SlideShare ist ein Scribd-Unternehmen logo
1 von 21
Non tumorous dysfunction of ovary
Affecting 5 to 10 % of all reproductive age
group in women
Hyperandrogenism
Untimely secretion of LH
LH : FSH > 2 - 3 : 1(50 % of
cases)

Oligomenorrhoea
Anovulatory infertility
Hirsutism
Hyperinsulunemia
Hyper prolactinemia
Obesity
C.V.D.
Diabetes
Signs / Symptoms

Frequency in PCOS
Patients (%)

Infertility

55 – 75

Oligomenorrhea

50 – 90

Amenorrhea

26 – 51

Abnormal uterine bleeding

30

Normal Menstrual Pattern

22

Hirsutism

60 – 90

Acne

24 – 27

Virilization

0 – 28

Obesity

40 – 60

Polycystic Ovaries on USG

50 – 75
Hyperandrogenism

Ovary
pathogenesis

Hypothalamus
and Pituitary
FSH

New
follicular
growth
continous

LH

Defective follicular maturtion

Atretic follicle

Chronic anovulation

⇑
Andorgens
by Thea
cells
pathogenesis

Large

20 – 100
cystic
follicles

Surface
area
doubled
Volume ⇑
2–8
times

Stroma
thickness

Tunica
thickened
pathogenesis

Insulin Resistance [IR]
Hyperinsulinemia [HI]

Genetic

⇑ Serine
phosphorylation

Insulin
Receptor

⇓ Tyrosin acetophosphorylation

Reduced glucose transport

Hyperinsulinemia
ADRENAL CORTEX

25%
50%
Testosteron
e

Almost
100%

90%
50%
Androstenedion
e

DHEA

50%
10%
25%

OVARY

DHEAS
PCOS - Important cause of Hirsutism
GnRH
ESTROGEN
PERIPHERAL FAT

DECREASED SHBG

PITUITARY
INCREASED LH

ANDROGEN
5α reductase
INCREASED DHT

INCREASED FREE
TESTOSTERONE

HIRSUTISM
Insulin Resistance and Hyperinsulinaemia

↓ SHBG

Insulin with IGF 1
Receptors

Hyperestrogeneamia
Altered Pulsatile LH
release

↑ Free Estrogens

↑ Free Testosterone

↑ Ovarian
Androgens

HYPERANDROGENISM

HIRSUTISM

↑ Serum LH
Excessive growth
of androgen
dependent
sexual hair

HIRSUTISM

Upper Lip

Chin

Ear

Cheek

Lower Abdomen

Periareolor region
Genetic
• Number of pilosebaceous
units

Amount of
androgen
production

• Racial and ethnic factors

5α – reductase
level and activity

Sensitivity of pilosebaceous
unit to DHT

VELLUS HAIR – Short, fine , less pigmented
TERMINAL HAIR => (1) Anagen (2) Catagen (3) Telagen
Day 2
1

LH : FSH > 2 – 3 : 1

2

Serum testesterone – twice the upper
normal (Normal 20 – 80 ng / dl)

3

SHBG ⇓

4

Prolactin – mild elevation < 50 ng / dl

5

Serum Insulin ⇑

6

(normal fasting 20 – 24 µIU / ml)
Fasting glucose : Insulin ratio < 4.5

7

USG – 10 – 15 cysts of 2 to 10 mm
Bharati Hospital
Jan 2003 – Dec 2004
Total worked up cases

154

PCOS

20

Hirsutism

29

PCOS + Hirsutism

7
Anovulation

Hyperandrogenis
m
Therapy

Mechanism of Action

OCPs
Medroxyprogesterone acetate
Gn RH – analogues

Hormonal suppression

Glucocorticoids
Spirinolactone
Cryproterone Acetate

Anti androgens

Flutamide
Ketoconazole
Finasteride

Enzyme inhibitors

Depilatory creams
Electrolysis
Laser hair removal

Mechanical methods
Desogestrel + E2
(0.15mg + 20 µgm)

Levonorgestrel + E2
(0.1mg + 20 µgm)

Cyprotene acetate + E2
Dianette (2 + 35 µgm)
Clomiphene citrate

Gonadotropins
Metformin – 500 mg twice / thrice a day
Metformin + Clomiphene citrate
Troglitazone 400 mg daily
Not used – hepatic dysfunction
Pcos

Weitere ähnliche Inhalte

Was ist angesagt?

