Oleh:

Dryan Ariapratita

Pembimbing:
dr.H Dadan Susandi SpOG

Polycystic Ovarian
Syndrome
 Practice Essential
Women with polycystic ovarian syndrome (PCOS)
have abnormalities in the metabolism of
androgens and estrogen and in the control of
androgen production.

PCOS can result from abnormal function of the

hypothalamic-pituitary-ovarian (HPO) axis.

A woman is diagnosed with polycystic ovaries (as

opposed to PCOS) if she has 12 or more follicles in
at least 1 ovary
Essential update: AACE/ACE and AES Society release
new guidelines

In November 2015, the American Association of

Clinical Endocrinologists (AACE), American College
of Endocrinology (ACE), and Androgen Excess and
PCOS Society (AES) released new guidelines in the
evaluation and treatment of PCOS.
Essential update: AACE/ACE and AES Society release
new guidelines

The diagnostic criteria for PCOS should include two

of the following three criteria:
chronic anovulation
hyperandrogenism (clinical/biologic)
polycystic ovaries

In addition to clinical findings:

obtain levels of serum 17-hydroxyprogesterone and
anti-Mllerian hormone to aid the diagnosis of PCOS.
Essential update: AACE/ACE and AES Society release
new guidelines

Free testosterone levels sensitive for

determining androgen excess,obtained with
equilibrium dialysis techniques

Women with PCOS should also be evaluated

and/or treated for :
Reproductive function
Hirsutism
Alopecia
Acne
 Sign and Symptoms
Major :
Menstrual dysfunction
Anovulation
Hyperandrogenism

Other Signs and Symptoms :

Hirsutism
Infertility
Obesity and metabolic syndrome
Diabetes
Obstructive sleep apnea
 Diagnosis
On examination, findings in women with PCOS
may include the following:
Virilizing signs
Acanthosis nigricans
Hypertension
Enlarged ovaries: May or may not be present;
evaluate for an ovarian mass
 Diagnosis
Testing Exclude all other disorders that can result
in menstrual irregularity and hyperandrogenism,
including
Adrenal or ovarian tumors
Thyroid dysfunction
Congenital adrenal hyperplasia
Hyperprolactinemia
Acromegaly
Cushing syndrome
 Diagnosis
Baseline screening laboratory studies for women
suspected of having PCOS include the following:
Thyroid function tests (eg, TSH, free thyroxine)
Serum prolactin level
Total and free testosterone levels
Free androgen index
Serum hCG level
Cosyntropin stimulation test
Serum 17-hydroxyprogesterone (17-OHPG) level
Urinary free cortisol (UFC) and creatinine levels
Low-dose dexamethasone suppression test
Serum insulinlike growth factor (IGF)1 level
 Diagnosis
Other tests used in the evaluation of PCOS
include the following:
Androstenedione level
FSH and LH levels
GnRH stimulation testing
Glucose level
Insulin level
Lipid panel
 Diagnosis
Imaging tests The following imaging studies may
be used in the evaluation of PCOS:
Ovarian ultrasonography, preferably using transvaginal
approach
Pelvic CT scan or MRI to visualize the adrenals and
ovaries
 Diagnosis
Procedures An ovarian biopsy may be performed
for histologic confirmation of PCOS; however,
ultrasonographic diagnosis of PCOS has generally
superseded histopathologic diagnosis.
Endometrial biopsy may be obtained to evaluate
for endometrial disease, such as malignancy.
 Management
Lifestyle modifications are considered first-line
treatment for women with PCOS. Such changes
include the following :
Diet
Exercise
Weight loss
 Pharmacotherapy
Pharmacologic treatments are reserved for so-
called metabolic derangements, such as
anovulation
hirsutism
menstrual irregularities.

First-line medical therapy usually consists of an

oral contraceptive to induce regular menses.
 Pharmacotherapy
Medications used in the management of PCOS
include the following:
Oral contraceptive agents (eg, ethinyl estradiol,
medroxyprogesterone)
Antiandrogens (eg, spironolactone, leuprolide, finasteride)
Hypoglycemic agents (eg, metformin, insulin)
Selective estrogen receptor modulators (eg, clomiphene
citrate)
Topical hair-removal agents (eg, eflornithine)
Topical acne agents (eg, benzoyl peroxide, tretinoin topical
cream (0.020.1%)/gel (0.010.1%)/solution (0.05%),
adapalene topical cream (0.1%)/gel (0.1%, 0.3%)/solution
(0.1%), erythromycin topical 2%, clindamycin topical 1%,
sodium sulfacetamide topical 10%)
 Surgery
Surgical management of PCOS is aimed
mainly at restoring ovulation. Various
laparoscopic methods include the following:
Electrocautery
Laser drilling
Multiple biopsy
Etiology
Epidemiology
Prognosis
Patient Education
History
Physical Examination
Diagnostic Considerations
Differential Diagnoses
Approach Considerations
Screening Laboratory Studies
Hormone Levels
Imaging for PCOS
Histologic Findings
Approach Considerations
Lifestyle Modifications
Drug Treatment
FDA Safety Alerts
Metabolic Derangements
Medication Summary