3. Introduction
Polycystic ovarian syndrome is a condition in
which a woman’s levels of the sex hormones
are out of balance which leads to the growth
of ovarian cysts
4. Definition
PCOS is a syndrome of ovarian dysfunction
along with cardinal features of LH
hypersecretion ,ovarian hyperandrogenism
,hyperinsulinemia,reduced fertility
5. History
1721
Antonio Vallisneri
“…Young peasant woman, married, moderately plump, infertile, with ovaries
larger than normal, like doves’ eggs, lumpy, shiny and whitish”
1935
Dr. Irving Stein and Dr. Michael Leventhal
Coined Stein-Leventhal disorder
1980
Linked to hyperinsulinemia and impaired glucose tolerance
2006
What causes PCOS?
6. Epidemiology
The most common endocrine disorder
in women of reproductive age ~ 2%-
8% of women
About 18% of women had PCOS, and
that 70% of them were previously
undiagnosed
10. Risk Factors
Genetic link
1st degree relatives of patients with
PCOS may be at high risk for diabetes
and glucose intolerance
Obesity (50%)
Increased insulin resistance (30%-35%)
11. Complication
Metabolic Syndrome
43% increase MS regardless of body weight
Insulin resistance
Type II diabetes
○ 5x increase risk
Cardiovascular disease
2x increase risk
High cholesterol
High blood pressure
12. Cardiovascular risk in
PCOD
Endothelium dysfunction (impaired NO
vasodilation)
Disorders of coagulation & fibrinolysis
Plasminogen activator inhibitor-1
Plasminogen activator activity
Fibrinogen levels
Activation of coagulation
Hypertension
Dyslipidemia
13. Pregnancy Complications
Spontaneous Abortions
Increased in high BMI/PCOS patients
Impaired Glucose Tolerance
Gestational Diabetes
Hypertension
Small for Gestational Age
14. Physical Examination
Vaginal ultrasound
Cysts
2-8 millimeter diameter
Often a “string of pearls”
Enlarged ovary
Thickened endometrium
Lack of menses
17. Aim Of Treatments
To reduce the the symptoms
To increases fertility
Reduce weight
Increase insulin resistance
Reduce cholesterol
18. Oral Contraceptives
Combined-Oral Contraceptive (COC)
○ Decrease Androgen production
○ Break continuous estrogen
○ Decrease risk of endometrial cancer
○ Corrects abnormal bleeding
Progesterone
○ 10-14 days a month
○ Regulates menstrual cycle
○ Prevents endometrial cancer
○ Does not improve androgen levels
19. Diabetes Medication
Metformin (Glucophage, Glucophage XR)
○ Type II Diabetes Medication
○ Treats insulin resistance
○ Improves ovulation
○ May reduce androgen production
– even in non-obese women
Does it prevent endometrial cancer?
Is it safe for pregnant women?
23. Surgery Complications
Scar tissue
Lasts a few months
80% ovulation rate
50% pregnancy rate
Only used if failed
previous treatments
24. Natural Treatment
To reduce weight
Six month weight-loss program for overweight anovulatory
women
○ Lost an average of 6.3 kg (13.9 lbs)
○ Decreased fasting insulin and testosterone levels
○ 92% resumed ovulation (12/13)
○ 85% became pregnant (11/13)
25. Diet
Hypocaloric diets insulin resistance
10-20% protein, ~50% carbohydrates
< 30% total fat, < 10% saturated fat
Cereal fiber
Substitute nonhydrogenated unsaturated
fats for saturated and trans-fats
omega-3 fatty acids from fish, fish oil
supplements, or plant sources
fruits, vegetables, nuts, and whole grains
refined grain products
26. Consume more foods
rich in complex
carbohydrates
monounsaturated fat
fiber with a ratio of
omega-6 to
omega-3 fatty acids
Phytoestrogens
should be included in
diet
Reduce
Total caloric intake
Saturated fat
Cholesterol
27. IAYT is found to be useful for people
with diabetes type 2
No mechanism related to insulin resistance