Description
PCOS is one of the most common, but treatable, causes of infertility in women. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation).In this webinar Dr Pakhee Agarwal will help us understand Management of PCOS and Implications for fertility.
Résumé
- Polycystic Ovarian Syndrome (PCOS) is a syndrome involving multiple symptoms and organ systems. Common symptoms include acne, excessive hair growth, hair loss, and obesity. These symptoms often begin around puberty and can lead to dermatological visits before gynecological consultations.
- Obesity is a significant factor, contributing to hormonal imbalances due to fat acting as a hormone factory. This disbalance can result in irregular menstrual cycles, heavy bleeding, and infertility, particularly in women in their late 20s and 30s.
- PCOS is classified into three types based on dysfunction: hypothalamic-pituitary issues (low FSH, LH, estrogen), axis imbalances (normal hormones but anovulation), and ovarian failure (high FSH, LH, low E2). PCOS is synonymous with anovulation, accounting for 75% of cases.
- Diagnosis of PCOS involves the presence of at least two out of three criteria: hyperandrogenism (clinical or biochemical), ovulatory dysfunction (oligo or anovulation), and polycystic ovaries on ultrasound. A misdiagnosis can occur due to interpreting multicystic ovaries, common in young girls, as polycystic ovaries.
- Clinical hyperandrogenism manifests as hirsutism, acne, and male pattern balding. Biochemical hyperandrogenism is confirmed through tests measuring testosterone, free testosterone, and other androgen levels. Ultrasound criteria for polycystic ovaries include at least 20 follicles (2-9mm) and an ovarian volume of at least 10ml.
- Oligo-anovulation presents as abnormal menstrual patterns, including oligo-menorrhea (infrequent periods), secondary amenorrhea (absence of periods), and dysfunctional uterine bleeding. Vaginal ultrasound is preferable for detecting follicles, though abdominal ultrasound is used in those not sexually active.
- PCOS is further categorized into four phenotypes based on the presence or absence of hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. Types C and D, lacking hyperandrogenism or ovulation issues, are generally milder.
- PCOS can also be classified as obese or lean. Obese individuals with PCOS often exhibit more hyperinsulinemia, insulin resistance, and elevated testosterone levels. They face higher risks of endometrial hyperplasia and associated health complications.
- Treatment of PCOS includes lifestyle modifications, specifically diet and exercise, and medical management. The oral contraceptive pill can regulate cycles, reduce bleeding, and treat acne. Insulin sensitizers like metformin address insulin resistance and enhance treatment effectiveness.
- PCOS affects fertility through anovulation and compromised oocyte quality due to ovarian hyperandrogenism and hyperinsulinemia. These factors disrupt follicle maturation, leading to growth arrest. Medications like chlomophen can stimulate follicle growth.
- Fertility treatment considerations include the patient's age, duration of marriage, and confirmation of infertility. Infertility is defined as no pregnancy after one year of unprotected intercourse or six months for women over 35. Spontaneous pregnancy is uncommon with PCO.
- Pregnancy risks associated with PCOS encompass increased miscarriage rates, gestational diabetes, preeclampsia, fetal anomalies, preterm birth, macrosomia, and a higher chance of cesarean delivery. Treatment aims to regularize cycles, address acne and hair growth, manage blood sugar, and boost pregnancy chances.
Exemple de certificat
À propos des intervenants
Dr Pakhee Agarwal
Robotic & Minimally Invasive Genecology Surgeon Fortis Memorial Research Institute
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