1 / 26

PCOS

PCOS FOR MEDICAL STUDENT PRESENTATION

sagar145
Download Presentation

PCOS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PCOS(Poly Cystic Ovarian Syndrome) DR. SAGAR D DHERANGE MS OBGYN-A

  2. Irving F. Stein, Sr., Michael L. Leventhal Stein Leventhal Syndrome (1935)

  3. WHY TO STUDY • HIGH PREVALANCE RATE • COMMONEST ENDOCRINE DISORDER DURING REPRODUCTIVE AGE • COMMONEST CAUSE OF INFERTILITY • COMMONEST TREATABLE CAUSE OF INFERTILITY , IF DIAGNOSED • COMMONEST COMPLAINT IN UNMARRIED PATIENTS OF GYNAECOLOGY • OFTEN ASSOCIATED WITH OBESITY, HIRSUITISM, INFERTILITY , ENDOCRINOPATHY

  4. PREVALANCE • (AS PER WHO, 7 February 2025) • Polycystic ovary syndrome (PCOS) affects an estimated 6–13% of reproductive-aged women. • Up to 70% of affected women remain undiagnosed worldwide. • PCOS is the commonest cause of anovulation and a leading cause of infertility.

  5. PREVALANCE IN INDIA • prevalence of PCOS from 2010 to 2021- • close to 10% using Rotterdam's criteria and AES criteria • while it was 5.8% using the NIH criteria. (1) • Amongst infertile women, about 20% infertility is attributed to anovulation caused by PCOS.(2)

  6. DEFINATION It is a heterogeneous condition characterized by menstrual irregularity, hyperandrogenism, obesity and polycystic ovaries on ultrasound.(3)

  7. AETIOLOGY • EXACT CAUSE- UNKNOWN • Risk FACTORS • change in lifestyle, diet and stress • Genetic factors - CYP21 gene mutation • familial factors - X-linked dominant mode of inheritance • environment factors- in the utero or in early adolescent life,

  8. Pathological events • 1) HPO - abnormality • 2) Hyperandrogenism • 3) Insulin Resistance • 4) Anovulation • 5) Obesity

  9. MAIN CULPRIT • Insulin resistance • Reduced insulin reception activity peripherally insulin resistance • Hyperandrogen • Enhanced serine phosphorylation unification activity in the ovary

  10. Pathophysiology of pcos (4)

  11. Diagnostic criteria ESHARE (Rotterdam) 2003 • Irregular menses • Hyper Androgenism • Polycystic appearance on USG

  12. Diagnostic criteria ESHARE (Rotterdam) 2003 • Any 2 of following 3 to be present • 1) Oligo or Anovulation • 2) Clinical or biochemical hyperandrogenism • 3) Polycystic Ovaries on Ultrasound • 12 or more follicles • Each follicle 2-9 mm in diameter • Necklace pattern of follicles • Ovarian volume > 10 cm³

  13. Rotterdam Criteria 15 August 2023 • any 2 of the following 3 criteria • 1. Anovulation presented as amenorrhea or oligomenorrhea • 2. Hyperandrogenemia (excess of androgens/testosterone) or hyperandrogenism presented as hirsutism • 3. PCOM - Polycystic Ovarian Morphology on USG meaning volume of each ovary more than 10 ml and /or number of follicles greater than 20 (size 2-9mm).

  14. Clinical features • 1) Menstrual Abnormality- oligomenorrhoea, Amenorrhoea or DUB • 2) Obesity • 3) Hirsuitism • 4) Acne, Alopecia • 5) Viralism • 6) Acanthosisnigricans- Thickening & pigmentation of skin at nape of neck, inner thighs, groins, axilla due to insulin resistance

  15. HAIR-AN syndrome • 1) Hyper Androgenism. • 2) Insulin Resistance • 3) AcanthosisNigricans.

  16. Endocrine Abnormalities 1) Elevated LH 2) Normal FSH 3) Elevated LH: FSH Ratio (>3:1) 4) Elevated Androgen 5) Low SHBG (Sex hormone Binding Globulin) 6) Mildly elevated prolactin 7) Elevated fasting insulin 8) Abnormal glucose tolerence test 9) Dyslipidaemia

  17. Complications • 1) Obesity • 2) Dyslipidaemia • 3) Diabetes mellitus • 4) Coronary heart disease • 5) Endometrial & Breast cancer

  18. WHAT INVESTIGATION HAS TO BE DONE…? • BODY MASS INDEX • SR INSULIN • SR FSH • SR LH • SR TESTOSTERONE • SR SHBG • SR PROLACTIN • THYROID FUNCTION TEST • HBA1C • LIPID PROFILE • SR AMH

  19. Management • 1) Weight Reduction • INTERMITTENT FASTING • EXERCISE

  20. 2) Combined OCP • Desogesterol + Ethinyl estradiol- Tab Femilon • Cyproterone Acetate + Ethinyl estradiol Tab Krimson • Drospirenone + Ethinyl estradiol Tab Dronis

  21. 3) Insulin sensitizers • Metformin 500 mg OD - Tab Glycomate • Myoinositol & D ChiroInositol Vit D3 - Tab OvacetForte • Berberin Extract Myoinositol & D Chiro Inositol Vit D3 Tab Beritol

  22. Treatment for Hirsutism • Anti Androgens- Cyproterone • Laser techniques

  23. Treatment for infertility • Ovulation induction – letrozole, clomiphene citrate

  24. Surgery – Laproscopic Ovarian Drilling • Bariatric Surgery

  25. References • BharaliMD, Rajendran R, Goswami J, Singal K, Rajendran V. Prevalence of Polycystic Ovarian Syndrome in India: A Systematic Review and Meta-Analysis. Cureus. 2022 Dec 9;14(12):e32351. doi: 10.7759/cureus.32351. PMID: 36628015; PMCID: PMC9826643. • Howkins & bourne, Shaws Textbook of Gynaecology , Elsevier Publication ,16th Edition , Page No 431 • Lakshmi sheshadri, Essentials of Gynaecology, second edition, Wolters Kluwer (India) , Page No 268 • Sagar Dherange, Smita Chodankar, A Concise Textbook Of Obstetrics & Gynaecology, Walnut Publication October 2024, Page No 470

  26. Thank You

More Related