Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS), also known as chronic ovarian androgenism, is an endocrine imbalance resulting from insulin.

Average age of onset is 15-35 years.

 

 

Causes and Risk Factors

 

Causes include:

 

 

 

 

 

Signs, Symptoms, and Diagnosis

A diagnosis requires two of the following three:

 

  • history
  • physical exam
  • lab investigations
  • diagnostic imaging

History

Infertility

Family history of diabetes

Physical Exam

Patients are often obese, showing signs of hirsutism and virilization

acanthosis nigricans, or the browning of skin folds, may also be present

Lab Investigations

Insulin resistance in people of various body types; OGTT may be positive

LH:FSH of >2:1, with LH chronically high

  • DHEAS and free testosterone: increased; most sensitive test

Diagnostic Imaging

Transvaginal ultrasound shows polycystic ovaries appearing like a string of pearls

Laparoscopy is not necessary, but shows a white ovary with multiple follicular cysts

 

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Differential Diagnosis

Differential includes:

 

 

 

Pathophysiology

 

Obesity leads to increased aromatase conversion to estrogen, which decreases FSH secretion and increases that of LH. Increased ovarian secretion of androgens ensues, leading to hirsutism.

Decreased FSH and increased LH lead to anovulation, oligomenorrhea, and infertility.

 

 

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Treatments

Non-medications

Weight-loss through excercise and diet is critical to reduce peripheral production of estrogen.

 

Medications

OCP or cyclic Provera can be used to prevent endometrial hyperplasia from excess levels of estrogen, as well as reduce hirsutism.

oral hypoglycemics (metformin) to reduce insulin resistance

Medications can be used to induce ovulation (clomiphene citrate - an estrogen receptor blocker which works on the hypothalamus to induce LH/FSH)

Spironolactone, finasteride, or flutamide may all be used to reduce excess androgen production.

In vitro fertilization

 

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Consequences and Course

Consequences include:

 

 

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Resources and References