polycystic Ovary Syndrome all details.pptx

Introduction
Demography
Etiology
Physiology
Pathophysiology
Clinical features
Differential diagnosis
Investigations
Treatment
Complications
Summary
Conclusion
References
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Heterogeneous disorder that is defined by a combination of signs and symptoms of androgen excess and ovarian dysfunction with the clinical manifestations of oligomenorrhoea, subfertility, hirsutism and acne
Normal Range of Androgen : 6.0 -86 nanogram per decilitre (ng/dL) in females .
 Other Names:
Polycystic ovary disease
Functional ovarian hyperandrogenism
Ovarian hyperthecosis
Sclerocystic ovary syndrome
Stein-Leventhal syndrome

1. Polycystic Ovarian Syndrome Presented By: Divya Ashok Dhule M.Pharm .(Pharmaceutical Chemistry) 2 nd Semester Department of Pharmaceutical Sciences Rashtrasant Tukadoji Maharaj Nagpur University Nagpur-440033 Fig.1 Polycystic ovary

2. Contents: Introduction Demography Etiology Physiology Pathophysiology Clinical features Differential diagnosis Investigations Treatment Complications Summary Conclusion References

3. Introduction Heterogeneous disorder that is defined by a combination of signs and symptoms of androgen excess and ovarian dysfunction with the clinical manifestations of oligomenorrhoea, subfertility, hirsutism and acne Normal Range of Androgen : 6.0 -86 nanogram per decilitre (ng/dL) in females .   Other Names: Polycystic ovary disease Functional ovarian hyperandrogenism Ovarian hyperthecosis Sclerocystic ovary syndrome Stein-Leventhal syndrome

4. 1935 -American gynaecologists Irving F Stein and Michael L Leventhal . It is the most common endocrine disorder of women of reproductive age group. Prevalence varies among races and ethnicities: • USA – 4-12% • European studies – 6.5-8% Northern Nigeria– 12.2% • Southern Nigeria– 27.6% Affects premenopausal women, and the age of onset is most often perimenarchal . Associated with clinical, social and psychological problems. Management aims to lower body weight and insulin levels, restore fertility, restore regular menstruation, treat hirsutism or acne, and prevent complications.

5. Demography: Fig.2 Percentage of the population knowledge about PCOS and percentage of population whose PCOS diagnosed and Non Diagnosed Aayushi  Mathur, Aman Tiwari ,Indian Journal of Obstetrics and Gynecology Research,2023 July 17;4(7);330-334

6. Etiology : Fig.3 Schematic illustration shows the proposed pathophysiology and features of PCOS Diamanti- Kandarakis E, Kandarakis H, Legro RS. The role of genes and environment in the etiology of PCOS. Endocrine. 2006 Aug;30:19-26

7. Physiology of Menstruation   Fig.4 Hypothalamic–pituitary–ovarian axis

8. Fig.5 Formation of Hormone s

9. Fig. 6 Clinical Physiology of Menstrual Cycle

10. Fig.7 Pathophysiology of PCOS

11. Symptoms And Complications Of Pcos 12

12. Diagnostic Criteria 13

13. Differential Diagnosis : Hyperthyroidism Hypothyroidism Hyperprolactinaemia Hypogonadotropic hypogonadism Primary ovarian failure Acromegaly Late onset CAH Androgen secreting ovarian tumour Androgen secreting adrenal tumour Cushing syndrome

14. Investigations Biochemical tests • FSH ,LH • Testosterone – Total and Free FAI (Free Androgen Index) • Thyroid function tests. • Serum Prolactin • Blood Sugar Test: 2hr GTT (Oral Glucose Tolerance Test) • Fasting Insulin Level • Fasting Lipid Profile • DHEA-S (Dehydroepiandrosterone sulfate ) • 17 α hydroxyprogesterone • Cortisol

15. Radiological tests • Ultrasound scan • CT scan • MRI scan Histology Histology Endometrial biopsy

16. Treatment No universal treatment for PCOS is available Treatment is individualized, based on: Woman’s goal Severity of symptoms Technique include: • Conservative • Medical • Surgical

17. Treatment: Fairly regular cycle intervals (8 to 12 menses per year) Mild hyperandrogenism Encourage weight loss Diet modification Exercise

18. Medical Management Aim: • Lower insulin levels • Restore regular menstruation • Restore fertility • Treat hirsutism or acne • Prevent endometrial hyperplasia and endometrial cancer

19. Medical Treatment Restoration of ovulation/menstruation Combined Oral Contraceptive Pills • Suppress gonadotropin release • Reduce androgen levels • Induce regular menstrual cycles Cyclic progestogens • When COCP is contraindicated (e.g. MPA) • Intrauterine progestogen device (IUS or implants) • Insulin sensitizing agents

20. Medical Treatment: Insulin resistance / hyperinsulinaemia : 1)Metformin • Improves peripheral insulin sensitivity by reducing hepatic glucose production • Increases target tissue sensitivity to insulin • Decreases androgen levels • Helps spontaneous ovulation 2) Thiazolidinedione • Improves entry of glucose into muscle and fat • Suppresses hepatic gluconeogenesis.

