POLYCYSTIC OVARIES

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POLYCYSTIC OVARIES

• Occurs in 23 of women
• The cysts are immature follicles of about 4-6mm
  diam.
• Menstrual problems are common

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POLYCYSTIC OVARIES

• Diagnosis is made by ultrasound scanning
• Biochemistry may be helpful
• Raised LH (LHFSH gt3)
• Raised testosterone
• Decreased SHBG

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POLYCYSTIC OVARIES
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POLYCYSTIC OVARIAN SYNDROME

• Polycystic ovarian syndrome occurs in about
  10-20 of women with PCO
• Likely to be genetic, through either parent
• Condition is associated with insulin resistance

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POLYCYSTIC OVARIAN SYNDROME

• Symptoms of PCOS
• BMI gt 30
• Subfertility amenorrhoea
• - oligomenorrhoea
• Androgenisation acne
• greasy skin
• inappropriate hirsutism
• Increased miscarriage rate

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POLYCYSTIC OVARIAN SYNDROME
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POLYCYSTIC OVARIAN SYNDROME
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POLYCYSTIC OVARIAN SYNDROME

• Positive correlation between insulin resistance
  and anovulatory infertility

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POLYCYSTIC OVARIAN SYNDROME

• Insulin resistance is associated with
• Stimulation of androgen production
• Impairment of local steroidogenesis
• Stimulation of plasminogen activator inhibitor-1
  (PAI-1)
• Limitation of follicular growth
• ?obesity

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POLYCYSTIC OVARIAN SYNDROME

• Diagnosis of infertility associated with PCOS
• Anovulation
• Ultrasound demonstration of polycystic ovaries
• Hyperandrogenisation
• 2 of the 3 must be present

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POLYCYSTIC OVARIAN SYNDROME

• INVESTIGATIONS for subfertility
• As before plus
• GTT
• Possibly insulin tolerance test
• Renal and hepatic function

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POLYCYSTIC OVARIAN SYNDROME

• Treatments for anovulatory infertility in PCOS
• Clomiphene
• Gonadotrophin therapy
• Ovarian drilling
• IVF
• Metformin with/without clomiphene

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POLYCYSTIC OVARIAN SYNDROME
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POLYCYSTIC OVARIAN SYNDROME

• Treatment
• Metformin 500 mg tds (500 mg increased in weekly
  increments)
• Initial 6 months treatment
• If no evidence of ovulation, add clomiphene

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POLYCYSTIC OVARIAN SYNDROME

• Metformin
• 58 ovulatations out of 114 patients
• 51

• Placebo
• 36 ovulations out of 111 patients
• 31

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POLYCYSTIC OVARIAN SYNDROME

• Metformin plus clomiphene
• 87 ovulations out of 105
• 89

• Placebo plus clomiphene
• 40 ovulations out of 113
• 28

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POLYCYSTIC OVARIAN SYNDROME

• Other problems associated with PCOS
• Obesity
• Best treated by strict dieting
• Metformin not helpful unless combined with strict
  dieting
• Other treatments may be of help

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POLYCYSTIC OVARIAN SYNDROME

• Oligo- and amenorhoea
• In those not attempting pregnancy, a bleed at
  least every 3 months is essential
• This may be promoted by either a 10 day course of
  progestogens or cyclical use of c.o.c. (Dianette
  or Yasmin)

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POLYCYSTIC OVARIAN SYNDROME

• Hirsutism and androgenisation
• Shaving
• Depilatories
• Electrolysis
• Laser
• Cyproterone acetate

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POLYCYSTIC OVARIAN SYNDROME

• Pregnancy and miscarriage
• Miscarriage rates as high as 30, ? Due to raised
  LH
• Metformin shown to be useful in uncontrolled
  trials
• No evidence of teratogenicity with metformin