A major cause of female infertility
A major cause of female infertilityA major cause of female infertility
A major cause of female infertility
Ahmed Abdel-Aal
 
Abnormal uterine bleeding and Management
Abnormal uterine bleeding and ManagementAbnormal uterine bleeding and Management
Abnormal uterine bleeding and Management
nium
 
AUB : Definition, Epidemology and Causes
AUB : Definition, Epidemology and CausesAUB : Definition, Epidemology and Causes
AUB : Definition, Epidemology and Causes
Bethelhem Berhanu
 

Was ist angesagt? (19)

AUB in reproductive age group women
AUB in reproductive age group womenAUB in reproductive age group women
AUB in reproductive age group women
 
Menstrual disorders, peri menopausal period kumar vikash -55
Menstrual disorders, peri menopausal  period  kumar vikash -55Menstrual disorders, peri menopausal  period  kumar vikash -55
Menstrual disorders, peri menopausal period kumar vikash -55
 
A major cause of female infertility
A major cause of female infertilityA major cause of female infertility
A major cause of female infertility
 
Abnormal Uterine Bleeding in Perimenopausal Women
Abnormal Uterine Bleeding in Perimenopausal WomenAbnormal Uterine Bleeding in Perimenopausal Women
Abnormal Uterine Bleeding in Perimenopausal Women
 
Types of Menstrual disorders and there causes and symptoms
Types of Menstrual disorders and there causes and symptomsTypes of Menstrual disorders and there causes and symptoms
Types of Menstrual disorders and there causes and symptoms
 
Disorders of menstruation
Disorders of menstruationDisorders of menstruation
Disorders of menstruation
 
Abruptio placenta
Abruptio placentaAbruptio placenta
Abruptio placenta
 
Abnormal uterine bleeding
Abnormal uterine bleedingAbnormal uterine bleeding
Abnormal uterine bleeding
 
Menstrual disorders
Menstrual disorders Menstrual disorders
Menstrual disorders
 
Abnormal Uterine Bleeding by Kemi Dele
Abnormal Uterine Bleeding by Kemi DeleAbnormal Uterine Bleeding by Kemi Dele
Abnormal Uterine Bleeding by Kemi Dele
 
Abnormal uterine bleeding and Management
Abnormal uterine bleeding and ManagementAbnormal uterine bleeding and Management
Abnormal uterine bleeding and Management
 
Infertility
InfertilityInfertility
Infertility
 
Female Infertility - NewLife Clinic India
Female Infertility - NewLife Clinic IndiaFemale Infertility - NewLife Clinic India
Female Infertility - NewLife Clinic India
 
Abnormal Uterine Bleeding (AUB) -Etiopathogenesis
Abnormal Uterine Bleeding (AUB) -EtiopathogenesisAbnormal Uterine Bleeding (AUB) -Etiopathogenesis
Abnormal Uterine Bleeding (AUB) -Etiopathogenesis
 
1. aub (dr. nuru)
1. aub (dr. nuru)1. aub (dr. nuru)
1. aub (dr. nuru)
 
PALM-COEIN Classification of AUB (Abnormal Uterine Bleeding)
PALM-COEIN Classification of AUB (Abnormal Uterine Bleeding)PALM-COEIN Classification of AUB (Abnormal Uterine Bleeding)
PALM-COEIN Classification of AUB (Abnormal Uterine Bleeding)
 
Infertility
InfertilityInfertility
Infertility
 
AUB : Definition, Epidemology and Causes
AUB : Definition, Epidemology and CausesAUB : Definition, Epidemology and Causes
AUB : Definition, Epidemology and Causes
 
Abnormal uterine bleeding
Abnormal uterine bleedingAbnormal uterine bleeding
Abnormal uterine bleeding
 

Ähnlich wie Pcos

Infertility
InfertilityInfertility
Infertility
berbets
 

Ähnlich wie Pcos (20)

Infertility
InfertilityInfertility
Infertility
 
unit 2 #1
unit 2 #1unit 2 #1
unit 2 #1
 
Infertility
InfertilityInfertility
Infertility
 
Thyroid
ThyroidThyroid
Thyroid
 
Premalignant Lesions of the Endometrium
Premalignant Lesions of the EndometriumPremalignant Lesions of the Endometrium
Premalignant Lesions of the Endometrium
 
Workshop d1
Workshop d1Workshop d1
Workshop d1
 
PCOS
PCOSPCOS
PCOS
 
Polycystic ovarian disease (PCOS)
Polycystic ovarian disease (PCOS) Polycystic ovarian disease (PCOS)
Polycystic ovarian disease (PCOS)
 
Anovulation, conditions of the ovary
Anovulation, conditions of the ovaryAnovulation, conditions of the ovary
Anovulation, conditions of the ovary
 
subfertility-150624160345-lva1-app6892.pdf
subfertility-150624160345-lva1-app6892.pdfsubfertility-150624160345-lva1-app6892.pdf
subfertility-150624160345-lva1-app6892.pdf
 
Subfertility
SubfertilitySubfertility
Subfertility
 
Female reproductive disorders.pdf
Female reproductive disorders.pdfFemale reproductive disorders.pdf
Female reproductive disorders.pdf
 
Infertility for 4th year med students
Infertility  for  4th year med studentsInfertility  for  4th year med students
Infertility for 4th year med students
 
Subfertility / OBS & GYN ( updated )
Subfertility  / OBS & GYN ( updated  )Subfertility  / OBS & GYN ( updated  )
Subfertility / OBS & GYN ( updated )
 
