1. Polycystic Ovary Syndrome DI WEN M.D., Ph.D. DI WEN M.D., Ph.D. Professor & Chairman Professor & Chairman Department Of Obstetrics & Gynecology Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine Renji Hospital Affiliated to SJTU School of Medicine

2. Introduction Introduction Definition:Definition: –polycystic ovary syndrome (PCOS) is a generic description for a broad spectrum of clinical and morphological findings in women with an endocrine dysfunction, specifically abnormal androgen production and metabolism.

3. Introduction Introduction PCOS was first identified by Stein and Leventhal in 1935 so that it can also be known as Stein – Leventhal Syndrome.PCOS was first identified by Stein and Leventhal in 1935 so that it can also be known as Stein – Leventhal Syndrome.

4. Etiology & Pathopysiology Etiology & Pathopysiology What we think we know. “ Vicious cycle ”“ Vicious cycle ” Abnormal gonadotropin secretionAbnormal gonadotropin secretion –Excess LH and low, tonic FSH Hypersecretion of androgensHypersecretion of androgens –Disrupts follicle maturation –Substrate for peripheral aromatization Negative feedback on pituitaryNegative feedback on pituitary –Decreased FSH secreation Insulin resistance, Elevated insulin levelsInsulin resistance, Elevated insulin levels

5. Pathology Pathology Ovaries: enlarged and/or polycystic ovariesOvaries: enlarged and/or polycystic ovaries Endometrium: Lack of ovulation for an extended period of time may cause excessive thickening of the endometrium (the lining of the uterus).Endometrium: Lack of ovulation for an extended period of time may cause excessive thickening of the endometrium (the lining of the uterus).

6. Pathology Pathology

7. What Are the Symptoms of PCOS? Irregular or Lack of Menses:Irregular or Lack of Menses: Women will have “spotty” periods (1 every couple of months). Also, in some women with PCOS they simply cease having a menses at all. Women will have “spotty” periods (1 every couple of months). Also, in some women with PCOS they simply cease having a menses at all.

8. Symptoms Symptoms Hirsutism :Hirsutism : –Excessive body hair. In women with PCOS dark, coarse hair will appear on the face, neck, chest, arms, and in between the legs.

9. Symptoms Symptoms Weight Problems :Weight Problems : –Depending on the woman, there could be a decrease of weight or a rapid fluctuation of weight that settles around the stomach that will lead to morbid obesity.

10. Symptoms Symptoms Acne :Acne : –Because women with PCOS are producing more male hormone, that produces more sebum (skin oils and old tissue) and causes blocked pores and more acne around the jawline, arms and chest.

11. Symptoms Symptoms Alopecia or Female Pattern Baldness :Alopecia or Female Pattern Baldness : –This is caused by the increase of male hormone in the women's body. Thinning or loss of hair is usually contained to top of the scalp, but in severe cases loss of hair in front or on the hairline has been documented.

12. Other Symptoms Other Symptoms “Dirty Skin” or Acanthosis Nigricans :“Dirty Skin” or Acanthosis Nigricans : –This condition causes light brown to black rough patches around the neck and under arms. Migraines :Migraines : –Severe headaches that cause light sensitivity, nausea and dizziness.

13. Diagnosis Diagnosis  BBT (basal body temperature)  B ultrasound: multiple small ovarian cysts multiple small ovarian cysts enlarged ovary enlarged ovary  Endometrium biopsy(Curettage ) before menses reveal to proliferative glands before menses reveal to proliferative glands  Determination of LH,FSH,E2,P,T,PRL ， Ins ， (LH:FSH ≧ 3:1)  Laparoscopy

14. Treatment Treatment If pregnancy is desired—— cause ovulation –anti-estrogens(clomiphene) –Gonadotropins –insulin-lowering agents –anti-androgens (agents that lower –androgen levels) –gonadotropin releasing hormone –agonists (GnRHa)

15. Treatment Treatment If pregnancy is not desired to reduce the risk of endometrial cancer ( birth control pills)to reduce the risk of endometrial cancer ( birth control pills) –cyclical progesterone (MPA, Provera) –insulin-lowering agents (metformin,Glucophage) –anti-androgens.

16. Long Term Effects: Infertility Long Term Effects: Infertility Many women experience infertility while having PCOS.Many women experience infertility while having PCOS. Many will have to go to an fertility doctor to conceive.Many will have to go to an fertility doctor to conceive. To conceive women with PCOS have to learn to monitor ovulation by taking their Basal Body Temperature (BBT) and examining cervical mucus.To conceive women with PCOS have to learn to monitor ovulation by taking their Basal Body Temperature (BBT) and examining cervical mucus.

17. Long Term Effects: Heart Disease Long Term Effects: Heart Disease There is new evidence that finds women with PCOS are at a higher risk for metabolic cardiovascular disease.There is new evidence that finds women with PCOS are at a higher risk for metabolic cardiovascular disease. Both diseases are characterized by insulin resistance, high blood pressure, and obesity.Both diseases are characterized by insulin resistance, high blood pressure, and obesity.

18. DI WEN M.D., Ph.D. DI WEN M.D., Ph.D. Professor & Chairman Professor & Chairman Department of Obstetrics & Gynecology Department of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine Renji Hospital Affiliated to SJTU School of Medicine Thanks for Your Attention Thanks for Your Attention