- November 13, 2015
- Posted by: emobile
- Category: Trending Issues
Polycystic ovary syndrome (PCOS) is a constallation of signs and symptoms which includes menstrual irregularities such as oligomenorrhea (menstrual cycle > 35days) or amenorrhea, hirsutism (male pattern of hair distribution in females), acne, polycystic ovary appearance on ultrasound scan and infertility. It is the commonest cause of anovulation worldwide and usually familial. Approxmately 10% of individuals with PCOS will have galactor…rhea (breast milk discharge in a non breastfeeding female).
Clinical presentation is usually during reproductive age with some of the above symptoms and signs. About 50% of individuals with PCOS are obese (body mass index of 30 and above).
It has been linked with insulin insensitivity with most individuals with PCOS developing type II diabetes mellitus later in life.
Investigations to be done include a hormone profile [luteinizing hormone (LH), follicular stimulating hormone (FSH), estradiol and prolactin], Antimullerian hormone assay and a trans-vaginal ultrasound scan.
Diagnosis is based on Amsel criteria, with 2 of the 3 criteria needed to make a diagnosis. These criteria include oligomenorrhea or oligo-ovulation; clinically features of PCOS such as acne & hirsuitism or biochemical features in which LH is atleast twice as high as FSH; and an USS feature in which 12 or more follicles with a diameter of 2-9mm are seen arranged peripherally with an ovarian volume of 10ml or more.
Treatment is usually based on presenting complaints and these may range from hirsuitism to menstrual irregularities to infertility.
1st line treatment for Infertility in patients with PCOS is via ovulation induction using agents such as clomiphene citrate, aromatase inhibitors (eg letrozole), insulin sensitizers (eg metformin), dopamine agonists (eg bromocriptine, cabergoline), glucocorticoids, gonadotorphin releasing hormone analogues (eg buserelin, luphere & zoladex), gonadotrophins (FSH) and sometimes laparoscopic ovarian diathermy. In vitro fertilization + embryo transfer is also a treatment modality