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Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of childbearing age, affecting 6-10% of women. It is characterized by irregular or absent ovulation, signs of hyperandrogenism such as hirsutism or acne, and polycystic ovaries. The cause is not fully known but factors like genetics, insulin resistance, and obesity play a role. Treatment focuses on lifestyle changes like weight loss and medication to improve symptoms, regulate menstrual cycles, treat infertility, and prevent long term health risks like diabetes. Managing PCOS can be challenging and requires sensitivity to the psychological impact on patients.
Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of childbearing age, affecting 6-10% of women. It is characterized by irregular or absent ovulation, signs of hyperandrogenism such as hirsutism or acne, and polycystic ovaries. The cause is not fully known but factors like genetics, insulin resistance, and obesity play a role. Treatment focuses on lifestyle changes like weight loss and medication to improve symptoms, regulate menstrual cycles, treat infertility, and prevent long term health risks like diabetes. Managing PCOS can be challenging and requires sensitivity to the psychological impact on patients.
Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of childbearing age, affecting 6-10% of women. It is characterized by irregular or absent ovulation, signs of hyperandrogenism such as hirsutism or acne, and polycystic ovaries. The cause is not fully known but factors like genetics, insulin resistance, and obesity play a role. Treatment focuses on lifestyle changes like weight loss and medication to improve symptoms, regulate menstrual cycles, treat infertility, and prevent long term health risks like diabetes. Managing PCOS can be challenging and requires sensitivity to the psychological impact on patients.
women. • Responsible for 80% of all cases of anovulatory subfertility. • Estimated prevalence is 6–10% of women of childbearing age. • USS evidence of polycystic ovaries is seen in 20– 30% of women Rotterdam criteria for diagnosing PCOS
Requires the presence of two out of the following three
variables and exclusion of other disorders: Irregular or absent ovulation(cycle >42 days). Clinical or biochemical signs of hyperandrogenism: • acne • hirsutism • alopecia. Polycystic ovaries on pelvic USS: ≥ 12 antral follicles on one ovary. • Ovarian volume >10mL. Aetiology
The pathogenesis of PCOS is not fully known. There is hypersecretion
of LH in ~60% of PCOS patients (LH stimulates androgen secretion from ovarian thecal cells). Elevated LH:FSH ratio is often seen, but is not needed for diagnosis. The following factors have been implicated: Genetic (familial clustering). Insulin resistance with compensatory hyperinsulinaemia (defect on insulin receptor). Hyperandrogenism (elevated ovarian androgen secretion). Obesity: • BMI >30 in 35–60% of women with PCOS • central obesity • worsens insulin resistance Investigation
Basal (day 2–5): LH, FSH, TFTs, prolactin, and testosterone.
If hyperandrogenisim: • dehydroepiandrosterone sulphate (DHEAS) • androstenedione • SHBG. Exclude other causes of secondary amenorrhoea. • Pelvic USS. Examination • BMI. • Signs of endocrinopathy, hirsutism, acne, alopecia, acanthosis nigricans Long-term health consequences of PCOs
• Obesity, insulin resistance, and metabolic
abnormalities including dyslipidaemia are all risk factors for ischaemic heart disease • Type II diabetes is a known risk of obesity and insulin resistance, and pregnant women with PCOS are at increased risk of gestational diabetes • Long periods of s amenorrhoea, with resultant unopposed oestrogen, are a risk factor for endometrial hyperplasia and, if untreated, endometrial carcinoma. Polycystic ovarian syndrome: management
• The options should focus on the main concern
of the woman. • Lifestyle modification • This is the cornerstone to managing PCOS in overweight women. Even amodest weight loss (5%) can improve symptoms. Improving menstrual regularity
2) Antiandrogens such as eflornithine facial cream, finasteride, or spironolactone: • can be used to help with acne and hirsutism • can take 6–9mths to improve hair growth • avoid pregnancy (feminizes a male fetus). 3) COCP: • reduces serum androgen levels by increasing SHBG levels • co-cyprindiol combines ethinylestradiol and cyproterone acetate, providing a regular monthly withdrawal bleed and beneficial antiandrogenic effects . Subfertility
• Weight loss alone may achieve spontaneous ovulation.
• Ovulation induction with antioestrogens or gonadotrophins. • Laparoscopic ovarian diathermy. • IVF if ovulation cannot be achieved or does not succeed in pregnancy. Women with PCOS who undergo IVF are at increased risk of ovarian hyperstimulation syndrome • Insulin sensitizer Metformin has been most widely used • Metformin combined with ovulation induction with clomifene citrate increased ovulation and pregnancy rates • Does not significantly improve hirsutism, acne, or weight loss, despite lowering androgen levels and improving insulin sensitivity. Psychological issues
• PCOS can be difficult to manage and patients
may require additional motivation. • Symptoms can be distressing and result in low self-esteem. It is therefore important to manage patients sensitively