POLYCYSTIC OVARIAN SYNDROME (PCOS)

POLYCYSTIC OVARIAN SYNDROME (PCOS)

Dr Shazia Jabbar
Assistant Professor
Faculty of Obs Gyn
DMC/ DUHS
LEARNING OBJECTIVES

At the end of the lecture students should be able to:

Explain the Etiology of PCOs
Describe the Pathophysiology of PCOs
Establish the Diagnosis of PCOs
Discuss Consequences and management of PCOs.

PCOS is the most common cause of chronic anovulatory

amenorrhoea.
It is characterized by amenorrhoea or oligomenorrhoea ,
physical signs of hyperandrogenism( hirsutism, acne) and the
presence of enlarged polycystic ovaries.

ETIOLOGY
It is a complex heterogenous disorder of uncertain etiology
It is genetic disease as studies of family members of PCOS pts
indicate that an autosomal dominance mode of inheritance
occurs

PATHOPHYSIOLOGY
Combination of
exaggerated pulsatile GnRH secretion causing elevated circulating
Lutenizing hormone & an increased LH/FSH ratio
hypersecretion of androgens, disrupts follicle maturation & is a
substrate for peripheral aromatization
 negative feedback inhibition on pituitary leading to reduced FSH
secretion
defect in insulin signaling for glucose transport and lipolysis
causing
insulin resistance

Diagnosis
Based on clinical & biochemical evaluation

Classical features of oligo/amenorrhoea with obesity& or

clinical symptom of hyperandrogenism in addition to U/S
features of PCO ( polycystic ovary 2-8 mm 10 or more cysts
arranged around echodensestroma) are diagnostic of PCOS.

Investigations
Fasting serm insulin levels
Serum FSH/LH ratio
Serum prolactin
 Serum lipid profile
Fasting blood sugar
SHBG
Serum androgens
Testosterone
Androstenedione
DHEAS
17 OH progesterone

Consequences
Long term consequences
DM
Cardiovascular disease
Dyslipidemia
Psychological d/t (obesity, hirsutism, infertility)

Risk of malignancy
Endometrial
ovary

Management
Treatment of PCOS aims to
reduce insulin resistance
Establish ovulation when fertility is desired
To prevent prolonged unopposed estrogen activity during
anovulation & its associated risk for endoometrial hyperplasia &
cancer
Antiandrogens to treat acne &hirsutism

1 Non medical
Lifestyle modification ( wt loss, altered diet,exercise, altering
psychological attitude)
2 medical
a Metformin for treating Hyperinsulinemiawill prevent DM , gestational
DM miscarriages & regulates cycles
b Anti androgens ( cyproterone acetate)

Menstrual irregularity:
non medical regime
Metformin
COCP

Subfertility
Clomiphene citrate
PCOS is health problem affecting 7- 10% reproductive age
group women
It is important to address this issue early as the best
treatment is prevention.

THANK YOU