PCOS

P O LY C Y S T I C O V A R Y S Y N D R O M E

DEFINITION
POLYCYSTIC OVARY SYNDROME

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 Polycystic Ovarian Syndrome (PCOS) is one of the most

common endocrine system disorders that affect women
in their reproductive age (Azziz et al., 2004).
PCOS is considered a multifactorial disorder with
various genetic, endocrine and environmental
abnormalities.
Increased risk of cardiovascular disease, hypertension,
diabetes and other metabolic complications, especially
after menopause

De Leo et al. Reproductive Biology and Endocrinology (2016) 14:38

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PATHOGENESIS AND RISK

FACTORS
POLYCYSTIC OVARY SYNDROME

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Intrauteri
ne
Genetics
exposures
PCO

Environm S
Obesity
ent/lifesty
le

Alexandra Rotstein. Polycystic ovarian syndrome (PCOS). McMaster Pathophysiology Review. Available at:
http://www.pathophys.org/pcos/

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PATHOGENESIS
AND RISK
FACTORS

Alexandra Rotstein. Polycystic ovarian syndrome (PCOS). McMaster Pathophysiology Review. Available at:
http://www.pathophys.org/pcos/
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PATHOPHYSIOLOGY
POLYCYSTIC OVARY SYNDROME

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Alexandra Rotstein. Polycystic ovarian

syndrome (PCOS).
McMaster Pathophysiology Review.
Available at: http://www.pathophys.org/pcos/
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Theory of prenatal origin of PCOS and its

development at puberty

Musacchio MC, Cappelli V, Massaro MG, Morgante G, Petraglia F. Genetic, hormonal and metabolic aspects of PCOS: an update. Reprod Biol Endocrinol. 2016 Jul

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Alteration of extra- and intra-ovarian factors may

compromise follicular development and oocyte
development in PCOS

Musacchio MC, Cappelli V, Massaro MG, Morgante G, Petraglia F. Genetic, hormonal and metabolic aspects of PCOS: an update. Reprod Biol Endocrinol. 2016 Jul

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In a normal cycle, only the dominant follicle responds to LH when it reaches 10mm
diameter. In PCOS the response to LH occurs inappropriately in smaller follicles and
many antral follicles reach terminal differentiation before time, producing a greater
quantity of steroids and inhibin B that exert negative feedback on FSH production

Musacchio MC, Cappelli V, Massaro MG, Morgante G, Petraglia F. Genetic, hormonal and metabolic aspects of PCOS: an update. Reprod Biol Endocrinol. 2016 Jul

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Hyperinsulinemia stimulates
directly cytochrome p450 enzymes
in the ovary or indirectly through
action of LH or IGF-1, causing
hyperandrogenism

Musacchio MC, Cappelli V, Massaro MG, Morgante G, Petraglia F. Genetic, hormonal and metabolic aspects of PCOS: an update. Reprod Biol Endocrinol. 2016 Jul

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DIAGNOSIS
POLYCYSTIC OVARY SYNDROME

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Calon Dokter Sukses

AES suggested criteria for the

diagnosis of PCOS.
Ricardo Azziz, Enrico Carmina, Didier Dewailly, et al. Criteria for Defining Polycystic Ovary Syndrome as a Predominantly Hyperandrogenic
Syndrome: An Androgen Excess Society Guideline. The Journal of Clinical Endocrinology & Metabolism. 2016;91(11):42374245

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CLINICAL
MANIFESTATIONS
POLYCYSTIC OVARY SYNDROME

Calon Dokter

Calon Dokter Sukses

Melissa, Hunter, PeterJ, Carek. Evaluation and Treatment of Women with Hirsutism. AMERICAN FAMILY PHYSICIAN . Medical University of
South Carolina, Charleston, South Carolina. volume 67, number 12 www.aafp.org/afp. 2003

TREATMENT
POLYCYSTIC OVARY SYNDROME

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Modifikasi Gaya Hidup

Terapi Infertilitas

Terapi Gangguan Menstruasi

Terapi Gejala Akibat Hormon

Androgen/Hirsutisme
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Jennifer et al. An algorithm for treatment of infertile women with polycystic ovary syndrome. Middle
East Fertility Society Journal.

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MODIFIKASI GAYA HIDUP

PENURUNAN BB
O L A H RAG A
DIET

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Penurunan Berat Badan

Obesitas

penurunan kadar SHBG

peningkatan androgen
PCOS

Oligoanovulation kronis
respon terapi kurang pada
pengobatan clomiphene
citrate, gonadotropin

risiko sindrom
metabolik, diabetes
mellitus (DM),
dislipidemia

peluang kehamilan yang lebih

rendah
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Diet
Pola diet diabetes tipe 2 direkomendasikan untuk pasien PCOS

Serat
asam lemak omega-3
omega-9

karbohidrat olahan
lemak trans
lemak jenuh

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TERAPI INFERTILITAS
A R O M ATA S E I N H I B I T O R
GONADOTROPIN
T E RA P I P E M B E DA H A N
HORMON FSH
F E RT I L I S A S I I N -V I T R O ( I V F )

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Terapi pembedahan
Laparoskopi pengeboran ovarium (LOD)
Jika ovulasi tidak dapat diinduksi dengan
terapi clomiphene citrate, metode lain dari
induksi ovulasi dapat digunakan sebagai
pengobatan infertilitas
Membantu meningkatkan resistensi insulin
dan produksi androgen ovarium, serta
meningkatkan kadar SHBG
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TERAPI GEJALA AKIBAT

HORMON ANDROGEN
P I L KO N T RA S E P S I O RA L
ANTIANDROGEN
S T E R O I D O RA L
S U P L E M E N V I TA M I N D
A N T I J E RAWAT

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KB Hormonal
Ethinyl
estradiol

GnRH

Siklus
menstruasi
teratur

Sekresi
LH & FSH

Dikombinasi
dengan
progesteron
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Anti Androgen
Antiandrogens (androgen receptor blockers (flutamide, spironolacton)
and 5a-reductase inhibitors (finasteride, spironolactone))
merupakan obat pilihan pertama untuk kasus hirsutisme saat ini.

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Flutamide
menghambat aktivitas enzim tipe II
5- reduktase

inhibitor kompetitif dari androgen

menghambat efek LH pada atresia sel teka dan

granulosa
flutamide jmenginduksi penurunan androgen plasma

siklus hiperandrogenisme terganggu

ovulasi dapat dikembalikan

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TERIMA KASIH

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Rumus Resistensi Insulin

fasting insulin (microU/L) x
fasting glucose (nmol/L)/22.5
kadar glukosa puasa (mg/dL) x
kadar
insulin puasa (ng/mL) / 405