POLYCYSTIC OVARIAN SYNDROME (PCOS)......

PCOS is a common problem among women of reproductive age.

1. POLYCYSTIC OVARIAN SYNDROME (PCOS) Ameena Kadar K A Fourth s em M Pharm Dept. of Pharmacy Practice Sanjo College of Pharmaceutical Studies

2. Ameena Kadar K A 2 WHAT IS PCOS? Polycystic ovarian syndrome (PCOS) is a common hormonal disorder affecting an increasing number of women between puberty and menopause. It is called as a ‘syndrome’ because it refers to a number of symptoms experienced at the same time. It is also known as ‘stein-Leventhal syndrome’ or ‘hyperandrogen anovulation syndrome’. Polycystic ovarian syndrome (PCOS) is a disorder of chronically abnormal ovarian function and hyperandrogenism (abnormally elevated androgen levels). The cysts are fluid-filled and contain immature eggs. PCOS is characterized by m enstrual disorders, hyperandrogenism, obesity, hirsutism and presence of polycystic ovaries.

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4. Ameena Kadar K A 4 ETIOPATHOGENESIS Peripheral insulin resistance leads to hyperinsulinemia . This is the major trigger for disordered ovarian function and androgen excess. Hyperinsulinemia may manifest clinically as part of a metabolic syndrome that includes diabetes mellitus, dyslipidemia and coronary artery disease (CAD). Decreased Sex Hormone Binding Globulin (SHBG causes an increase in levels of free active androgens (hyperandrogenism), accounting for the more marked hirsutism, acne and other manifestations of hyperandrogenism. Elevated estrogen stimulates hyperplasia of ovarian stroma theca cells, and the unopposed estrogen affects on the endometrium may lead to abnormal uterine bleeding and increased risk of endometrial cancer. Biochemical profile on PCOS may include: Increased levels of androgen levels Increased serum concentration of LH Increased testosterone and androstenedione. Increased prolactin

5. Ameena Kadar K A 5 Increased insulin Low to normal FSH Low to normal estradiol while estrone level is increased Decreased sex hormone binding- globulin (SHBG)

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7. Ameena Kadar K A 7 RISK FACTORS Age (reproductive age) Presence of other conditions such as obesity, subclinical vascular disease, type 2 diabetes mellitus, dyslipidemia, non-alcoholic steatohepatitis and obstructive sleep apnea. Family history Ethnicity or race,

8. Ameena Kadar K A 8 CLINICAL MANIFESTATIONS OF PCOS Menstrual disorders (amenorrhea, menorrhagia) Obesity Acne Oily skin and hair Excess hair growth on the face and body (hirsutism) Hair thinning or scalp hair loss (alopecia) Weight gain or trouble losing weight Darkened skin patches (Acanthosis nigricans) Difficulty in getting pregnant Mood changes, depression, anxiety Sleep apnea (a sleep disorder in which abnormal pauses of breathing occur during sleep)

9. Ameena Kadar K A 9 DIAGNOSIS Physical Examination Blood tests Blood sugar level Cholesterol level Changes in LH & FSH Transvaginal ultrasound

10. Ameena Kadar K A 10 NON PHARMACOLOGICAL MANAGEMENT Lifestyle modifications Healthy diet Regular exercise Avoid high-sugar foods Take low-carbohydrate diet Take a protein rich diet to balance blood sugar levels Sound sleep Reduce stress Emotional stability Supplementation of key nutrients such as magnesium, chromium, inositol, berberine etc.

11. Ameena Kadar K A 11 PHARMACOLOGICAL MANAGEMENT Combination of birth control pills; Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Regulating hormones can lower the risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Progestin therapy: T aking progestin for 10 to 14 days, one to two months can regulate the periods and protect against endometrial cancer. Progestin therapy does not improve androgen levels and would not prevent pregnancy. Treating Insulin resistance: Metformin, a biguanide oral anti-diabetic medication is used for this purpose. It also reduces the levels of androgens thus decreasing the hirsutism and acne. Hormonal therapies: Clomiphene citrate, helps to produce eggs to correct the irregular or absent ovulation. This antiestrogen medication is taken during the first part of the menstrual cycle. Gonadotropins: Synthetic versions of FSH and hCG. This directly acts on the ovaries. Letrozole : It stimulates the ovaries.

12. Ameena Kadar K A 12 5. Thiazolidinedione has been studied to improve ovulation and increase the pregnancy rate in women with PCOS. 6 . Spironolactone: Spironolactone decreases the incidence of hirsutism by 40% to 88%. Doses of 50 to 100 mg twice daily for 6 to 12 months have been used for this purpose. Women should not become pregnant while taking spironolactone.

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14. Ameena Kadar K A 14 REFERENCES Leon Shargel , Alan H Mutnick, Paul F Souney , Larry N Swanson. Comprehensive pharmacy review for Naplex . Eighth edition. Page No. 527 – 529. Pharmacotherapeutics for second-year diploma in pharmacy. V N Raje . Page No. 137 – 139. https:// www.drsheahan.com.au/wp-content/uploads/polycystic-ovary-syndrome-pcos.pdf

15. Ameena Kadar K A 15 HAVE A GOOD DAY!