Polycystic Ovary Syndrome

1. Polycystic Ovary Syndrome DI WEN M.D., Ph.D., Professor & Chairman Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine

2. Introduction • Definition: polycystic ovary syndrome (PCOS)is a generic description for a broad spectrum of clinical and morphological findings in women with an endocrine dysfunction, specifically abnormal androgen production and metabolism. • PCOS was first identified by Stein and Leventhal in 1935 so that it can also be known as Stein – Leventhal Syndrome. PCOS

3. Etiology & Pathopysiology What we think we know. • “Vicious cycle” • Abnormal gonadotropin secretion • Excess LH and low, tonic FSH • Hypersecretion of androgens • Disrupts follicle maturation • Substrate for peripheral aromatization • Negative feedback on pituitary • Decreased FSH secreation • Insulin resistance, Elevated insulin levels PCOS

4. Pathology • Ovaries: enlarged and/or polycystic ovaries • endometrium: Lack of ovulation for an extended period of time may cause excessive thickening of the endometrium (the lining of the uterus). PCOS

5. Pathology PCOS

6. What Are the Symptoms of PCOS? • Irregular or Lack of Menses: Women will have “spotty” periods (1 every couple of months). Also, in some women with PCOS they simply cease having a menses at all. PCOS

7. Symptoms • Hirsutism : Excessive body hair. In women with PCOS dark, coarse hair will appear on the face, neck, chest, arms, and in between the legs. PCOS

8. Symptoms • Weight Problems : Depending on the woman, there could be a decrease of weight or a rapid fluctuation of weight that settles around the stomach that will lead to morbid obesity. PCOS

9. Symptoms • Acne : Because women with PCOS are producing more male hormone, that produces more sebum ( skin oils and old tissue) and causes blocked pores and more acne around the jawline, arms and chest. PCOS

10. Symptoms • Alopecia or Female Pattern Baldness : This is caused by the increase of male hormone in the women's body. Thinning or loss of hair is usually contained to top of the scalp, but in severe cases loss of hair in front or on the hairline has been documented. PCOS

11. Other Symptoms • “Dirty Skin” or Acanthosis Nigricans : This condition causes light brown to black rough patches around the neck and under arms. • Migraines : Severe headaches that cause light sensitivity, nausea and dizziness. PCOS

12. Diagnosis • BBT (basal body temperature) • B ultrasound: multiple small ovarian cysts enlarged ovary • Endometrium biopsy(Curettage ) before menses reveal to proliferative glands • Determination of LH,FSH,E2,P,T,PRL，Ins，(LH:FSH≧3:1) • Laparoscopy PCOS

13. Treatment • If pregnancy is desired ------ cause ovulation anti-estrogens(clomiphene) Gonadotropins insulin-lowering agents anti-androgens (agents that lower androgen levels) gonadotropin releasing hormone agonists (GnRHa) PCOS

14. Treatment • If pregnancy is not desired to reduce the risk of endometrial cancer ( birth control pills) cyclical progesterone(MPA, Provera) insulin-lowering agents(metformin ,Glucophage) anti-androgens. PCOS

15. Long Term Effects: Infertility • Many women experience infertility while having PCOS. • Many will have to go to an fertility doctor to conceive. • To conceive women with PCOS have to learn to monitor ovulation by taking their Basal Body Temperature (BBT) and examining cervical mucus. PCOS

16. Long Term Effects: Heart Disease • There is new evidence that finds women with PCOS are at a higher risk for metabolic cardiovascular disease. • Both diseases are characterized by insulin resistance, high blood pressure, and obesity. PCOS

17. Thanks for Your Attention DI WEN M.D., Ph.D. Professor & Chairman Department of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine