Polycystic Ovary Syndrome

Prepared by:
Qaso murad
Muna monif
Galawish ajaj
Ghassan mahmood
Emad Qasim

Introduction
Definition: polycystic ovary syndrome
(PCOS) is a generic description for a broad
spectrum of clinical and morphological
findings 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
known as Stein Leventhal Syndrome.
PCOS

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.
PCOS

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.

PCOS

PCOS-Epidemiology
Very prevalent disease affecting between
10 percent of women overall.

Prevalence much higher in obese women

(28%)

PCOS-Epidemiology
PCOS accounts for 95% of cases of
hyperandrogenism
PCOS is responsible for over 20% of all
cases of amenorrhea
PCOS is responsible for up to 74% of all
cases of anovulatory infertility.

The Etiology of PCOS

A genetic disorder of ovarian androgen
secretion
Etiology of PCOS is hotly debated
Most agree that the ovary, rather than
the adrenal is the principal source of
excess androgen production.

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

PCOS

Pathology
Ovaries: enlarged and/or polycystic
ovaries

endometrium: Lack of ovulation for an

extended period of time may cause
excessive thickening of the endometrium
(the lining of the uterus).
PCOS

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.
PCOS

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Symptoms
Hirsutism

Excessive
body hair. In women with
PCOS dark, coarse hair
will appear on the face,
neck, chest, arms, and in
between the legs.

2006-12-6

PCOS

11

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.
PCOS

12

Symptoms
Acne : Because women

with
PCOS
are
producing more male
hormone, that produces
more sebum ( skin oils
and old tissue) and
causes blocked pores
and more acne around
the jawline, arms and
chest.

PCOS

13

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.

PCOS

14

Other Symptoms
Dirty Skin or Acanthosis
Nigricans : This condition
causes light brown to black
rough patches around the
neck and under arms.
Migraines
:
Severe
headaches that cause light
sensitivity, nausea and
dizziness.
PCOS

15

Reviow of the symptomes

PCOS

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Symptoms make all doctors to be busy

Frequency:
5-10% of females

Dermatologist

Disorder of
hair growth,
Acne

Fertility problem
Menstrual
Gynecologyst dysfunction

Internist

Obesity problem
pseudo Cushings
disease

General
practitioner

Diagnosis
include:

Pelvic exam
BBT (basal body temperature)
Transvaginal ultrasound:
Endometrium biopsy(Curettage )
before menses reveal to proliferative glands
Determination of LH,FSH,E2,P,T,PRL Ins
(LH:FSH 3:1)
Blood test
Lipid Profiles
PCOS

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Pelvic exam
Pelvic exam. During a pelvic exam,
doctor visually and manually inspects
your reproductive organs for signs of
masses, growths or other
abnormalities

Basal Body Temperature BBT

low basal temperature below 97.5 Fahrenheit in

pre-ovulatory stage have been diagnosed as PCOS

PCOS

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Transvaginal Ultrasound
12 or more follicles in each ovary
Each follicle measuring 2-9 mm diameter
Increased ovarian volume (>10 mL)

Blood tests
Blood tests. Your blood may be drawn to
measure the levels of several hormones to
exclude possible causes of menstrual
abnormalities or androgen excess that mimic
PCOS. Additional blood testing may include
a glucose tolerance test, in which glucose
levels are measured while fasting and after
drinking a glucose-containing beverage
PCOS

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Lipid Profiles and PCOS

Almost 70% of patients with PCOS have an
abnormal lipid profile and high triglycerides
and low high-density lipoprotein (HDL)
cholesterol are often found. *

*Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with
polycystic ovary syndrome. Am. J. Med. 111, 607-613 (2001).

MEDICAL TREATMENT
Weight loss
Hyperandrogenism
Endometrial protection
Insulin resistance
Ovulation induction

Weight Loss
Weight loss alone is associated with a reduction in

testosterone, leading to resumption of ovulation and

often pregnancy.

Hyperandrogensim
Combination oral contraceptives
Spirinolactone antiandrogen properties

Endometrial Protection
Risk of unopposed estrogen endometrial
hyperplasia
Combination OCPs vs. Intermittent
progestin therapy

Metformin

Metformin
A biguanide most widely used drug
worldwide for the treatment of type 2
diabetes.
Primary action inhibits hepatic glucose
production
Secondarily increases peripheral sensitivity
to insulin

Resources
Jean Hailes Foundation Website
www.jeanhailes.org.au
FertilitySA website
www.fertilitysa.com.au
Polycystic Ovary Syndrome Association of Australia
(POSAA)
www.main.posaa.asn.au
Brochures

Any Questions?

Thanks