Polycystic ovary syndrome overview
|
Polycystic ovary syndrome Microchapters |
|
Differentiating Polycystic ovary syndrome from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Polycystic ovary syndrome overview On the Web |
|
American Roentgen Ray Society Images of Polycystic ovary syndrome overview |
|
Risk calculators and risk factors for Polycystic ovary syndrome overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Please help WikiDoc by adding content here. It's easy! Click here to learn about editing.
Overview
PCOS is the most common form of chronic anovulation associated with androgen excess. Polycystic ovary syndrome occurs in approximately 5% to 10% of reproductive-age women. The diagnosis of PCOS is made by excluding other hyper androgenic disorders like nonclassic adrenal hyperplasia, androgen-secreting tumors, hyperprolactinemia in women with chronic anovulation and androgen excess. During the reproductive years, PCOS is associated with important reproductive morbidity, including infertility, irregular uterine bleeding, and increased pregnancy loss. The endometrium of the patient with PCOS must be evaluated by biopsy because long-term unopposed estrogen stimulation leaves these patients at increased risk for endometrial cancer. PCOS is also associated with increased metabolic and cardiovascular risk factors. These risks are linked to insulin resistance and are compounded by the common occurrence of obesity, although insulin resistance also occurs in nonobese women with PCOS. PCOS is considered to be a heterogeneous disorder with multifactorial causes. PCOS risk is significantly increased with a positive family history of chronic anovulation and androgen excess, and this complex disorder may be inherited in a polygenic fashion
Historical Perspective
PCOS was first described in 1935 by American gynecologists Irving F. Stein, Sr. and Michael L. Leventhal, from whom its original name of Stein–Leventhal syndrome is taken. The earliest published description of PCOS was in 1721 in Italy. Cyst-related changes to the ovaries were described in 1844
Classification
PCOS may be classified into 4 types based upon severity of symptoms into asymptomatic form, mild form, classical form and metabolic form
Pathophysiology
Causes
The underlying defect in patients with PCOS remains unknown, but the harmonal imbalance between LH, FSH and estrogen are mainly responsible for the development of polycystic ovary syndrome. Most studies suggest that more than one factor could play a role in developing PCOS.
Differentiating Polycystic ovary syndrome overview from Other Diseases
Polycystic ovary syndrome must be differentiated from other causes of irregular or absent menstruation and hirsutism, such as congenital adrenal hyperplasia, cushing's syndrome, hyperprolactinemia, and other pituitary or adrenal disorders.
Epidemiology and Demographics
Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders of reproductive-age women, with a prevalence of 4-12% in the United States. Up to 10% of women are diagnosed with PCOS.
Risk Factors
Common risk factors in the development of Polycystic ovary syndrome are hyperinsulinemia secondary to insulin resistance, obesity, family history of PCOS among first-degree relatives, premature adrenarche, fetal androgen exposure, and low birth weight
Screening
According to Royal College of Obstetricians and Gynaecologists (RCOG) thyroid function tests, serum prolactin levels, and a free androgen index are baseline screening tests recommended for women with suspected polycystic ovarian syndrome (PCOS).
Natural History, Complications, and Prognosis
If left untreated patients with PCOS can develop heart disease due to elevated cholesterol and increased levels of androgens. Increased lengths of time without a menstrual period leads to unopposed exposure of endometrium to estrogen can result in uterus cancer. Complications that can develop as a result of polycystic ovary syndrome are insulin resistance/type II diabetes, high blood pressure, dyslipidemia, strokes, miscarriage, and infertility. The prognosis for fertility in patients with polycystic ovary syndrome is good with treatment, unless there are other unknown fertility problems.
Diagnosis
Diagnostic Criteria
PCOS was previously defined according to the proceedings of an expert conference sponsored by the National Institutes of Health (NIH) in 1990, which described the disorder as including hyperandrogenism or hyperandrogenemia (or both), oligo-ovulation, and exclusion of known disorders of androgen excess and anovulation. Another expert conference held in Rotterdam in 2003 defined PCOS, after the exclusion of related disorders, by the presence of two of the following three features oligo-ovulation or anovulation, clinical or biochemical signs of hyperandrogenism (or both), and polycystic ovaries. In essence, the Rotterdam 2003 criteria expanded the NIH 1990 definition by creating two new phenotypes ovulatory women with polycystic ovaries plus hyperandrogenism and oligo-anovulatory women with polycystic ovaries but without hyperandrogenism.
History and Symptoms
The significant information that needs to focused in the history of the patient includes menstrual abnormalities, infertility, signs of virilization on physical examination and family history of PCOS among first-degree relatives.The most common symptoms of PCOS include amenorrhea or oligomenorrhea, abnormal uterine bleeding and androgenization, including hirsutism, acne, oily skin.
Physical Examination
Patients with polycystic ovary syndrome usually appear obese. During the physical examination, it is essential to search for and document signs of androgen excess (hirsutism, virilization, or both), insulin resistance (acanthosis nigricans), and the presence of unopposed estrogen action (well-rugated vagina and stretchable, clear cervical mucus) to support the diagnosis of PCOS