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

“Vicious cycle”Abnormal gonadotropin secretion

Excess LH and low, tonic FSHHypersecretion of androgens

Disrupts follicle maturationSubstrate for peripheral aromatization

Negative feedback on pituitaryDecreased FSH secreation

Insulin resistance, Elevated insulin levels

What we think we know.

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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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SymptomsHirsutism : Excessive bod

y 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 Acanthosi

s 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 ovaryEndometrium biopsy(Curettage )

before menses reveal to proliferative glands Determination of LH,FSH,E2,P,T,PRL， Ins， (LH:FS

H 3:1)≧Laparoscopy

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TreatmentIf 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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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.

Treatment

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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.

DI WEN M.D., Ph.D.

Professor & Chairman

Department of Obstetrics & Gynecology

Renji Hospital Affiliated to SJTU School of Medicine

Thanks for Your Attention