PCOS – POLYCYSTIC OVARIAN SYNDROME

What is PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal disorder. Depending on diagnostic criteria, 6% to 20% of young women are affected. Features of Polycystic ovary syndrome can be noticed during the early adolescent years. Both normal female features of development and PCOS seem to have irregular menstrual cycles, anovulation, and acne. 
Women with this disorder may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels.
The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.
Polycystic ovary syndrome constitutes 90% of anovulation
6-8% of all woman in the reproductive age group
Leading cause of infertility in women

How polycystic ovarian syndrome is diagnosed?

Diagnostic criteria
Rotterdam’s criteria for the diagnosis of Polycystic ovary syndrome
Oligo/anovulation
Clinical/biochemical evidence of hyperandrogenism
Polycystic ovaries on USG (>12 small antral follicles in an ovary)

Investigation

Examination
BMI
Hirsutism
Lab-testosterone, SHBG, thyroid prfile, PRL, GTT, lipid profile, FSH, LH, E2
Transvaginal ultrasonography- pco in one or both ovaries, >=12follicles 2-9 mm or increased ovarian volume >10ml

What causes PCOS?

Iatrogenic – surgical, radiotherapy, chemotherapy
Autoimmune
X chromosome abnormalities
Infections – herpes, cytomegalovirus
FSH,LH receptor mutations
Food habits

Clinical features

Hyperandrogenism
Hirsutism
Acne
Androgenic alopecia
Menstrual irregularity
Oligomenorrhea (70-75%)
Amenorrhea (20%)
Infertility (30-70%) 
Obesity
Insulin resistance
Acanthosis nigricans
Skin tags
Impaired Glucose tolerance
Type 2 DM 2

Not all symptoms may be present but the severity of each symptom varies

Long term risks of PCOS

Diabetes
Cardiovascular risks
Hypertension
Dyslipidemia
Endometrial cancer
Breast cancer
Recurrent pregnancy loss
Ovarian failure after surgery
Obstructive sleep apnea
Malignancy risks

Clinical representation of women in PCOS

PCOS and infertility
Ovulation
Fertilization
Implantation
Fetal viability
Healthy liveborn
Poor oocyte quality
Endometrial abnormality
Effects of hyperinsulinemia
Effects of gestational diabetes and hypertension

Adolescent PCOS management

A simple and healthy diet
Weight reduction,5% in 6 months
Lifestyle modification
Hormone therapy
Ovulation induction
Bariatric surgery
Vit – D

Treatments

Treatment for infertility
5-10% pregnancy rate
Donor oocyte program