Polycystic Ovary Syndrome

DI WEN

M.D., Ph.D.,

Professor & Chairman

Department Of Obstetrics & Gynecology
Renji Hospital Affiliated to SJTU School of Medicine

Introduction
Definition: polycystic ovary syndrome
(PCOS) is a generic description for a broad
spectrum of clinical and morphological
findings in women with an endocrine
dysfunction,
specifically
abnormal
androgen production and metabolism.
PCOS was first identified by Stein and
Leventhal in 1935 so that it can also be
known as Stein Leventhal Syndrome.
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PCOS

Etiology & Pathopysiology

What we think we know.
Vicious cycle
Abnormal gonadotropin secretion
Excess LH and low, tonic FSH

Hypersecretion of androgens
Disrupts follicle maturation
Substrate for peripheral aromatization

Negative feedback on pituitary

Decreased FSH secreation

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Insulin resistance, Elevated
insulin
levels
PCOS

Pathology
Ovaries: enlarged and/or polycystic
ovaries

endometrium: Lack of ovulation for an

extended period of time may cause
excessive thickening of the endometrium
(the lining of the uterus).
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PCOS

Pathology

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PCOS

What Are the Symptoms of PCOS?

Irregular

or Lack of
Menses: Women will have
spotty periods (1 every
couple of months). Also, in
some women with PCOS they
simply cease having a menses
at all.

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PCOS

Symptoms
Hirsutism

Excessive
body hair. In women with
PCOS dark, coarse hair
will appear on the face,
neck, chest, arms, and in
between the legs.

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PCOS

Symptoms
Weight Problems :
Depending on the
woman, there could be
a decrease of weight or
a rapid fluctuation of
weight that settles
around the stomach
that will lead to morbid
obesity.
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PCOS

Symptoms
Acne : Because women
with
PCOS
are
producing more male
hormone, that produces
more sebum ( skin oils
and old tissue) and
causes blocked pores
and more acne around
the jawline, arms and
chest.

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PCOS

Symptoms
Alopecia or Female

Pattern Baldness :
This is caused by the
increase of male hormone
in the women's body.
Thinning or loss of hair is
usually contained to top of
the scalp, but in severe
cases loss of hair in front or
on the hairline has been
documented.

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PCOS

10

Other Symptoms
Dirty Skin or Acanthosis
Nigricans : This condition
causes light brown to black
rough patches around the
neck and under arms.
Migraines
:
Severe
headaches that cause light
sensitivity, nausea and
dizziness.
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Diagnosis
BBT (basal body temperature)
B ultrasound:
multiple small ovarian cysts
enlarged ovary
Endometrium biopsy(Curettage )
before menses reveal to proliferative glands
Determination of LH,FSH,E2,P,T,PRL Ins
(LH:FSH 3:1)
Laparoscopy

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Treatment
If pregnancy is desired ------ cause ovulation
anti-estrogens(clomiphene)
Gonadotropins
insulin-lowering agents
anti-androgens (agents that lower
androgen levels)
gonadotropin releasing hormone
agonists (GnRHa)

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Treatment
If pregnancy is not desired
to reduce the risk of endometrial cancer ( birth
control pills)
cyclical progesterone (MPA, Provera)
insulin-lowering agents (metformin ,Glucophage)
anti-androgens.
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Long Term Effects: Infertility

Many women experience infertility while
having PCOS.
Many will have to go to an fertility doctor to
conceive.
To conceive women with PCOS have to
learn to monitor ovulation by taking their
Basal Body Temperature (BBT) and
examining cervical mucus.
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PCOS

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Long Term Effects: Heart Disease

There is new evidence that finds women
with PCOS are at a higher risk for
metabolic cardiovascular disease.

Both diseases are characterized by insulin

resistance, high blood pressure, and obesity.

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Thanks for Your Attention

DI WEN

M.D., Ph.D.

Professor & Chairman

Department of Obstetrics & Gynecology
Renji Hospital Affiliated to SJTU School of Medicine