POLYCYSTIC OVARIAN

SYNDROME
By: Saleen Khan

EPIDEMIOLOGY

Can occur in women of reproductive age (11-45)

Between 1 in 10 and 1 in 20 women of childbearing age

has PCOS

As many as 5 million women in the United States may

be affected

PATHOPHYSIOLOGY

Increased pulsatile release of GNRH from hypothalamus

Increased LH/FSH release

Increased LH Increased androgen production in Theca cells

Hirsuitism

Decreased FSH Inability for follicle to mature

Inability to release Progesterone

Increased Testosterone Increased aromatization of adipocytes

Increased estrogen

Unopposed estrogen follicles frozen in tertiary/antral phase

annovulation cysts

SYMPTOMS

Hirsuitism
Polycystic Ovaries
Acne
Anovulation Infertility
Oligomenorrhea/Amenorrhea
Obesity
Low Adiponectin Insulin Insensitivity
Hyperinsulinism Low SHBG Increased free Testosterone
Alopecia
Dyslipidemia
Hypertension
Oily Skin

DIAGNOSIS

In 2003 a consensus workshop sponsored by ESHRE in Rottardam

indicated PCOS to be present if any 2 out of 3 criteria are met
Oligoovulation and or Anovulation
Excess androgen activity
Polycystic ovaries (by gynecologic ultrasound)
Other entities are excluded that would cause these

In 2006, the Androgen Excess PCOS Society suggested a

tightening of the diagnostic criteria to all of:
Excess androgen activity
Oligoovulation/anovulation and/or polycystic ovaries
Exclusion of other entities that would cause excess
androgen activity

EXCLUSION OF OTHER
DISEASES

Oral glucose tolerance

Fasting glucose
Fasting insulin
TSH
Pregnancy Test
Lipid Panel
Hormonal Panel
Serum Prolactin
Low Dose Dextamethasone Test
Urine Free Cortisol

DIFFERENTIALS

Hypothyroidism
CAH 21 Hydroxylase Deficiency
Cushings Syndrome
Hyperprolactinemia
Diabetes Mellitus

TREATMENT

Insulin Resistance Metformin & Glitazones

Obesity Weight loss (Most effective treatment)

Scientific Review 2013 shows improved
hyperandrogenism, insulin resistance, lipids, mentrual
regularity.

Infertility Clomophine Citrate (Inhibits Estrogen in

hypothalamus)

Hirsuitism Spironolactone (Androgen receptor

antagonist) or BCP (Down regulate FSH/LH release)

ALTERNATIVE

Myo-Inositol proven to help relieve symptoms

Sold as supplement under the name Inositol

Exercise!

Weight targets/BMI targets

Vitamin D levels help prevent metabolic syndrome

Carb intake from fruits, vegetables and whole wheat

POSSIBLE COMPLICATIONS
Endometrial Hyperplasia
Endometrial Cancer
Hypertension
Depression
Cardiovascular Disease
Sleep Apnea
Fatty Liver Disease
Autoimmune Thyroiditis

SOURCES

http://www.medicinenet.com/polycystic_ovary/page3.htm#
how_is_pcos_diagnosed
http://www.nlm.nih.gov/medlineplus/ency/article/000369. htm
http://emedicine.medscape.com/article/256806-overview# aw2aab6b2b3
http://www.mayoclinic.org/diseases-conditions/pcos/basics/tests-diagnosi
s/con20028841
http://www.womenshealth.gov/publications/our-publications/fact-sheet/po
lycystic-ovarysyndrome.html
http://www.webmd.com/women/tc/polycystic-ovary-syndrome-pcos-topicoverview