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Polycystic Ovarian Syndrome PowerPoint Presentation

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Description : Check out this medical titled "Polycystic Ovarian Syndrome" by Dr Louise Knowles.

This medical talks about Polycystic Ovarian Syndrome (PCOS), a hormonal disorder that affects women of reproductive age. It is characterized by the presence of multiple small cysts on the ovaries, which can cause irregular or absent menstrual cycles, and infertility.

The exact cause of PCOS is not fully understood, but it is believed to involve a combination of genetic and environmental factors. Insulin resistance and high levels of androgens (male hormones) are also thought to play a role in the development of PCOS.

Tags : Polycystic Ovarian Syndrome, PCOS, hormonal disorder, women of reproductive age, endocrinology, endocrinology

Published on : Apr 21, 2023 | Views : 1717 | Downloads : 1

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Slide 1-

Polycystic Ovarian Syndrome Dr Louise Knowles
Slide 2-

PCOS; points to cover today Diagnosis Clinical Features; presentation and long term consequences Hormonal Disturbances Subtypes PCOS Investigations Management.
Slide 3-

PCOS Originally described 1935 by Stein and Leventhal. Redefined 2003 by American and European Societies reproductive medicine Patient likely to present with menstrual disturbance, acne, hirsutism, infertility.
Slide 4-

PCOS; genetics Heterogenous; familial clustering. Autosomal dominant inheritance, variable penetrance in females; 50% chance of offspring being affected Phenotype manifests itself via raised androgen levels secreted by ovarian theca cells. Severity seems to be determined by factors such as obesity
Slide 5-

PCOS Statistics Incidence: 15-25% UK Women 50% UK Asian Women South Asian women present at younger age and often have more severe symptoms
Slide 6-

USS assessment 20-30% Caucasian women have PCO 5-15% Caucasian women have PCOS Polycystic ovaries not necessary to make diagnosis of PCOS
Slide 7-

Ultrasound assessment of the polycystic ovary: international consensus 12 or more follicle measuring 2-9mm and/or Increased ovarian volume (>10cm3) ASRM Consensus 2003
Slide 8-

Diagnostic Criteria Two out of three criteria required 1.Anovulation or oligo-anovulation 2.Hyperandrogenism Clinical (hitsuitism, acne) Biochemical (raised testosterone) 3.Polycystic ovaries(12 or more follicles,2-9mm diameter)
Slide 9-

Diagnostic criteria Other causes of menstrual disturbance and hyperandrogenism must be excluded.
Slide 10-

Hyperandrogenism Alopecia Hirsuitism Acne
Slide 11-

Differential Diagnoses Cushings Adrenal/Ovarian tumours ( virilisation) Congenital adrenal hyperplasia Menopause/Ovarian failure Exogenous- anabolic steroid, testosterone medication Hypothalamic/pituitary disorders
Slide 12-

Long Term Consequences Metabolic syndrome, with increased risk type 2 diabetes, hyperlipidaemia Fertility problems Psychological distress Endometrial cancer Increase risk sleep apnoea
Slide 13-

Endocrinology Normal function of the pituitary and ovary Hormonal abnormalities underlying PCOS
Slide 14-

PCOS; the hormones In women with PCOS, the theca cells of the ovary produce excess androgens, which may be due to hyperinsulinaemia or increased serum levels of luteinizing hormone (LH)
Slide 15-

Androgenic Effects Insulin Resistance Insulin  Weight gain Testosterone  Inhibits SHBG Fat storage Acne Hirsuitism Irreg periods Infertility
Slide 16-

PCOS; the hormones Insulin resistancehyperinsulinaemia as a key factor in PCOS for many women  Insulin and LH lead to  androgen production from theca cells.  androgen leads to follicular arrest and anovulation
Slide 17-

Subtypes of PCOS LH Driven Insulin Driven
Slide 18-

LH Driven Slim High LH High Impaired GTT (10%) Responds to ovarian diathermy
Slide 19-

