POLYCYSTIC OVARIAN SYNDROM

Definition

The most widely accepted definition from the 2003 Rotterdam ESHRE/ASRM sponsored workshop on PCOS, are that any two of the following three criteria were required to diagnose PCOS after excluding other causes of androgen excess.

  • Ovulatory dysfunction such as anovulation/ oligoovulation
  • Clinical or biochemical evidence of hyperandrogenism such as hirsuitism or acne
  • Polycystic ovarian morphology on ultrasound can be seen in 10-20% of normally ovulating women. So best definition of PCOS is hyperandrogenic anovulation.

But polycystic ovaries on ultrasound can be seen in 10-20% of normally ovulating women. So the best definition of PCOS is hyperandrogenic anovulation.

Clinical Presentation
  • Infrequent menstrual periods, no menstrual periods, and/or irregular bleeding
  • Increased growth of hair on the face, chest, stomach, back, thumbs, or toes
  • Acne, oily skin, or dandruff
  • Pelvic pain
  • weight gain or obesity, usually carrying extra weight around the waist
  • Type 2 diabetes
  • High cholesterol
  • High blood pressure
  • Male-pattern baldness or thinning hair

PCOS usually presents for the first time at puberty along with weight gain. The most common presentation is menstrual disorders along with hirsuitism. 50-70% of PCOS are obese, but theses problems are only the tip of the iceberg as will be seen later. Irregular or infrequent menstrual cycles are common in the first few years following the menarche but are usually self limiting once ovulation is established. If it persists even at 4 years lit is best to start evaluation or earlier if associated with signs of hyperandrogenism.

Differential diagnosis

It is important to rule lout hyperprolactinaemia as other causes of irregular periods. Also other causes of hirsuitism like masculinising ovarian tumours, adrenal tumours and the occasional girl with late lonset congenital adrenal hyperplasia.

Clinical evaluation
  • History of amenorrhoea/oligomenorrhoea
  • Family history of irregular periods or diabetes
  • Hirsuitism, acne and seborrhea

Acanthosis nigricans or the presence of dark, velvety patches in the armpits, nape of neck and under the breasts. Almost all girls with this condition will have insulin resistance and PCOS.
Body mass index is calculated as weight in kg/ Height in m2. A value above 27 is considered high in the Indian context.
Waist hip ration Waist circumference is measured as the smallest waist diameter usually at the level of the umbilicus. Hip circumference is measured lat the broadest part of the lower body usually at the level of the trochanters. An increased waist hip ratio givers rise to central lo rappel type obesity.

Investigations
  • Ultrasound scan to rule out ovarian tumours and to confirm the presence of polycystic ovaries
  • Hormonal investigations
    • Thyroid functions tests
    • Prolacting
    • Free testosterone is the best marker of ovarian androgen production
    • DHEAS is usually increased if there is an adrenal cause
    • 17 alpha hydroxyl progesterone if late onset congenital adrenal hyperplasia is suspected, but this is extremely rare.
  • Metabolic tests

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