pcos 5,6 true.ppt

7/28/2019 PCOS 5,6 true.ppt

1/21

MANAGEMENT OFHYPERANDROGENISM

ASSOCIATED WITHPOLYCYSTIC OVARY

SYNDROME


2/21

HYPERANDROGENISM

Clinical manifestations: Hirsutism Acne

alopecia


3/21

TREATMENT OF HIRSUTISM

Use of local cosmetic measures in conjunction withpharmacologic treatment will achieve a quick andoptimum response

Medical treatment Aims to reduce androgen levels Lower androgen production Augment androgen binding to specific plasma proteins Block androgen action at the level of the target tissue.


4/21

ORAL CONTRACEPTIVES Estrogen component:

suppresses LH and ovarian androgen production Enhances hepatic production of SHBG, thus reducing free and

unbound fraction of plasma testosterone Drospirenone + ethinyl estradiol


5/21

ANTI-ANDROGENS Cyprotenone acetate + ethinyl estradiol

Inhibits binding of testosterone to the androgen recetor

Spironolactone, flutamide, finasteride


6/21


7/21

TREATMENT OF ACNE

RETINOIDS Elimination of microcomedones by preventing the

inflammatory stages Topical retinoid + antimicrobial

Target abnormal follicle keratinization P. acnes proliferation Inflammation Increased sebum production


8/21

ORAL CONTRACEPTIVES Increase hepatic synthesis of SHBG, decreases free serum

testosterone Inhibit FSH and LH production, decreases ovarian androgen

synthesis OCP + dropirenone


9/21

ANTI-ANDROGENS Cyprotenone acetate + ethinyl estradiol Spironolactone


10/21

TREATMENT OF ALOPECIA

TOPICAL MINOXIDIL Efficacy can be assessed 6-12months of treatment

ANTIANDROGENS Not FDA approved

HAIR SURGERY


11/21

MANAGEMENT OF

INFERTILITY ASSOCIATEDWITH POLYCYSTIC OVARYSYNDROME


12/21

LIFESTYLE MODIFICATIONS

Obesity adversely affects reproduction and isassociated with anovulation and pregnancy loss

Obesity adversely affects reproduction and is

associated with late pregnancy complications Obesity is associated with diminished response to

clomiphene citrate treatment or laparoscopicovarian drilling


13/21

Obesity is associated with diminished response togonadotropin therapy

BMI 20-25kg/m2 Weight loss Diet and exercise


14/21

CLOMIPHENE CITRATE

Induction of ovulation in most anovulatory womenwith PCOS

Patient selection: body weight/body mass index,

female, age and the presence of other infertilityfactors Ovulation rate: 75-80% Conception rate: 22% per cycle Limited to the minimum effective dose and to no

more than 6 ovulatory


15/21


16/21

INSULIN-SENSITIZING AGENTS

Less effective than CC in inducing ovulation Metformin + CC provides more benefit than using CC alone


17/21

Gonadotropins Laparoscopic ovarian drilling 2nd line intervention

Starting dose: 37.5-75IU/day Human menopausal gonadotropins Urinary FSH Recombinant FSH


18/21

Strict cycle cancellation should be agreed uponwith the patient before ovulation induction therapyto avoid potential higher order multiple

pregnancies and ovarian stimulation syndrome


19/21

Laparoscopic Ovarian Drilling No risk of hyperstimulation syndrome or higher order multiple

pregnancy Indications:

Cc resistance develops Those who require gonadotopin treatment but who cannot be

monitored PCOS women who require laparoscopic assesment


20/21

ASSISTED REPRODUCTIONTECHNIQUES

Intrauterine insemination Indications:

Women with PCOS and an associated male factor Women with PCOS who failed to conceive after maximum of 6

successful induction of ovulation


21/21

In-Vitro Fertlilization Indications:

Tubal damage Endometriosis Male factor infertility

GnRH agonist + GnRH antagonist redces the risk of OHSS Metformin prior to or during IVF decreases the risk of OHSS

pcos 5,6 true.ppt

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