Keterangan
Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders among women of reproductive age. PCOS is a common diagnosis in women presenting with infertility. Polycystic ovary syndrome causes irregular menstrual cycles, excessive body or facial hair and polycystic ovaries as its main symptoms. Polycystic means "many cysts," and PCOS often causes clusters of small, pearl-sized cysts in the ovaries.
Early diagnosis of PCOS is important as it has been linked to an increased risk for developing several medical conditions including insulin resistance, type 2 diabetes, high cholesterol, high blood pressure and heart disease. PCOS is an emerging health problem during adolescence therefore promotion of healthy lifestyles and early interventions are required to prevent future morbidities
Ringkasan
- Polycystic Ovary Syndrome (PCOS) is a multifactorial condition linked to insulin resistance, hormone imbalances, and a self-perpetuating cycle. Insulin resistance leads to elevated insulin levels (hyperinsulinemia), decreasing sex hormone-binding globulin (SHBG) produced by the liver. SHBG normally binds excess testosterone, preventing hyperandrogenism. Reduced SHBG causes free testosterone to circulate, contributing to symptoms.
- Clinical manifestations of PCOS can be programmed in utero, as stated by Barker's hypothesis. Later, problems arise, beginning with congenital malformations or growth restriction at birth and premature pubarche (early signs of hyperandrogenism) as children grow. Obesity is followed by further issues like acanthosis nigricans, pseudoacromegaly, metabolic syndrome, acne, hirsutism, alopecia, and anovulation.
- Irregular menstrual cycles, often the earliest sign, occur in 60-85% of affected women. Diagnosing adolescent girls is difficult, as irregular menstruation is typical for this age group. The definition varies for the first three years post-menarche: periods less than 21 days apart, more than 45 days apart, or no period for more than three months.
- Androgenism includes hirsutism (excess body hair), acne, seborrhea (oiliness), alopecia (hair loss), and, rarely, hyperthecosis (virilization). Heretism can be assessed using the modified Ferriman-Gallwey scoring system. Obesity with an apple-shaped abdomen is common, with specific waist circumference and waist-hip ratio cutoffs.
- Acanthosis nigricans, characterized by dark skin discoloration, is a sign of insulin resistance. A variant called HAIR-AN syndrome involves hyperandrogenemia, insulin resistance, and acanthosis nigricans. Obstructive sleep apnea is also a concern, especially in obese patients. The psychological impact includes poor self-esteem, depression, anxiety, negative body image, and eating disorders.
- Infertility is present in almost 50% of PCOS women due to anovulation. Those who do conceive face higher risks of pregnancy complications. Diagnosing PCOS involves a comprehensive history (including prenatal history), physical examination, and potential gynecological examination.
- Differential diagnoses depend on the primary symptom (irregular cycles, infertility, hyperandrogenism) and the patient's age. In young women, congenital adrenal hyperplasia must be ruled out, as well as androgen excess. Also Cushing's syndrome, apparent cortisone reductase deficiency, or androgen over production.
- Ultrasound reveals increased follicle numbers per ovary (typically small cysts). The consensus now defines 20 or more follicles per ovary with sophisticated ultrasounds. The volume of the ovary can also indicate PCOS.
- Lab tests may include LH/FSH ratio, free testosterone, total serum testosterone, DHEAS (especially in young women), serum prolactin, TSH (thyroid function), 17-hydroxyprogesterone (for congenital adrenal hyperplasia), ACTH (for Cushing's), oral glucose tolerance test (OGTT), serum insulin, or fasting glucose-to-insulin ratio.
- Management prioritizes lifestyle modification: diet and exercise, caloric restriction, increased physical activity, and avoiding smoking, alcohol, and excess caffeine. A 5-10% weight loss can improve outcomes. Bariatric surgery is an option for severe obesity.
- For persistent menstrual disorders, cyclical progesterone or combined oral contraceptive pills (OCPs) can be used. Anti-androgen medications like spironolactone may be used for hirsutism. Dermatological treatments (electrolysis, laser) should be delayed until hormone levels stabilize.
- Metformin and myo-inositol are other treatment options. Vitamin D deficiency should be addressed. Psychological support is critical. For infertile women with PCOS, ovulation induction with clomiphene citrate, gonadotropins, or aromatase inhibitors may be employed. Laparoscopic ovarian drilling is a surgical option. Complication monitoring is necessary due to the risk of metabolic syndrome, diabetes, hypertension, cardiovascular disease, dyslipidemia, and endometrial malignancy.
Contoh Sertifikat
Tentang Pembicara
Dr Krishna Kumari
Consultant Gynecology, Apollo Hospital
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