21. Medical Treatment 2)Treatment of hirsutism • COCP :Lowers androgen level Oestrogen component increases SHBG • Eflornithine hydrochloride (Inhibits the Ornithine Decarboxylase) • GnRH agonists • Antiandrogens (e.g. spironolactone, cyprotene acetate, flutamide) • 5 α reductase inhibitor (e.g. finasteride) • Hair removal – depilation or epilation 1)Treatment of infertility • Clomiphene citrate • Tamoxifen • Clomiphene + Metformin • Gonadotropin alone or with hCG • Assisted Reproductive Technology 3)Treatment of acne • COCP • Topical Retinoids • Topical Benzoyl Peroxide • Topical and Systemic Antibiotics • Isotretinoin 4) Alternative medicine  Acupuncture : • Helps menstrual regulation • Decreases body weight • Reduces headache • Improves mood Myo-inositol : • Promotes proper insulin utilization • Balances ovarian hormone functions • Regularises menstrual cycle • Improves fertility

22. Surgical Treatment : 1)Ovarian wedge resection (rarely done) 2)Oophorectomy (rarely done) • When fertility is not desired and symptoms are severe 3)Laparoscopic ovarian drilling (laser, electrocautery, multiple biopsy) • For clomiphene resistants • Mechanism unclear • May be due to destruction of androgen producing stroma

23. Natural treatment for PCOS : 1. Natural Molecule supplementation in the management of PCOS : Inositols Resveratrol Flavonoids Flavones Vitamin C Vitamin D Omega 3 fatty acid 2. Natural Remedies for PCOS : (Phytoestrogenic and Non etrogenic Herbs) Liquorice Ginseng Black Cohosh Dong qui Hops and kelp 3. Natural Compounds with promising Potential in treating PCOS : Polyphenols(against various Stresses) Polyhydroxyphenols ( Cardioprotection , Anticarcinogenic, Antioxidant, Anti –apoptotic, Anti inflammatory properties )

24. Complications Short Term Long Term Obesity Diabetes mellitus Infertility Endometrial Cancer Irregular Menses Hypertension Abnormal Level Cardiovascular Diseases Hirsuitism Depression Acne Sleep Apnea Glucose intolerence Reduces health related quality of life Acanthosis Nigricans

25.   Summary : • PCOS is a clinical disorder associated with hormonal and menstrual abnormalities . • It may be associated with short and long term complications. • Diagnosis involves clinical, laboratory and radiological methods . • Treatment depends on the need of the patient and severity of symptoms. • Treatment can be conservative, medical or surgical .

26. Conclusion: Polycystic ovarian syndrome  is one of the most important endocrine disorders that affects females in the reproductive age and may lead to serious complications. Further studies are needed to determine the exact aetiology of PCOS, methods of prevention and proper management.

27. References: 1. Royal College of Obstetricians & Gynaecologists. Long-term consequences of polycystic ovary syndrome: green-top guideline No 33. Royal College of Obstetricians and Gynaecologists. 2014. 2. Kabel AM. Polycystic ovarian syndrome: insights into pathogenesis, diagnosis, prognosis, pharmacological and non- pharmacological treatment. J Pharma Reports. 2016 Jan 1;1(103):2. 3. Hoffman BL, Schorge JO, Bradshaw KD, Halvorson LM, Schaffer JI. Williams gynecology . McGraw-Hill Interamericana ; 2017. 4. Omokanye L O, Ibiwoye-Jaiyeola O A, Olatinwo A, Abdul I F, Durowade K A, Biliaminu S A. Polycystic ovarian syndrome: Analysis of management outcomes among infertile women at a public health institution in nigeria . Niger J Gen Pract 2015;13:44-834 5. https://emedicine.medscape.com/article/256806-overview. Accessed online 20/02/2019 . 6.Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology. 2018 Mar 23. 7. Akpata CB, Uadia PO, Okonofua FE. Prevalence of Polycystic Ovary Syndrome in Nigerian Women with Infertility: A Prospective Study of the Three Assessment Criteria. Open Journal of Obstetrics and Gynecology . 2018 Sep 29;8(12):1109.

28. Bulsara J, Patel P, Soni A, Acharya S. A review: Brief insight into Polycystic Ovarian syndrome. Endocrine and metabolic science. 2021 Jun 30;3:100085.
Siddiqui S, Mateen S, Ahmad R, Moin S. A brief insight into the etiology , genetics, and immunology of polycystic ovarian syndrome (PCOS). Journal of assisted reproduction and genetics. 2022 Nov;39(11):2439-73.
Banerjee TS, Pandit AK. Polycystic Ovarian Syndrome: A Brief Mini Review on Current Updates. BN Seal Journal of Science Volume VIII Issue 1 September 2016:77.
H, Masud J, Islam YN, Haque FK. An update on polycystic ovary syndrome: A review of the current state of knowledge in diagnosis, genetic etiology , and emerging treatment options. Women’s Health. 2022 Aug;18:17455057221117966.
Singh S, Pal N, Shubham S, Sarma DK, Verma V, Marotta F, Kumar M. Polycystic ovary syndrome: etiology , current management, and future therapeutics. Journal of Clinical Medicine. 2023 Feb 11;12(4):1454.

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