06/27/2017

Polycystic Ovarian Syndrome: PCOS

By Dr.Narumalar MBBS., DGO, MS - General Surgery - Sun Jun 05, 8:45 pm

POLYCYSTIC OVARY SYNDROME

The commonest endocrine disorder affecting women
Incidence – 6 to 10% of reproductive age group

Presence of any of the following two criteria defines PCOS:
Ultrasound appearance of polycystic ovaries
Menstrual disturbances – amenorrhoea or oligomennorrhoea
Evidence of hyper androgenism – acne, hirsutism etc.
Prevalence of PCOS is rising because of increasing obesity.

Environmental factors suggested for PCOS are:

Intrauterine insult (genetic variants)
Dietary habits (Hi-calorie diet, increased fat in diet, increased glucose in diet insulin resistance
Sedentary life style
Ethnicity

Conditions associated with PCOS:

Obesity
Gestational Diabetes
Metabolic Syndrome

Consequences associated with PCOS:

Hyperinsulinemea and Hyperandrogenism
Type II Diabetes / Insulin resistance
High Blood pressure
Dyslipidemea
Cardiovascular disease
Stroke
Weight gain
Acanthosis nigricans
Auto immune thyroiditis
Cerebrovascular accidents
Recurrent spontaneous abortion
Sleep apnoea
Endometrial hyper plasia and cancer

Standard Diagnostic Assessments

History taking
USG abdomen
Laparoscopic examination
Serum FSH, LH, Prolactin, 17 (OH) Progesterone, Testosterone, Insulin, Blood Glucose, LH / FSH ratio, Serum TSH

Management:

For menstrual disturbances and desire for contraceptions – Low Dose oral contraceptive pills. This inhabits LH, decreases the circulating levels of androgens, increases sex hormone binding globulin hence decreases free circulating testosterone and decreases DHEAS levels if DHEAS is more than 5ng /ml oral dexamethasone 0.25 to 0.5mg per day is advised.
The combination pill can be a low dose Oestrogen and a non-androgenic progesterone or an anti androgen (cyproterone acetate).
For added cycle regularization Dydrogestrone can be given from 14th to 28th day.

Hirsutism:
Electrolysis and Laserphoto thermolysis can be done – though not permanent.
Suppression of androgens using oral contraceptives

Choice of Medication:

If increased Testosterone —- Oral Contraceptive Pills
If increased DHEAS 5ng /ml —- Oral contraceptives and Dexamethaxone
If increased Testosterone and
DHEAS more than 7 ng/ml —– Oral contraceptives and Dexamethaxone

If increased 3alpha DiaolG,
normal testosterone and normal DHEAS —– Spironolactone

Acne:

Topical and systemic retinoids
Topical antibacterial agents
Androgen suppression by OC and antiandrogenic drugs
The antiandrogen receptor blockers —– Spironolactone, cyproterone acetate and
Fluitamide can be combined with OC for
optimal results
Dys functional Uterine Bleeding:
T. Medroxy Progesterone acetate 10 mg daily from day 15th to day 25th

Infertility:

T. Letrozole 2.5mg – 5mg per day from Day 2 to Day 7th has higher pregnancy rate than clomiphene citrate 100 mg per day.
T. Letrozole avoids the effect on the endometrium.
For improved results ovulation induction, sonographic monitoring of ovulation, timed intercourse or intrauterine insemenition are recommended.
Step up and step down protocols using FSH
IVF results improved with LEOS therapy (Laproscopic Electro Coagulation of ovarian surface). LEOS is successful in clomiphene citrate resistant cases.
IVF treatment of infertility in PCOS patients are related to Oocyte quality, risks of hyperstiumulation, endomaterial receptivity implantation and multiple pregnancy.

Long Term Sequences of PCOS:

Metabolic SyndromeCardio vascular disease
Impaired glucose tolerance and diabetes
Endomatrial cancer

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