POLYCYSTIC OVARY SYNDROME

PCOS IS THE MOST COMMON FORM OF CHRONIC

ANOVULATION ASSOCIATED WITH ANDROGEN
EXCESS.

IS ONE OF THE MOST COMMON FEMALE

ENDOCRINE
DISORDERS
AFFECTING
APPROXIMATELY 5% - 10% OF WOMEN OF
REPRODUCTIVE AGE (12-45 YEARS OLD) AND IS
ONE OF THE LEADING CAUSES OF FEMALE
SUBFERTILITY.

The Principal features are :

Obesity.
Anovulation
Amenorrhea
Excessive amounts or effect of
androgen hormon

Insulin Resistance, diabetes,

and obesity are all stongly
correlated with PCOS

Signs and Symptoms.

Menstrual disorder.
Infertility, resulting from chronic anovulation
Hirsutism, hyperandrogenism
Metabolic syndrome

JMFA 41

DIAGNOSIS.
History of ovulatory dysfunction :
amenorrhea,
other

oligomenorrhea,

or

form of irregular uterine bleeding) of

pubertal onset

JMFA 41

Physical Examination:
Sign of androgen excess (hirsutism or virilization or
both).
Insulin resistance ( acanthosis nigricans), and
The presence of unopposed estrogen action ( well
rugated vagina and stretchable clear cervical
mucus).

A. Moderate acanthosis nigricans.

B. Severe acanthosis nigricans

Gynecologic ultrasonography:
Spesifically looking for small ovarian
follicles.

Laparoscopic

examination

reveal a thickened, smooth,

outer surface of the ovary.

Blood
level
hormones).

of

may
pearl-white

androgen

(male

Androstenedione,
testosterone
and
Dehydroepiandrosterone sulfat may be
elevated.

PCOS:
The National Institutes of Health 1990;
Suggested that a patient has PCOS if she
has All of the following,
1.Hyperandrogenism and /or hyperandrogenemia.
2.Oligo-ovulation
3.Exclusion of known disorders of androgen excess and
anovolation.

Consensus in Rotterdam 2003 :

PCOS : 2 out of 3 criteria are met.
1. Oligo-ovulation and/or anovulation.
2. Clinical and/or biochemical sign of
hyperandrogenism.
3. Polycystic ovaries (by gynecologic ultrasound)

JMFA 43

MANAGEMENT
Lowering of insulin levels:
Metformin
Thiazolidinediones
Restoration of Fertility :
Clomiphen citrate and FSH

MANAGEMENT
Treatment of hirsutism.
contraceptive pill (cyproterone acetate)
Flutamide
Spirinolactone
Restoration of regular menstruation.
a uterine progestogen device (mirena)
progestin implant (Implanon).