DYSFUNCTIONAL UTERINE BLEEDING.ppt
DYSFUNCTIONAL UTERINE BLEEDING.pptDYSFUNCTIONAL UTERINE BLEEDING.ppt
DYSFUNCTIONAL UTERINE BLEEDING.ppt
 
Infertility Overview, Approach and Evaluation
Infertility Overview, Approach and EvaluationInfertility Overview, Approach and Evaluation
Infertility Overview, Approach and Evaluation
 
Endo ca
Endo caEndo ca
Endo ca
 
Premalignant Gynaecological Conditions
Premalignant Gynaecological ConditionsPremalignant Gynaecological Conditions
Premalignant Gynaecological Conditions
 
EBM Management of Polycystic Ovary
EBM Management of  Polycystic OvaryEBM Management of  Polycystic Ovary
EBM Management of Polycystic Ovary
 
Ovarian tumors
Ovarian tumorsOvarian tumors
Ovarian tumors
 

Mehr von Jitendra Ingole

Bleeding in early pregnancy
Bleeding in early pregnancyBleeding in early pregnancy
Bleeding in early pregnancy
Jitendra Ingole
 
Manthena raju a proven cure diabetes
  Manthena raju  a proven cure diabetes  Manthena raju  a proven cure diabetes
Manthena raju a proven cure diabetes
Jitendra Ingole
 

Mehr von Jitendra Ingole (20)

Hepatitis acute
Hepatitis acute Hepatitis acute
Hepatitis acute
 
Dysfunctional Uterine Bleeding (DUB)
Dysfunctional Uterine Bleeding (DUB)Dysfunctional Uterine Bleeding (DUB)
Dysfunctional Uterine Bleeding (DUB)
 
Doctor as detective
Doctor as detectiveDoctor as detective
Doctor as detective
 
Collection of blood for investigation met microteaching ppt
Collection of blood for investigation met microteaching pptCollection of blood for investigation met microteaching ppt
Collection of blood for investigation met microteaching ppt
 
Diabetes & high cholesterol _ Dr Ingole
Diabetes & high cholesterol _ Dr IngoleDiabetes & high cholesterol _ Dr Ingole
Diabetes & high cholesterol _ Dr Ingole
 
Dr Ingole_hypertension treatment concepts ,.,
Dr Ingole_hypertension treatment concepts ,.,Dr Ingole_hypertension treatment concepts ,.,
Dr Ingole_hypertension treatment concepts ,.,
 
Epilepsy and pregnancy ..,,
Epilepsy and pregnancy ..,, Epilepsy and pregnancy ..,,
Epilepsy and pregnancy ..,,
 
Subtle signs of myocardial ischaemia on ecg
Subtle signs of myocardial ischaemia on ecgSubtle signs of myocardial ischaemia on ecg
Subtle signs of myocardial ischaemia on ecg
 
COPD Asthma Workshop
COPD Asthma Workshop COPD Asthma Workshop
COPD Asthma Workshop
 
Diplopia
DiplopiaDiplopia
Diplopia
 
Iugr (1)
Iugr (1)Iugr (1)
Iugr (1)
 
Uterine anomalies
Uterine anomaliesUterine anomalies
Uterine anomalies
 
Caesarean section
Caesarean sectionCaesarean section
Caesarean section
 
Bleeding in early pregnancy
Bleeding in early pregnancyBleeding in early pregnancy
Bleeding in early pregnancy
 
Amenorrhoea Amenorhhea
Amenorrhoea AmenorhheaAmenorrhoea Amenorhhea
Amenorrhoea Amenorhhea
 
Abortion
AbortionAbortion
Abortion
 
Abnormal cytology & histology of cervix _ Histopathology
Abnormal cytology & histology of cervix _ Histopathology Abnormal cytology & histology of cervix _ Histopathology
Abnormal cytology & histology of cervix _ Histopathology
 
Water and you-manthena raju
Water and you-manthena rajuWater and you-manthena raju
Water and you-manthena raju
 
Doctor as detective new
Doctor as detective newDoctor as detective new
Doctor as detective new
 
Manthena raju a proven cure diabetes
  Manthena raju  a proven cure diabetes  Manthena raju  a proven cure diabetes
Manthena raju a proven cure diabetes
 

Kürzlich hochgeladen

Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Dipal Arora
 

Kürzlich hochgeladen (20)

Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Dehradun Just Call 9907093804 Top Class Call Girl Service Available
 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
 
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
Call Girls Bhubaneswar Just Call 9907093804 Top Class Call Girl Service Avail...
 
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Tirupati Just Call 8250077686 Top Class Call Girl Service Available
 
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
 
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Haridwar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Haridwar Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Haridwar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Haridwar Just Call 8250077686 Top Class Call Girl Service Available
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
 
Call Girls Siliguri Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Cuttack Just Call 9907093804 Top Class Call Girl Service Available
 
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
 
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Faridabad Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Agra Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Agra Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Agra Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Agra Just Call 8250077686 Top Class Call Girl Service Available
 
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeTop Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
 
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 9332606886 𖠋 Will You Mis...
 
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
 
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
 

Pcos