PCOD

• Complex interaction of genetic, metabolic, neurologic, endocrinal & environmental factors
• It starts in adolescence
• Sequelae continue even after menopause
• Prevalence 4 -10%
• Familial occurrence
  

PCOD
 Rotterdam criteria

• Menstrual irregularity due to anovulation
  or oligoovulation
• Hyperandrogenism- clinical / biochemical
• Polycystic ovaries by USG- >12 follicles in each ovary,2- 9mm or ovarian volume >10mm

POLYCYSTIC OVARIES - USG

Pathophysiology of Polycystic Ovary Syndrome

• LH Hypothesis
• Insulin Hypothesis
• Ovarian Hypothesis

CLINICAL FEATURES

• Menstrual disturbances 80%
• Hirsutism 70%
• Obesity 60%
• Insulin resistance 50%
• Infertility 60%

Facial Hirsutism in PCOS

FERIMAN – GALLWAY SCORING

1980s – Association with PCOD HAIR-AN Syndrome Hyperandrogenism Insulin resistance Acanthosis nigricans

Acanthosis Nigricans

D/D Congenital Adrenal Hyperplasia Hyperprolactinemi Thyroid disfunction Cushing Syndrome Hyperthecosis ovarii Ovarian & Adrenal tumors Hypogonadotropic Hypogonadism INVESTIGATION History & examination LH:FSH, E2, Testosteron, SHBG, 17hydroxy progesteron, DHEAS, Prolactin, TFT, GTT & Insulin levels, Lipid Profile, USG, MRI

HIRSUTISM LAB EVALUATION

TREATMENT

• Lifestyle modifications
• Discuss the role of weight & body composition on PCOD
• Weekly group meeting with parents
• Aerobic exercises for 1hr/day
• Nutrition & diet – most important
• Cease smoking

TREATMENTMENSTRUAL REGULATION

• Weight Reduction is most important
• COC
       Yasmin / Yamini
       Diane35 / Dianette
• Progesterons
       For protection of Endometrium

TREATMENT FOR HIRSUTISM (PCOD)

• Weight Reduction
• Mechanical & Cosmetic methods
• COC
• Anti-androgens Cyproteron Acetate
       Spironolactone
       Finasteride
• Progesteron
• GnRh

HYPERINSULINEMIATREAMENT

• Weight reduction
• Life style modification
• Insulin-sensitizers Metformin
      1500-2000 mg/day
      Rosiglitazone
      2-8mg/day

LONGTERM CONSEQUENCESOf Polycystic Ovarian Disease

• Definite- Type II DM, Dyslipidemia, Endometrial Cancer
• Possible- Obesity, Insulin resistance, Metabolic syndrome, Gall Bladder diseases, CVS disorders, Hypertension, Loss of self esteem, obstetric complication
• Controversial – ovarian & breast cancer

PRACTICE POINT

• Do not ignore your problems.
• Consult doctor today