Polycystic Ovary Syndrome Ding Ding M.D., Ph.D. Department of Obstetrics & Gynecology

Ob/Gyn Hospital

Fudan Unoversity

PCOS 2

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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Genetic Predisposition

Aging

Pregnancy

Drugs

Lifestyle

Insulin Resistance

Insulin Resistance

HyperinsulinemiaHyperinsulinemia

Altered Fat MetabolismAltered Fat Metabolism

Altered Steroid Hormone MetabolismAltered Steroid Hormone Metabolism

PCOS: Acne, hirsutism, Hyperandrogenism, infertility

PCOS: Acne, hirsutism, Hyperandrogenism, infertility

Adapted from Cristello F et al, Gynecological Endocrinology, 2005.

Android Obesity

Android Obesity

↑ Lipid Storage↑ Lipid Storage

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Pathology Ovaries:bilateral enlarged and/or polycystic o

varies

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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What Are the Symptoms of PCOS? Oligomenorrhea:

Reduction in frequency of menses

Between 35 days and 6 months.

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Symptoms Hirsutism : Excessive bo

dy hair. In women with PCOS dark, coarse hair will appear on the face, neck, chest, intergluteal, axillary and pubic area.

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Symptoms Obesity

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Symptoms

Acne : Because women with PCOS are producing more androgen, 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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Other Symptoms “Dirty Skin” or Acanth

osis Nigricans : This condition causes light brown to black rough patches around the neck and under arms.

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Diagnosis BBT (basal body temperature) Ultrasound:

multiple small ovarian follicles

enlarged ovaries Endometrium biopsy(Curettage )

before menses reveal to proliferative glands

Elevated free testosterone LH:FSH 3:1≧ 10-30% hyperprolactinmia hyperinsulinmia Laparoscopy

PCOS 11Balen AH et al4

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Polycystic Ovary

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PCOS: Metabolic Disorder Insulin Resistance

High association with PCOS 10% have Type 2 Diabetes 30%-35% have Impaired Glucose Tolerance (IGT)

Obesity 50% of PCOS patients are obese

Amplifies biochemical and clinical abnormalities of PCOS

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PCOS: Long-term Risks Cancer

Chronic anovulatory, persistently elevated estrogen levels, uninterrupted by progesterone, PCOS women found an increased risk of endometrial cancer

The risk of ovarian cancer is also increased two-to three fold

Cardiovascular Disease PCOS is characterized by endothelial dysfunction and resi

stance to vasodilating action of insulin Increased risk of myocardial infarction in PCOS women t

han age-matched controls

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Sleep Apnea Increased Sleep Disordered Breathing (SDB) and

daytime sleepiness in PCOS vs. controls

Depression Higher prevalence in PCOS patients, associated with

higher body mass index (BMI, P=0.05) and greater insulin resistance (P=0.02)

PCOS: Metabolic Disorder

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Pregnancy Complications Spontaneous Abortions

Increased in high BMI/PCOS patients

Impaired Glucose Tolerance

Gestational Diabetes

Hypertension

Small for Gestational Age

Wang JX et al, Human Reproduction, 2001.

Turhan NO et al, International Journal of Gynecology & Obstetrics, 2003.

Bjercke S et al, Gynecologic and Obstetric Investigation, 2002.

Weerakiet S et al, Gynecological Endocrinology, 2004.

Sir-Petermann T et al, Human Reproduction, 2005.

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Treatment: Weight Loss

calorie-restricted diets Exercise a 5% reduction in body mass was still able to

restore ovulation Six month weight-loss program for overweight

anovulatory women Lost an average of 6.3 kg (13.9 lbs) Decreased fasting insulin and testosterone levels 92% resumed ovulation (12/13) 85% became pregnant (11/13) Clark AM et al, Human Reproduction, 1995.

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Treatment Fertility Treatment

If pregnancy is desired ------ induce ovulation

Clomiphene Citrate Anti insuline resistance-Metformin 1000-1500mg/d

anti-androgens

Laparoscopic ovarian drilling (LOD): reduce ovarian sourced androgen

IVF

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Laparoscopic Ovarian Drilling Lasers burn holes in

enlarged follicles Stimulates ovulation

by reducing LH and androgen

Improve local microcirculation

Mayo Clinic 2006

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If pregnancy is not desired

to reduce the risk of endometrial cancer ( birth control pills)

OC: Diane-35: reduce LH and androgencyclical progesterone (Medroxyprgesterone)Anti insuline resistance-Metformin 1000-1500mg

/d, GlucophageAnti-androgens

Treatment

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Case presentation 22 y.o. college student, do not want to conceive Obese, oligomenorrhea, LMP: 3 months ago Hirsutism at face, axillary and pubic area Face acne Testosterone is mildly elevated DHEAS is normal LH 35mIU/ml, FSH 9 mIU/ml

Examination? Diagnosis? Treatment?

Ding Ding M.D., Ph.D. Department of Obstetrics & Gynecology

Ob/Gyn Hospital

Fudan Unoversity

Thanks for Your Attention