PCOD || Gynecology

Summary

This lecture covers polycystic ovarian syndrome (PCOS), detailing its pathology rooted in increased androgen production leading to hirsutism and hormonal imbalances. It explains how elevated estrogen negatively impacts follicle-stimulating hormone, disrupts ovulation, and causes endometrial issues. The talk also addresses PCOS's link to insulin resistance, cardiovascular risks, and potential cancers. The Rotterdam criteria for diagnosis and treatment options, including lifestyle changes, medications, and surgery, are also discussed.

Takeaways

• 🌟 Polycystic Ovarian Syndrome (PCOS) is also known as Stein-Leventhal Syndrome and is characterized by increased androgen production.
• 🔬 The excess androgens lead to hirsutism (excessive hair growth) and are converted to estrogens by the aromatase enzyme, causing a cascade of hormonal imbalances.
• 📉 High estrogen levels decrease follicle-stimulating hormone (FSH) and increase luteinizing hormone (LH), resulting in an altered LH to FSH ratio, typically more than 2:1 in PCOS.
• 🚫 The lack of a LH surge, which is necessary for ovulation, leads to oligomenorrhea or amenorrhea, and eventually, multiple cysts in the ovaries.
• ⚠️ Increased LH stimulates theca cells to produce more androgens, perpetuating the cycle and contributing to the thickening of ovarian tissue.
• 🌡 Unopposed estrogen can lead to endometrial hyperplasia, which may progress to cancer, and PCOS patients are at higher risk for endometrial and breast cancers.
• 🏃‍♀️ Lifestyle modifications and weight reduction are the first-line treatments for PCOS, aiming to reduce obesity and improve insulin resistance.
• 💊 Oral contraceptive pills (OCPs) are often prescribed to regulate menstrual cycles and manage hirsutism in PCOS patients.
• 🩺 Metformin is used to address insulin resistance, a common comorbidity in PCOS that can lead to type 2 diabetes.
• 🏥 Infertility in PCOS may be treated with selective estrogen receptor modulators like clomiphene citrate, with gonadotropins or LH/FSH injections as second-line options.

Q & A

What is Polycystic Ovarian Disease (PCOS) also known as?

Polycystic Ovarian Disease (PCOS) is also known as Polycystic Ovarian Syndrome and Stein-Leventhal Syndrome.

What is the basic pathology behind Stein-Leventhal Syndrome?

The basic pathology in Stein-Leventhal Syndrome is increased androgen production, which leads to various symptoms such as hirsutism.

How does increased androgen production lead to hirsutism?

Increased androgen production stimulates the growth of sexual terminal hair, resulting in hirsutism.

What is the role of the aromatase enzyme in the context of PCOS?

The aromatase enzyme converts androgen to estrogen, which has several effects including decreasing follicle stimulating hormone (FSH).

Why does increased estrogen lead to a decrease in FSH?

Increased estrogen exerts a negative feedback mechanism on FSH, as estrogen is produced by the ovaries in response to FSH stimulation from the pituitary gland.

What is the significance of the LH to FSH ratio in patients with PCOS?

In patients with PCOS, the LH to FSH ratio is more than 2:1, indicating an imbalance in these hormones.

How does the absence of an LH surge affect ovulation in PCOS?

The absence of an LH surge, which is necessary for ovulation, leads to a lack of ovulation in PCOS.

What are the long-term consequences of PCOS on a woman's health?

Long-term consequences of PCOS include increased cardiovascular risk factors, risk of diabetes mellitus due to insulin resistance, and increased risk of endometrial and breast carcinomas.

What is acanthosis nigricans and how is it related to PCOS?

Acanthosis nigricans is a condition characterized by pigmented, velvety skin, often in the neck and axilla areas, and it is related to insulin resistance, which is common in PCOS.

What are the Rotterdam criteria for diagnosing PCOS?

The Rotterdam criteria for diagnosing PCOS include the presence of oligomenorrhea or amenorrhea, clinical and biochemical symptoms such as hirsutism and increased serum testosterone, and the presence of 12 or more cysts in the ovaries on ultrasonography.

What is the first line of treatment for PCOS?

The first line of treatment for PCOS is weight reduction and lifestyle modifications. If necessary, treatment may also include oral contraceptive pills (OCPs) for irregular periods and metformin for insulin resistance.

What are the treatment options for infertility in PCOS?

For infertility associated with PCOS, the first line of treatment includes selective estrogen receptor modulators such as clomiphene citrate. Second line treatments may include gonadotropins or LH/FSH injections, and third line treatments may involve the use of GnRH analogs.