PREPARED BY

SADHANA REDDY

MANAGEMENT OF POLYCYSTIC OVARIAN

SYNDROME

TABLE OF CONTENTS• Introduction• History • Signs and symptoms• Causes• Diagnosis• Pathogenesis• Treatment• Conclusion

INTRODUCTION

• Polycystic ovary syndrome (PCOS) is a hormonal condition that can impact on physical and emotional health.

• Polycystic ovary syndrome (PCOS) is also called as hyperandrogenic anovulation (HA) or Stein-Leventhal syndrome.

HISTORY

• The condition was first described in 1935 by American gynecologists Irving F. Stein, Sr. and Michael L. Leventhal, from whom its original name of Stein-Leventhal syndrome is taken.

• The earliest published description of a person with what is now recognized as PCOS was in 1721 in Italy. Cyst-related changes to the ovaries were described in 1844.

SIGNS AND SYMPTOMS

Common symptoms of PCOS include the following:• Menstrual disorder• Infertility• Genetic link• High levels of masculinizing hormones• Metabolic syndrome

HIGH LEVELS OF MASCULINIZING HORMONES• The most common signs are acne and hirsutism (male pattern of

hair growth)

• But it may produce hypermenorrhea (heavy and prolonged menstrual periods), androgenic alopecia (increase hair thinning or diffuse hair loss), or other symptoms. Approximately three-quarters of people with PCOS have evidence of hyperandrogenemia.

ACNE Hirsutism

METABOLIC SYNDROME

• Metabolic syndrome is a disorder of energy utilization and storage.

• This appears as a tendency towards central obesity and other symptoms associated with insulin resistance. Serum insulin, insulin resistance, and homocysteine levels are higher in women with PCOS.

CAUSES

• The exact cause of PCOS remains unclear, but both genetics and lifestyle contribute.

GENETICS LIFESTYLE

HORMONAL CHANGES

GENETICS

HORMONAL CHANGES

INSULIN

Ovarian follicles /anovulation / oestrogen

Diabetes

Cardiovascular risk

factors / metabolicsyndrome

Menstrual disturbancesHirsutism / acne

Psychosocial issues: body image, self esteem, depression, anxiety

LIFESTYLE/OBESITY

ANDROGENS

DIAGNOSIS

There is no single feature that leads to a diagnosis of PCOS. A diagnosis is confirmed if two of these three features (without any other causes) are present:

1. Hyperandrogenism (higher levels of male type hormones in the blood)

2. Menstrual problems (e.g. lack of a period or irregular periods)

3. Polycystic ovaries (follicles) present on ultrasound.

Polycystic Ovary as seen on Sonography

Transvaginal ultrasound scan of polycystic ovary

PATHOGENESISPolycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), in particular testosterone, by either one or a combination of the following (almost certainly combined with genetic susceptibility):

• The release of excessive luteinizing hormone (LH) by the anterior pituitary gland

TREATMENT

Medical treatment of PCOS is tailored to the woman's goals. In broad terms, these may be considered under four categories:• Lowering of insulin resistance levels• Treatment of hirsutism or acne• Restoration of regular menstruation.

TREATMENT FOR HIRSUTISM AND ACNE• Drugs with anti-androgen effects such

as flutamide and spironolactone which can give some improvement in hirsutism. 

• Spironolactone is probably the most-commonly used drug in the US.

•  Eflornithine (Vaniqa) is a drug that is applied to the skin in cream form, and acts directly on the hair follicles to inhibit hair growth. It is usually applied to the face.

• For removal of facial hairs, electrolysis, or laser treatments are – at least for some – faster and more efficient alternatives than the above-mentioned medical therapies.

PCOS AND MEDICATIONSsome commonly used medications in the treatment of PCOS.

Metformin reduces insulin resistance and improves symptoms in PCOS. Benefits include:

• improves ovulation/cycles and can help with fertility (see reproductive health section)

• May prevent weight gain but does not cause weight loss

Oral contraceptive pill (OCP) are hormonal medications that are commonly prescribed for women with PCOS and has many actions such as:

• Reducing male type hormones and reducing excess hair

• Provides contraception

• Endometrium protection (by inducing menstruation) and cycle regulation

CONCLUSION

It is important to remember that effectively managing PCOS requires a lifelong focus which is aided by learning as much as possible about the condition. It is essential to understand the long term health risks associated with PCOS and to take preventive steps to reduce risk.

women who are educated about the condition, who feel understood and supported, will cope far better than those who are not.

Thank you