Polycystic Ovary Syndrome

Krishna B. Singh, MDDepartment of Obstetrics & GynecologyLSU Health Sciences CenterShreveport, LA

PCOS: Learning Objectives

After viewing this slide show, you’ll be able to understand that...

-PCOS is a common endocrine disorder-Multifactorial, heterogeneous condition-Clinical manifestations affect menses,

fertility-Multiple hormonal, biochemical

changes-Long-term implications are important

PCO Syndrome: Topics

Historical review Incidence Clinical features Diagnosis Management Summary

PCOS: Literature Review

Sclerocystic ovaries were described by Chereau (1844); Pozzi (1894); Waldo (1895)

Stein/Leventhal first described seven cases of infertility associated with enlarged polycystic ovaries (1935)

The NIH Consensus Conference (1990) The Rotterdam PCOS Consensus Group (2003)

Incidence: PCO Syndrome

The incidence varies: 5-10% (~5% USA) About 25% normal women may have

PCO by ultrasound criteria (BMJ 1986) Ultrasound findings don’t correlate with

serum hormone levels

Features of PCO Syndrome

Symptoms present since puberty: Cyclic menses with luteal-phase progesterone deficiency; hirsutism; hyperandrogenemia; infertility; chronic anovulation/miscarriages

Irregular menses in 25-75% women Obesity (60%); also non-obese women Hirsutism and/or acne (virilization rare)

Polycystic Ovarian Disease

PCO disease can be seen in women with pituitary neoplasms, hypo- or hyperthyroidism, diabetes, adrenal and pelvic neoplasms

Rule out PCOD to diagnose PCO syndrome Long-term care is important. Studies have

shown increased incidence of hypertension, hyperlipidemia and diabetes. Risk for CVD increased

PCO Syndrome: Facts/correlates

Genetic factors: autosomal or X-linked Positive correlations of androgen and

insulin levels in some studies Ultrasound findings don’t correlate with

serum hormone levels

Theories of PCO Syndrome PCO syndrome is a multifactorial disorder Theories are based on data in selected women Brain and limbic system control the

hypothalamus-pituitary-ovarian axis needed for reproductive cycle initiation and maintenance

Feedback CNS abnormality results in PCOS

CNS theories of PCO Beta-endorphin theory: Higher plasma levels

are found in women with PCO syndrome Progesterone deficiency/estrogen excess is

the key component Hyperandrogenism also important in PCO

women Hyperprolactinemia may cause breast

symptoms, diminish libido, and alter moods in some women

More PCO Theories... Rat PCO model: Persistent-estrus syndrome

Constant-light exposure; androgenized rat model; hypothalamic lesions

Other methods (DHEAS model) Monkey model: testosterone injections Human model: transvestites given

androgens

Diagnosis of PCO Syndrome

History and physical examination important; selected laboratory and hormonal tests during several visits are needed for confirmation

Both structured and descriptive notes are evaluated by the physician

Follow-up visits arranged @ regular intervals

PCOS: Differential Diagnosis Laboratory tests for confirmation:

LH/FSH, T Baseline values: Chem-22 @ morning Baseline serum hormones @ morning Pelvic ultrasound in some cases required Consider PCOD versus PCO syndrome

PCOS: Key to Diagnosis Rule out conditions which may require

referral; focus on the presenting signs and symptoms

Beware of misdiagnosis “on the fly” Beware of differential diagnosis History and physical exam; selected tests Know when to refer patients and where

PCOS: Management Options

Principal components: Confirm diagnosis and identify category; identify and manage concurrent illness; identify and manage patient needs

There are numerous options for successful PCO management

PCOS: Treatment Options General measures: diet, exercise, relaxation

for stress management Contraception: OCP; DMPA Hormones/drugs: Provera; Parlodel;

Clomiphene; hMG/hCG; IVF in selected women

Newer drugs for treatment of obesity, hyperinsulinemia, hyperandogenemia and hirsutism

PCO Syndrome and Infertility

About 60% PCO patients will have ovulatory cycles and pregnancy on clomiphene alone

About 50% PCO patients will respond to the combined clomiphene and dexamethasone within six months of treatment

PCO Syndrome: Summary

PCO syndrome remains an enigma despite many scientific studies done during the last three decades

Theories of PCO abound; terminology used may be confusing and definitions are not standardized

There are many treatment options

What This Means... Polycystic ovary syndrome is a common

disorder among reproductive age group of women; these women generally have irregular menstrual cycles

PCO has many facets of clinical presentation PCO can be successfully managed and treated

by conventional means