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| Polycystic
Ovarian
Disease |
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| WE RUN SPECIAL CLINIC |
PCOD
- Complex interaction of genetic, metabolic, neurologic, endocrinal & environmental factors
- It starts in adolescence
- Sequelae continue even after menopause
- Prevalence 4 -10%
- Familial occurrence
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| PCOD |
Rotterdam criteria
- Menstrual irregularity due to anovulation or oligoovulation
- Hyperandrogenism- clinical / biochemical
- Polycystic ovaries by USG- >12 follicles in each ovary,2- 9mm or ovarian volume >10mm
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| POLYCYSTIC OVARIES - USG |
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Pathophysiology of Polycystic Ovary Syndrome
- LH Hypothesis
- Insulin Hypothesis
- Ovarian Hypothesis
CLINICAL FEATURES
- Menstrual disturbances 80%
- Hirsutism 70%
- Obesity 60%
- Insulin resistance 50%
- Infertility 60%
| Facial Hirsutism in PCOS |
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| FERIMAN – GALLWAY SCORING |
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1980s – Association with PCOD
HAIR-AN Syndrome
Hyperandrogenism
Insulin resistance
Acanthosis nigricans
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| Acanthosis Nigricans |
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D / D
- Congenital Adrenal Hyperplasia
- Hyperprolactinemi
- Thyroid disfunction
- Cushing Syndrome
- Hyperthecosis ovarii
- Ovarian & Adrenal tumors
- Hypogonadotropic Hypogonadism
INVESTIGATION
- History & examination
- LH:FSH, E2, Testosteron, SHBG, 17hydroxy progesteron, DHEAS, Prolactin, TFT, GTT & Insulin levels, Lipid Profile, USG, MRI
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| HIRSUTISM LAB EVALUATION |
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TREATMENT
- Lifestyle modifications
- Discuss the role of weight & body composition on PCOD
- Weekly group meeting with parents
- Aerobic exercises for 1hr/day
- Nutrition & diet – most important
- Cease smoking
TREATMENT MENSTRUAL REGULATION
- Weight Reduction is most important
- COC
Yasmin / Yamini
Diane35 / Dianette
- Progesterons
For protection of Endometrium
TREATMENT FOR HIRSUTISM (PCOD)
- Weight Reduction
- Mechanical & Cosmetic methods
- COC
- Anti-androgens Cyproteron Acetate
Spironolactone
Finasteride
- Progesteron
- GnRh
HYPERINSULINEMIA TREAMENT
- Weight reduction
- Life style modification
- Insulin-sensitizers Metformin
1500-2000 mg/day
Rosiglitazone
2-8mg/day
LONGTERM CONSEQUENCES Of Polycystic Ovarian Disease
- Definite- Type II DM, Dyslipidemia, Endometrial Cancer
- Possible- Obesity, Insulin resistance, Metabolic syndrome, Gall Bladder diseases, CVS disorders, Hypertension, Loss of self esteem, obstetric complication
- Controversial – ovarian & breast cancer
PRACTICE POINT
- Do not ignore your problems.
- Consult doctor today
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