DR.

NIGAR SADAF
Gynaecology & Obstetric Department
Ziauddin University and Hospitals
POLYCYSTIC OVARIAN
SYNDROME
This syndrome was first described by Stein
and Leventhal in 1935 and is characterized by
hirsuitism, obesity, infertility and
oligomenorrhoea.

The hirsuitism found in association with PCOS
is due to hyperandrogenism.
Polycystic ovary syndrome has an unknown
aeitology.
Ovaries, adrenal glands, pituitary and
thyroid glands have all been investigated
for their contributory role in its
development.
There is no clear cut evidence of direct
involvement of hypothalamus, pituitary and
adrenal glands in the development of
polycystic ovary syndrome


The ovarian dysfunction may be due to
increased follicle number, theca cell
hyperplasia or dysregulation of P 450C 17
alpha enzyme involved in theca cell androgen
biosynthesis.


PCOS is associated with a number of
alterations in the hormonal levels, which are
best expressed in follicular phase of the
menstrual cycle.


The hormonal changes include;
LH: FSH ratio of 3:1
The baseline estrogen level is increased
Hyper prolactinaemia
Testosterone is only slightly raised
To make the diagnosis of PCOS on ultrasound
at least 3 of the following 4 features should
be present.
Peripheral distribution of follicles
10 or more follicles typically 2-8 mm in
diameter.
Increased stroma
Increased ovarian volume
6-7% of the population
The prevalance of PCOS may differ according
to ethnic background; for example, in women
of South Asian origin, PCOS presents at a
younger age, has more severe symptoms and
a higher prevalance.
Diagnosis of PCOS can only be made when
other aetiologies have been excluded (thyroid
dysfunction, congenital adrenal hyperplasia,
hyperprolactinemia, androgen secreting
tumors and Cushing syndrome).
Following criteria being diagnostic of the
condition:
Polycystic ovaries (either 12 or more
peripheral follicles or increased ovarian
volume (greater than 10 cm5)
Oligo or anovulation
Clinical and/or biochemical signs of
hyperandrogenism


HOW SHOULD WOMEN BE COUNSELLED?
Women diagnosed with PCOS should be
inform of the possible long-term risks to
health that are associated with their
condition. They should be advised regarding
weight control exercise.

Metabolic consequences of PCOS
PCOS and cardiovascular risk
PCOS and obstructive sleep apnoea
Women who have been diagnosed has having
PCOS before pregnancy ( such as those
requiring ovulation induction for conception
)should be screened for gestational diabetes
before 20wks of gestation with referral to a
specialist obstetric diabetic service if
abnormalities are detected
Oligo or amennorehea in women with PCOS
may predispose to endometrial hyperplasia
and later carcinoma.
It is good practice to recommend treatment
with progestogens to induced a withdrawal
bleed at least every 3-4 months.
There does not appear to be an association
with breast or ovarian cancer and no
additional surveillance is required
Exercise and weight control
Drug therapy
Surgery

Women should be advised that there is
insufficient evidence in favour of either
metformin or the oral contraceptive pill in
treating hirsuitism or acne.
Licensed treatments for hirsuitism include
oral contraceptive pills, dianette (oestrogen
and cyproterone acetate), cosmetic
measures ( such as laser, electrolysis,
bleaching, waxing and shaving).
In practice a combination of methods is often
required to achieve an acceptable cosmetic
result for the woman.