P O LY C Y S T I C O V A R Y S Y N D R O M E
Polycystic ovary syndrome (PCOS) is a heterogeneous disorder with variable clinical and endocrine features. There is no universally agreed definition or criteria. The diagnosis of PCOS is made when,in addition to the ultrasound finding of polycystic ovaries, there are associated symptoms (menstrual irregularity, hyperandrogenisation,obesity) or endocrine abnormalities (raised serum luteinising hormone (LH) and testosterone concentrations) .

Symptoms
Obesity – up to 40 per cent
Acne, hirsutism and alopecia – 70 per cent
Irregular periods and oligomenorrhoea (cycle interval longer than 35 days but less than 6 months)/amenorrhoea (no menstruation for more than 6 months) – up to 70 per cent
Subfertility – inhibition of production of insulin-like growth factor 1 (IGF1) binding protein results in an increased concentration of circulating free IGF1, further enhancing ovarian androgen production.IGF potentiates the action of follicle-stimulating hormone (FSH) in granulosa cells. It may initiate or perpetuate the ovulatory dysfunction in PCOS.
Alopecia


Basis for treatment strategies of PCOS
BMI should be normalised. An increased rate of hirsutism, cycle disturbance and infertility is correlated with a raised BMI. The incidence of diabetes in obese women with PCOS is 11 per cent. Weight loss improves the symptoms of PCOS and improves the patient’s endocrine profile, particularly by reducing hyperinsulinaemia and hyperandrogenism. Weight loss should be encouraged prior to ovulation induction treatment .Women with PCOS are not oestrogen deficient. Treatment depends on symptoms being complained about. Those with amenorrhoea are not at risk of osteoporosis, but are at risk of endometrial hyperplasia or adenocarcinoma. Cycle control and regular withdrawal bleeding may be managed with the oral contraceptive pill but a raised BMI has always been a contraindication because of the risk of venous thromboembolism. The combined oral contraceptive (COC)pill suppresses serum testosterone concentrations and improves hirsutism and acne. Ethinyloestradiol combined with cyproterone acetate is most suitable.

Weight reduction can lead to re-establishment of regular menstrual cycles.
Bleaching with hydrogen peroxide removes hair pigments.
Temporary methods of removing hair include plucking, shaving, waxing and depilatory creams. Plucking encourages hair growth and may cause folliculitis. Electrolysis is the only established physical method that offers the potential for permanent hair removal. It is time-consuming, painful and expensive; regrowth occurs. Pharmacological treatment slows the growth of new hair but does not lead to loss of established hair.The degree of hirsutism may be quantified , but usually a semiquantitative subjective report from the patient as to rate of growth and need for cosmesis is satisfactory to gauge the response to therapy.
Metformin inhibits the production of hepatic glucose and enhances the sensitivity of peripheral tissue to insulin, thereby decreasing insulin secretion.It reduces hyperandrogenism and abnormalities of gonadotrophin secretion in women with PCOS. It can restore menstrual cycles, ovulation and fertility. Metformin (1.5–2.5 g/day, given in divided doses) elevates SHBG.
Glucocorticoid therapy
Suppression of adrenal androgens decreases serum androgen concentrations by suppressing adrenocorticotrophic hormone (ACTH)-

Long-term associated medical conditions with PCOS
Hypertension
Cardiovascular disease
Diabetes mellitus
Dyslipidaemia – increased low density lipoproteins (LDL),
decreased high density lipoproteins (HDL) and increased
triglycerides
Endometrial carcinoma.
Screen longitudinally for diabetes, dyslipidaemia and hypertension.


O V U L AT I O N I N D U C T I O N I N A N O V U L AT O R Y W O M E N W I T H P C O S
Women with anovulatory infertility and oligomenorrhoea (menses occurring at intervals of more than 35 days) need ovulation induction. Clomiphene is the drug of first choice. The dose is commenced at 25–50 mg from days 2 to 6 of the cycle and an oestradiol level measured to check for a response. When it is 500 pmol/l, an ultrasound scan should be done to look for follicular size. If there is no response to clomiphene, ovarian diathermy may be done in the first instance because this has excellent pregnancy rates, subsequently,without the risk of multiple pregnancy that occurs with the use of gonadotrophins for ovulation induction . Occasionally a patient with PCOS has an all or nothing response to gonadotrophin stimulation. The only way to control for this is to do in vitro fertilisation (IVF)

hope this information will solve lots of queries to PCOS. Its true and scientific, i being a dental surgeon read whole gynae book to make these notes for my friends like me.
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