OvulationPCOS No ovulation Infrequent ovulation Progesterone
Androgens = ‘male-type’ hormone Sometimes increased hair growth on face, chest, back (hirsutism) Sometimes loss of hair on the scalp (alopecia) Sometimes acne Can be seen on a blood test Increased androgens
Transvaginal (internal)ultrasoun d is best Ultrasound appearance
Single cysts on ultrasound or follicles Loss of periods due to stress, rapid weight loss or excessive exercise Loss of periods due to premature menopause What is not PCOS?
Common - Estimated to affect between 12 and 21% of the population - Up to 70% remains undiagnosed Long and short term consequences Why is PCOS important?
Short termLong term Irregular periods Hair growth Acne Infertility Psychological Type 2 Diabetes Increased risk of cardiovascular disease eg. strokes, heart attacks
Not all women with PCOS are overweight Being overweight increases the signs and symptoms of PCOS Weight loss has been shown to reduce the signs and symptoms of PCOS and reduce the risk of long-term consequences Weight and PCOS
Speak with your GP They may organise appropriate tests if required May require input from other specialists Gynaecologist Fertility Specialist Endocrinologist Dermatologist May refer to other allied health professionals Dietician If you think you may have PCOS
No cure but very effective treatment options for managing the associated problems Removing the ‘cysts’ does not cure the problem LIFESTYLE CHANGE first line treatment for all PCOS problems Can PCOS be cured?
Anovulation = ovary does not release an egg In most instances ovulation can be restored with simple, inexpensive techniques
If overweight even small (5-10%) reduction in bodyweight can reduce insulin resistance and restore ovulation Other health benefits Benefits during pregnancy - reduces miscarriage rate - reduces diabetes during pregnancy WEIGHT LOSS
Laparoscopic banding, gastric sleeve operations Can be useful for very overweight woman who are unable to lose weight after prolonged efforts at lifestyle change General recommendation to defer conception for 12 months or until weight-loss stabilised WEIGHT LOSS SURGERY
Trade names Serophene® and Clomid® Generally low risk and low cost Twins 5-7%, Triplets 0.3% Response rate 60-85% Pregnancy rate 50% after 6 ovulatory cycles Clomiphene Citrate
Clomiphene tracking Allows assessment of response, intercourse timing and triggering Progesterone 10 days or blood test Period Day 1 Day 9 stop clomiphene Day scan Day 5 start clomiphene Ovulation + intercourse +/- trigger Day 21 Progesterone If no response increase dose
Medication used to reduce blood glucose levels in diabetes Taken 3-4 times a day May be useful for women who do not respond to maximum doses of clomiphene Sometimes beneficial on its own to induce ovulation in women with lower BMI Metformin
Use synthetic FSH to stimulate ovulation (GonalF® or Puregon®) Usually used for women who do not respond to Clomiphene Rare not to respond Additional trigger (ovulation) injection and luteal (lining)support medication usually required Gonadotropins
Puregon® Gonal F®
FSH Ovulation Induction Protocol Increase dose slowly - can be very sensitive 25-50iu/day Increase dose by 50% Increase dose by 50% Starting dose Scan d14 Scan d7 Scan d21 hCG 5000u Follicle =16mm
Day surgery procedure via keyhole surgery Can restore ovulation in % of women in the short term (few months) Lower risk of multiple pregnancy Laparoscopic Ovarian Drilling (LOD)
Generally last option Increased sensitivity to medication in patients with PCOS If other associated factors may be indicated, but not always necessary i.e semen abnormality IVF
If IVF is needed FertilitySA has outstanding pregnancy rates!
Jean Hailes Foundation Website FertilitySA website Polycystic Ovary Syndrome Association of Australia (POSAA) Brochures Resources
Consulting Clinic 345 Carrington Street Adelaide SA 5000 Phone e w