DR POURMATROUD [OB/GYN, INFERTILITY FELLOW
Women from menarche till menopause Could affected by this syndrome (poly Cystic ovary)
Causes of ovulatory dysfunction:
- hypothalamic anovulation
- premature and polycystic ovary syndrome
- age-related ovarian failure
- luteal phase defect (theoretical)
Causes 15% of infertility
Diagnosed by menstrual irregularities, basal body temperature charting, ovulation prediction kits, serum progesterone levels.
About 10-15 %
According to physical activity and wrong Diet, the prevalence are increasing among all of societies.
What is pcos?
PCOS stands for Polycystic Ovarian Syndrome.
It can also be known as Stein – Leventhal Syndrome.
It is one of the leading causes of infertility in women.
What causes PCOS is still a mystery to doctors even after discovering the disease 75 years ago.
rotterdam, may 2003 definition
PCOS could be defined when at least two of the following three features are present,
after exclusion of other etiologies :
- Oligomenorrhea and or Anovulation
- Clinical and/or biochemical Hyperandrogenism.
- Polycystic ovaries (sonar)
- Physical exam
- Laboratory finding
All of them are important for diagnosis
During ovulation, a women with PCOS will produce an abnormal amount of luteinizing hormone (LH) in the anterior pituitary, thus causing an increase of androgens (testosterone) and a decrease of follicle stimulating hormone ( FSH) and estrogen.
The body receives “mixed messages” from the increase of hormones and disrupts feedback from the pituitary to the ovaries thus, the follicles never develop and form pea sized cysts within the ovary.
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.
Hirsutism : Excessive body hair. In women with PCOS dark, coarse hair will appear on the face, neck, chest, arms, and in between the legs.
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.
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.
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, mbut in severe cases loss of hair in front or on the hairline has been documented.
“Dirty Skin” Acanthosis Nigricans
This condition causes light brown to black rough patches around the neck and under arms.
Severe headaches that cause light sensitivity, nausea and dizziness.
These include testing the major hormones involved in menstruation and chemical
balance such as :
Luteinizing Hormone (LH) & Follicle Stimulating Hormone (FSH).
Testosterone and Estrogen Levels.
Thyroid- Stimulating Hormone Level (TSH) Glucose Level for Insulin Resistance.
Transvaginal Ultrasound :
Uses sound waves to produce image of the reproductive organs. Doctor inserts a small transducer into the vagina and will measure the ovaries for enlargement.
At least one of the following: 12 or more follicles measuring 2–9 mm in diameter, increased ovarian volume (>10 cm3).
If there is a follicle >10 mm in diameter, the scan should be repeated at a time of ovarian quiescence in order to calculate volume and area.
The presence of a single PCO is sufficient to provide the diagnosis.
The distribution of follicles and a description of the stroma are not required for diagnosis.
Family History: Both the Doctor and the woman need to find out if there is an family history of PCOS.
Personal History: The Doctor needs to find out from the patient at what age was the first period, how long did they last and was there any pain involved.
As the disease has genetic basis, there isn’t any preventive methods. But early diagnosis and intervention could Prevent from obesity, metabolic syndrome, diabetes mellitus and vascular disease.
long term efefcts; 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.
After Roterdam consensus 2003 The diagnostic approach for PCOS should be based largely on history and physical examination, thus avoiding numerous laboratory tests that do not contribute to clinical management.
pcos; treatment approach
Weight loss if BMI>30
Clomiphene to induce ovulation
If DHEA-S >2, clomiphene + glucocorticoid (dexamethasone)
If clomiphene alone unsuccessful, try metformin + clomiphene.
Source: ACOG Bulletin, #34, “Management of Infertility caused by Ovulatory Dysfunction” Feb 2002.
- Metformin when there is sugar or insulin abnormality
- Cyproterone acetate or Spironolactone or Finasteride for hyperandrogenic signs
- Medroxyprogesterone acetate or Didrogestrone for menstrual regulation