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Polycystic Ovary Syndrome DI WEN M.D.,Ph.D.Professor&Chairman Department Of Obstetrics&Gynecology Renji Hospital Affiliated to SJTU School of MedicinePolycystic Ovary Syndrome IntroductionDefinition:Definition:polycystic polycystic ovary ovary syndrome syndrome(PCOS)(PCOS)is is a a generic generic description description for for a a broad broad spectrum spectrum of of clinical clinical and and morphological morphological findings findings in in women women with with an an endocrine endocrine dysfunction,dysfunction,specifically specifically abnormal abnormal androgen androgen production production and metabolism.and metabolism.IntroductionDefinition:2 Introduction PCOS PCOS was was first first identified identified by by Stein Stein and and Leventhal Leventhal in in 19351935 so so that that it it can can also also be be known known as as Stein Stein Leventhal SyndromeLeventhal Syndrome.IntroductionPCOS was first i3 Etiology&PathopysiologyWhat we think we know.What we think we know.“Vicious cycle”Vicious cycle”Abnormal gonadotropin secretionAbnormal gonadotropin secretion Excess LH and low,tonic FSHExcess LH and low,tonic FSH Hypersecretion of androgensHypersecretion of androgens Disrupts follicle maturationDisrupts follicle maturation Substrate for peripheral aromatizationSubstrate for peripheral aromatization Negative feedback on pituitaryNegative feedback on pituitary Decreased FSH secreationDecreased FSH secreation Insulin resistance,Elevated insulin levelsInsulin resistance,Elevated insulin levels Etiology&PathopysiologyWhat4 Pathology OvariesOvaries:enlarged enlarged and/or and/or polycystic polycystic ovariesovaries EndometriumEndometrium:Lack Lack of of ovulation ovulation for for an an extended extended period period of of time time may may cause cause excessive excessive thickening thickening of of the the endometrium endometrium(the(the lining lining of of the the uterus).uterus).PathologyOvaries:enlarged an5 Pathology Pathology6What Are the Symptoms of PCOS?Irregular or Lack of MensesIrregular or Lack of Menses:Women Women will will have have“spotty”“spotty”periods periods(1(1 every every couple couple of of months).months).Also,Also,in in some some women women with with PCOS PCOS they they simply simply cease cease having having a a menses menses at at all.all.What Are the Symptoms of PCOS?7 Symptoms HirsutismHirsutism:Excessive Excessive body body hair.hair.In In women women with with PCOS PCOS dark,dark,coarse coarse hair hair will will appear appear on on the the face,face,neck,neck,chest,chest,arms,arms,and and in in between the legs.between the legs.SymptomsHirsutism:8 Symptoms Weight ProblemsWeight Problems:Depending on the woman,there could Depending on the woman,there could be a decrease of weight or a rapid be a decrease of weight or a rapid fluctuation of weight that settles fluctuation of weight that settles around the stomach that will lead to around the stomach that will lead to morbid obesity.morbid obesity.SymptomsWeight Problems:9 Symptoms AcneAcne:Because Because women women with with PCOS PCOS are are producing producing more more male male hormone,hormone,that that produces produces more more sebum sebum(skin(skin oils oils and and old old tissue)tissue)and and causes causes blocked blocked pores pores and and more more acne acne around around the the jawline,jawline,arms and chest.arms and chest.SymptomsAcne:10 Symptoms Alopecia or Female Pattern Alopecia or Female Pattern BaldnessBaldness:This is caused by the increase of This is caused by the increase of male hormone in the womens body.male hormone in the womens body.Thinning or loss of hair is usually Thinning or loss of hair is usually contained to top of the scalp,but in contained to top of the scalp,but in severe cases loss of hair in front or severe cases loss of hair in front or on the hairline has been documented.on the hairline has been documented.SymptomsAlopecia or Female Pa11 Other Symptoms“Dirty Dirty Skin”Skin”or or Acanthosis Acanthosis Nigricans Nigricans:This This condition condition causes causes light light brown brown to to black black rough rough patches patches around around the the neck and under arms.neck and under arms.MigrainesMigraines:Severe Severe headaches headaches that that cause cause light light sensitivity,nausea and dizziness.sensitivity,nausea and dizziness.Other Symptoms“Dirty Skin”or12 DiagnosisqqBBT(basal body temperature)BBT(basal body temperature)qq B ultrasound:B ultrasound:multiple small ovarian cysts multiple small ovarian cysts enlarged ovary enlarged ovaryqqEndometrium biopsy(Curettage)Endometrium biopsy(Curettage)before menses reveal to proliferative before menses reveal to proliferative glandsglands qqDetermination of LH,FSH,E2,P,T,PRLDetermination of LH,FSH,E2,P,T,PRL，InsIns，(LH:FSH(LH:FSH 3:1)3:1)qqLaparoscopyLaparoscopy DiagnosisBBT(basal body temp13 TreatmentIf pregnancy is desiredIf pregnancy is desiredcause ovulation cause ovulation anti-estrogens(clomiphene)anti-estrogens(clomiphene)GonadotropinsGonadotropins insulin-lowering agentsinsulin-lowering agents anti-androgens(agents that lower anti-androgens(agents that lower androgen levels)androgen levels)gonadotropin releasing hormone gonadotropin releasing hormone agonists (GnRHa)agonists (GnRHa)TreatmentIf pregnancy is desi14 TreatmentIf pregnancy is not desiredIf pregnancy is not desired to reduce the risk of to reduce the risk of endometrial cancer(birth endometrial cancer(birth control pills)control pills)cyclical progesterone(MPA,cyclical progesterone(MPA,Provera)Provera)insulin-lowering agents(metformin insulin-lowering agents(metformin,Glucophage),Glucophage)anti-androgens.anti-androgens.TreatmentIf pregnancy is not 15 Long Term Effects:Infertility Many women experience Many women experience infertility while having PCOS.infertility while having PCOS.Many will have to go to an Many will have to go to an fertility doctor to conceive.fertility doctor to conceive.To conceive women with PCOS To conceive women with PCOS have to learn to monitor have to learn to monitor ovulation by taking their Basal ovulation by taking their Basal Body Temperature(BBT)and Body Temperature(BBT)and examining cervical mucus.examining cervical mucus.Long Term Effects:Infertilit16 Long Term Effects:Heart Disease There is new evidence that There is new evidence that finds women with PCOS are at finds women with PCOS are at a higher risk for metabolic a higher risk for metabolic cardiovascular disease.cardiovascular disease.Both diseases are characterized Both diseases are characterized by insulin resistance,high by insulin resistance,high blood pressure,and obesity.blood pressure,and obesity.Long Term Effects:Heart Dise17 DI WEN M.D.,Ph.D.Professor&Chairman Department of Obstetrics&Gynecology Renji Hospital Affiliated to SJTU School of Medicine Thanks for Your Attention DI WEN M.D.,
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