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Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome
ROTTERDAM CRITERIA
Presence of 2 out of 3
Hyperandrogenism
-Acne, Androgenic alopecia, Hirsutism
(Testosterone, Dehydroepiandrosterone)
Ovulatory dysfunction
-Oligomenorrhea, Amenorrhea
Polycystic Ovary
-26 follicles, 2-8mm, or ovary volume >10mL
COMMON COMORBIDITIES
- Metabolic syndrome
- 1/2 are Obese
- Increased risk for Cardiovascular disease
- 4-fold increase in risk of T2DM
- Increased prevalence of NAFLD, Sleep apnea,
dyslipidemia
- Mood Disorders
PCOS in adolescence
- Anovulation common in menarche, work-up for PCOS
PATHOPHYSIOLOGY delayed for 2 years since onset of oligomenorrhea
- Altered LH action, insulin resistance, possible - Must meet all 3 in ROTTERDAM CRITERIA before
predisposition to hyperandrogenism diagnosis and work-up
- Insulin resistance exacerbates hyperandrogenism by: TREATMENT
--suppressing synthesis of sex hormone-binding globulin -Individualized based on patient’s presentation and
--increasing adrenal and ovarian synthesis of androgens desire for pregnancy
--thereby increasing androgen levels
- These androgens lead to irregular menses and physical Anovulation and infertility
manifestations of hyperandrogenism - Lifestyle modification and weight reduction reduce
insulin resistance and significantly improve ovulation
- Lifestyle modification considered first-line therapy for
women who are overweight
Clomiphene – Selective Estrogen Receptor Modulator
(SERM)
- Triggers the pituitary gland to secrete an increased
amount of FSH and LH luteinizing hormone. This action
stimulates the growth of the ovarian follicle and thus
initiates ovulation
Letrozole – Aromatase inhibitor, Antiestrogen
- stops androgens from being converted into estrogen.
Deceased estrogen pituitary produces more FSH
- Recent studies show that Letrozole is associated with
higher live-birth rates and ovulation compared to
clomiphene
-Metformin – Controversial
Some studies show it confers no additional benefit
Irregular menses
- If not seeking pregnancy, Hormonal Contraception is
initial medication for both irregular menses and
hyperandrogenism manifesting as acne and hirsutism
- No superiority in different classes of Oral
Contraceptives in treating PCOS
-Metformin – Controversial
Studies have shown metformin can restore regular
menses but Oral Contraceptives are superior
Hirsutism
- Oral contraceptives most effective first-line therapy
for mild hirsutism
- Spironolactone – Aldosterone Receptor Antagonist,
Potassium Sparing Diuretic
Spironolactone, in daily doses of 50-200 mg, blocks
androgen receptors. Spironolactone also decreases
testosterone production, making it additionally effective
for hirsutism.
- Flutamide – Anti-androgen, Androgen Receptor
Antagonist
Effectiveness is minimal
Acne
- Hormonal Contraceptives first line + Topical Acne
Therapy (Retinoids, Antibiotics, Benzoyl Peroxide)
- Anti androgens, Spironolactone can be added