Heavy Period

Polycystic Ovarian Disease

WE RUN SPECIAL CLINIC

PCOD

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

PCOD

Rotterdam Criteria

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

POLYCYSTIC OVARIES - USG

Pathophysiology of Polycystic Ovary Syndrome

1. LH Hypothesis
2. Insulin Hypothesis
3. Ovarian Hypothesis

CLINICAL FEATURES

1. Menstrual disturbances 80%
2. Hirsutism 70%
3. Obesity 60%
4. Insulin resistance 50%
5. Infertility 60%

Facial Hirsutism in PCOS

FERIMAN – GALLWAY SCORING

1980s – Association with PCOD

1. HAIR-AN Syndrome
2. Hyperandrogenism
3. Insulin resistance
4. Acanthosis nigricans

Acanthosis Nigricans

D / D

1. Congenital Adrenal Hyperplasia
2. Hyperprolactinemi
3. Thyroid disfunction
4. Cushing Syndrome
5. Hyperthecosis ovarii
6. Ovarian & Adrenal tumors
7. Hypogonadotropic Hypogonadism

INVESTIGATION

1. History & examination
2. LH:FSH, E2, Testosteron, SHBG, 17hydroxy progesteron, DHEAS, Prolactin, TFT, GTT & Insulin
3. levels, Lipid Profile, USG, MRI

HIRSUTISM LAB EVALUATION

TREATMENT

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

TREATMENT MENSTRUAL REGULATION

1. Weight Reduction is most important
2. COC
1. Yasmin / Yamini
2. Diane35 / Dianette
3. Progesterons
1. For protection of Endometrium

TREATMENT FOR HIRSUTISM (PCOD)

1. Weight Reduction
2. Mechanical & Cosmetic methods
3. COC
4. Anti-androgens Cyproteron Acetate
1. Spironolactone
2. Finasteride
5. Progesteron
6. GnRh

HYPERINSULINEMIATREAMENT

1. Weight reduction
2. Life style modification
3. Insulin-sensitizers Metformin
1. 1500-2000 mg/day
2. Rosiglitazone
3. 2-8mg/day

LONGTERM CONSEQUENCES Of Polycystic Ovarian Disease

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

LONGTERM CONSEQUENCES Of Polycystic Ovarian Disease

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

PRACTICE POINT

1. Do not ignore your problems.
2. Consult doctor today