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PCOS

Pcos

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samone.jones99
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28 views18 pages

PCOS

Pcos

Uploaded by

samone.jones99
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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PCOS

OBJECTIVES
Define Identify List
Define PCOS.
Discuss potential List most
Discuss clinical
long-term common
presentation of
consequences. treatment
PCOS and define
approaches for
diagnostic
PCOS
criteria.
DEFINITION

Polycystic ovarian syndrome (PCOS) is a


hyperandrogenic state with oligo-
anovulation that any other disorder
cannot explain.

It is a diagnosis of exclusion.
ROTTERDAM
CRITERIA
PCOS is the most common hormonal
disorder in females of reproductive age
worldwide (5-15%).
It is characterized by two out of three of
the following:
1. Chronic Oligo-anovulation
2. Clinical or biochemical
hyperandrogenism
3. Polycystic ovaries.
ETIOLOGY
Genes

70% heritability

Environment
Obesity
Insulin resistance
PATHOPHYSIOLOGY
• Insulin excess, known to sensitize the ovary to luteinizing hormone
(LH).
• Theca cells in PCOS have overexpression of most steroidogenic
enzymes and proteins involved in androgen synthesis, including
P450c17, which has been highly identified.
• Granulosa cells prematurely luteinize primarily as a result of
androgen and insulin excess.
• Androgen excess enhances the initial recruitment of primordial
follicles into the growth pool. Simultaneously, it initiates premature
luteinization and impairs the dominant follicle selection.
HISTORY AND
PHYSICAL
A complete history and physical exam
are critical for the diagnosis of PCOS.
Two out of 3 diagnostic criteria rely on
history and physical exam.
Remember, PCOS is a diagnosis of
exclusion, and identifying the clinical
presentation of other conditions should
be done.
DDX
1.Thyroid disease
2.Hyperprolactinemia
3.Non-classical congenital adrenal hyperplasia.
CHRONIC ANOVULATON

Normal Anovulatory If unclear hx


menstrual cycle dx by history -Serum day 21
21-35 days progesterone or Luteal
<10 menses per year progesterone
3-7 days
to no cycles in a nL >10 ng/ml
moderate
month -Urine ovulation sticks (LH
Regular and
sticks)
recurring >35 days
-LH Peak should occur 1-
1.5 days before ovulation
POLYCYSTIC OVARIES
ASOCIATION
• Infertility
• Endometrial Cancer
• Obesity
• Metabolic disorder
• Insulin resistance/Type 2 diabetes

• Cardiovascular disease
• HTN
• Hyperlipidemia
• NFLD/NASH
• Depression
MANAGEMENT
• Exercise and calorie-restrictive diets are the best first-line
interventions for weight loss and impaired glucose tolerance (IGT)
• Hormonal Contraceptive for menstrual abnormalities, hirsutism,
and acne. The progestin component decreases LH levels,
indirectly decreasing ovarian androgen production.
• Metformin for PCOS patients with DM2 or IGT who fail lifestyle
modifications.
• Clomiphene citrate for infertility. Infertility needs a thorough
history (1 year of attempted fertility when under 35, 6 months
after 35 y/o).
• Letrozole blocks androgen to estrogen conversion, specific
indication in obese women with PCOS undergoing infertility
• Spironolactone for hyperandrogenism
• Rasquin LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease. [Updated 2022 Nov
15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
https://www.ncbi.nlm.nih.gov/books/NBK459251/

• Helena J Teede, Chau Thien Tay, Joop J E Laven, Anuja Dokras, Lisa J Moran, Terhi T Piltonen,
Michael F Costello, Jacky Boivin, Leanne M Redman, Jacqueline A Boyle, Robert J Norman,
Aya Mousa, Anju E Joham, the International PCOS Network , Recommendations from the
2023 international evidence-based guideline for the assessment and management of
polycystic ovary syndrome, European Journal of Endocrinology, Volume 189, Issue 2, August
2023, Pages G43–G64, https://doi.org/10.1093/ejendo/lvad096

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