Insulin Driven XS Centripetal fat Acanthosis Nigricans Longer inter-menstrual interval
Slide 20-

Investigations; PCOS LH;  or normal FSH often normal. Total testosterone; normal or slightly raised ( if >5 nmol/l exclude androgen secreting tumours) Free testosterone may be  SHBG normal or  Free androgen index normal or
Slide 21-

Investigations Free androgen index FAI  FAI =Total testosteronex100/SHBG Or;  Free Testosterone.
Slide 22-

Investigations for diff. diagnosis TSH Prolactin 17-hydroxyprogesterone ( CAH) DHEA-S and FAI ( androgen secreting tumours) 24 hr urinary cortisol ( Cushings)
Slide 23-

Investigations PCOS In addition to hormone profile; need to check Lipid profile LFT’s if high BMI HBa1C/GTT ( fasting glucose not sensitive enough)
Slide 24-

Other Menstrual Irregularities FSH + LH + E 
Slide 25-

Other Menstrual Iregularities FSH + LH + E  Ovarian failure/ menopause
Slide 26-

Other Menstrual Iregularities FSH + LH + E  Ovarian failure/ menopause FSH + LH + E
Slide 27-

Other Menstrual Iregularities FSH + LH + E  Ovarian failure/ menopause FSH + LH + E Hypothalamic/pituitary Underweight Overexercise Chronic Illness
Slide 28-

Management Aims: Managing symptoms Reducing long term consequences
Slide 29-

Management Weight management/ psychological support Hair removal. Oligo/amenorrhoea Infertility
Slide 30-

Weight Management Aim: 5-10% wt loss (can achieve 30% loss of visceral fat) Empower the patient Be kind Discuss long term health Depression in 70%
Slide 31-

Oligo/amenorrhoea Need to bleed every 3-4m to avoid unopposed oestrogen, increased risk endometrial cancer. Endometrial protection will be provided by desogestrel/implant/ Mirena. Consider COCP
Slide 32-

COCP Oestrogens increase SHBG Dianette Yasmin Any cocp will help prevent androgenic effects and give regular bleed enabling endometrial protection
Slide 33-

Fertility, when BMI>30 Clomiphene citrate Ovarian drilling( useful in LH driven PCOS) Ovulation induction IVF Weight loss alone may be enough.
Slide 34-

Goal weight 5-10% weight loss reduces visceral fat by 30%..... Beware of pregnancy Impact on insulin levels Give realistic goals; eg 1kg per week. Orlistat Bariatric surgery.
Slide 35-

What about metformin? Ineffective for hyperandrogenism Ineffective for anovulation Use for IGT( & continue if conceives?) May be used to reduce risk of ovarian hyperstimulation in IVF May be used in sec care in treatment infertility (Nice 2013)?
Slide 36-

Hirsutism Eflornithine ( Vaniqua); 4m trial.....£55 per tube!! Can be prescribed as NHS drug in PCOS/hirsutism (Spironolactone) Laser treatment
Slide 37-

Pregnancy and PCOS Gestational diabetes( OR 3.6)Do GTT at 24-28w Increased risk hypertension, preclampsia. Increased risk preterm birth/ small for dates infants. Increased risk PCOS in offspring 14% will have a major pregnancy related complication
Slide 38-

West Yorkshire! South Asian women resident in Yorkshire with anovular PCOS; Present younger Develop oligomenorrhoea younger Have more T2DM in families Have more acanthosis nigricans & hirsutism Have higher insulin resistance.
Slide 39-

PCO and the future Increasing incidence Needs holistic approach Primary care pivotal role with support specialists; gynaecology, dietician, counsellors, beauticians.
Slide 40-

Patient support groups www.verity-pcos.org.uk www.soulcysters.com American
Slide 41-

Useful references Polycstic Ovary Syndrome; Nice CKS Feb 2013 RCOG Green Top guideline No 33; Long Term Consequences of PCOS (2014) Hirsutism; Nice CKS Dec 2014 https://www.womens-health-concern.org have an excellent fact sheet for patients.