Description
About the Case Discussion Topic: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, characterized by irregular menstrual cycles, hyperandrogenism, and polycystic ovaries. This case discussion will explore the clinical presentation, diagnostic challenges, and individualized management strategies for patients with PCOS. Emphasis will be placed on lifestyle interventions, hormonal therapies, and the management of associated metabolic risks. The session aims to enhance clinical decision-making through real-world case scenarios and evidence-based approaches.
Summary Listen
- PCOS, a common hormonal disorder affecting 6-13% of women of reproductive age, often starts in the late teens or early 20s. Up to 80% of cases remain undiagnosed, contributing to infertility. PCOS is also a metabolic syndrome associated with insulin resistance, weight gain, and elevated androgen levels, requiring lifelong management.
- Common symptoms include irregular periods, defined as cycles shorter than 21 days or longer than 35 days, or fewer than eight cycles per year. Hyperandrogenous symptoms like hirsutism, acne, and oily skin, as well as weight gain and fertility issues, are also indicative. Diagnosis requires two of these symptoms, excluding other potential causes, based on ASRM and WHO guidelines.
- Lab tests include testosterone levels (free and total), DHEAS, and SHBG to assess hyperandrogenism, but other causes must be ruled out. Ultrasound findings, while not always necessary for diagnosis in adults, involve observing 20 or more follicles per ovary or an ovarian volume exceeding 10 ml. Transvaginal ultrasounds are preferred, and follicle size should be between 2-9mm.
- Blood tests also include LH, AMH, insulin, glucose tolerance tests, and hemoglobin A1C, considering BMI, age, and combined pill usage. Serum AMH levels peak between 20-25 years of age. A glucose tolerance test with 75mg glucose is ideal, but fasting glucose, insulin, and HbA1c can be used as alternatives, especially during pregnancy.
- Long-term risks include type 2 diabetes, heart disease, hypertension, endometrial cancer, depression, anxiety, and body image issues. Prevention involves lifestyle changes and progestogens like mini-pills or intrauterine devices.
- Treatment involves lifestyle changes (diet and exercise), medication (combined pills, metformin, inositol), and anti-androgens. Diet focuses on low-carb options, and exercise recommendations are 300 minutes per week. Combined pills regulate periods and address hyperandrogenous symptoms, but side effects need to be considered. Metformin targets insulin resistance and may affect B12 levels.
- For women seeking pregnancy, potential risks include gestational diabetes, hypertension, preeclampsia, preterm delivery, fetal macrosomia, and increased rates of cesarean sections. A glucose tolerance test before conception is recommended. While metformin is not contraindicated, its impact on gestational diabetes and hypertension is limited.
Sample Certificate
About the Speakers
Dr. Dragana Pavlovic Acimovic
Obstetrics and Gynecology specialist at Me One Medical Centre, Dubai, United Arab Emirates
Comments
Comments
You must be logged in to leave a comment.