PCOS PCOS and cardiovascular risk PCOS and obstructive sleep apnoea

Women who have been diagnosed has having PCOS before pregnancy ( such as those requiring ovulation induction for conception )should be screened for gestational diabetes before 20wks of gestation with referral to a specialist obstetric diabetic service if abnormalities are detected

Oligo or amennorehea in women with PCOS may predispose to endometrial hyperplasia and later carcinoma.

It is good practice to recommend treatment with progestogens to induced a withdrawal bleed at least every 3-4 months.

There does not appear to be an association with breast or ovarian cancer and no additional surveillance is required

Exercise and weight control Drug therapy Surgery

Women should be advised that there is insufficient evidence in favour of either metformin or the oral contraceptive pill in treating hirsuitism or acne.

Licensed treatments for hirsuitism include oral contraceptive pills, dianette (oestrogen and cyproterone acetate), cosmetic measures ( such as laser, electrolysis, bleaching, waxing and shaving).

In practice a combination of methods is often required to achieve an acceptable cosmetic result for the woman.

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