This document discusses polycystic ovarian syndrome (PCOS) and hirsutism. PCOS is a syndrome characterized by ovarian dysfunction, hyperandrogenism, and polycystic ovaries. It has no clear cause but is often genetic. Clinical features include irregular periods, hirsutism, obesity, and infertility. Diagnosis requires two of three features: irregular periods, clinical hyperandrogenism, or polycystic ovaries seen on ultrasound. Long-term risks include diabetes and heart disease. Treatment involves lifestyle changes, birth control pills, metformin, and clomiphene to induce ovulation. Hirsutism is excessive male-pattern hair growth and can be caused by PCOS or other conditions.
2. Polycystic ovarian syndrome
• PCOS is a syndrome of ovarian dysfunction
along with the cardinal features of
hyperandrogenism and polycystic ovary
morphology.
• The aetiology of PCOS is not completely clear,
but there is often a family history. It seems
likely that a gene is important in its
development.
3. Clinical features
• Oligomenorrhoea/amenorrhoea in up to 75 %
of patients, related to chronic anovulation.
• Hirsutism.
• Subfertility in up to 75 % of women.
• Obesity in at least 40 % of patients.
• Recurrent miscarriage in 50–60 % of women.
• Acanthosis nigricans (areas of increased skin
pigmentation occur in the axillae and other
flexures).
• May be asymptomatic.
4. Rotterdam criteria for diagnosis
of PCOS
Patients must have two out of the three features
below:
• amenorrhoea/oligomenorrhoea.
• clinical or biochemical hyperandrogenism
androgen excess (e.g. hirsutism).
• polycystic ovaries on ultrasound.
6. • The ultrasound criteria for the diagnosis of a
polycystic ovary are eight or more subcapsular
follicular cysts <10 mm in diameter and
increased ovarian stroma.
• Elevated serum LH levels and insulin resistance
and are also common features.
7. Long-term consequences of
PCOS
• PCOS is associated with an increased risk of
type 2 diabetes and cardiovascular events.
• possible risk of sleep apnoea .
• Oligo- or amenorrhoea in women with PCOS
may predispose to endometrial hyperplasia and
later carcinoma. It is good practice to
recommend treatment with Progestogens to
induce a withdrawal bleed at least every 3 to 4
months.
8. Management
1) Lifestyle advice: Dietary modification and
exercise is appropriate in these patients as
they are at an increased risk of developing
diabetes and cardiovascular disease later in
life.
2) Weight reduction
3) COCP: This should regulate menstruation.
4) Cyclical oral progesterone: used to regulate
menstruation.
9. 5) Metformin: This is beneficial in patients with
PCOS, those with hyperinsulinemia and
cardiovascular risk factors.
6) Clomiphene: used to induce ovulation where
subfertility is a factor.
7) Ovarian electrocautery :
Ovarian electrocautery should be considered for
selected anovulatory patients, especially those
with a normal BMI, as an alternative to
ovulation induction.
12. causes
1) Polycystic ovary syndrome
2) Cushing's syndrome.
high levels of the hormone cortisol
3) Congenital adrenal hyperplasia.
This inherited condition is characterized by abnormal
production of steroid hormones, including cortisol and
androgen, by adrenal glands.
4) Tumors.
Rarely, an androgen-secreting tumor in the ovaries or adrenal
glands may cause hirsutism
5) Medications.
Some medications can cause hirsutism. One such drug is
danazol, which is used to treat women with endometriosis.
5) Idiopathic
13. Treatment of Hirsutism
• Eflornithine cream (Vaniqua™) applied
topically.
• Cyproterone acetate (Dianette™), anti-
androgen contraceptive pill.
• Metformin: improves parameters of insulin
resistance, hyperandrogenemia, anovulation
and acne in PCOS.
• GnRH analogues : this regime should be
reserved for women intolerant of other
therapies.
• Surgical treatments, e.g. laser or electrolysis.
