PROFESSOR ZEINAB ABOTALIB Consultant Obstetrics & Gynaecology and infertility

PCOS: Defined? I ACOG and NIH (1990): hyperandrogenism and chronic anovulation excluding other causes Stein and Levanthal (1935): association of amenorrhea with polycystic ovaries and variably: hirsutism and/or obesity

PCOS: Epidemiology Prevalence: 4-6% females –Probably same world wide No difference between blacks and whites 75% of women w/ irregularity or infertility

PCOS: 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

PCO: Polycystic ovary –Usually in obese woman –FSH: LH ratio, in the proliferative phase of the cycle will be reversed –↑ Oestrogen –Hirsutism –Raised level of circulating insulin –Raised blood sugar

DIAGNOSIS: 1.History-irregular cycle -oligonorrhoea -Infertility -? galactorrhoea -recurrent abortions 2.Examination:-Usually obese but it can happen in thin patients -Hirsutism 3.Investigation:  ↑ LH  FSH may be normal  ↑ Oestrogen  Free testosterone may be ↑ or normal  Ultrasound - multiple small cysts at the periplery of the ovary looks like necklace.  Laparoscopy – thick, enlarged non-active ovaries

TREATMENT: Weight reduction Weight reduction Induction of ovulation Metformin Metformin Laparoscopic ovarian diathermy IVF

PCOS: Associated Disorders Diabetes Hyperlidpidemia (LDL, Triglycerides) ObesityHypertensionCAD? –Incr in Risk Factors, but not mortality

PCOS: Associated Disorders Endometrial CA Ovarian CA? +/- Breast CA NO increase in Osteoporosis Eating disorders Psychiatric dz

HIRSUITISM: Pathological - PCO, adrenal cortex trauma, Cushion syndrome ConstitutionalSITE:FaceChest Anterior abdominal wall INVESTIGATION: Free testosterone level, ATCH, FSH, LH

TREATMENT: Difficult  needs reassurance Hair removal by different methods Diane Cypreterone acetate – anti-androgen Treatment will take long time