Polycystic Ovary Syndrome

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Polycystic Ovary Syndrome
DI WEN M.D., Ph.D.,
Professor Chairman
Department Of
Obstetrics Gynecology
Renji Hospital Affiliated to SJTU
School of Medicine
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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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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
• Insulin resistance, Elevated insulin levels

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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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Pathology
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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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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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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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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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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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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,(LHFSH?31
  )
• 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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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