PCOS is a common hormonal disorder characterized by oligomenorrhea and hyperandrogenism. It can cause long term health risks like diabetes, cardiovascular disease, and endometrial cancer. Management involves lifestyle changes like weight loss through diet and exercise to improve symptoms. Medications may be used to treat irregular periods, hirsutism, and help with ovulation induction and fertility. Screening for metabolic complications is recommended due to increased risk.

1. PCOS Dr. Mridula A Benjamin Dept of Obs and Gyn RIPAS Hospital, Brunei

15. Metabolic syndrome 3 of the following 1. Waist circumference >88cm 2. Triglycerides >150 mg/dl 3. HDL <50 mg/dl 4. Blood pressure > 130/85 5. Fasting Blood glucose 110-126 &/or 2-h glucose 140-199 mg/dl

18. Cholesterol Pregnenolone Progesterone 17 OH-Pregnenolone 17 OH-Progesterone DHEA Androstenandion 17-20 Lyase 17 hydroxylase Theca cell Estrone estradiol Granulosa cell FSH LH OVARIAN STEROIDOGENESIS T

19. Obesity Insulin Free testosterone SHBG IGF-1 5-alfa reductase activity is stimulated IGF*** insulin like growth factor

21. Wt. increase Insulin receptor disorder Insulin increase Free estradiol increase High LH Low FSH Free testosterone increase Androstenandione increase SHBG decrease atresia Theca (IGF-I) Endometrial cancer Testosterone increase Estrone increase hirsutism IGFBP-I **** decrease IGFBP*** insulin like growth factor binding protein

29. STEPWISE APPROACH FOR OVULATION INDUCTION IN PCOS (ACOG,2002 ) 1. Weight loss: If BMI >30 K/m 2 2. Clomiphene citrate 3. CC + corticosteroids if DHES > 2ug/ml 4. CC + Metformin 5. Low dose FSH injection 6. Low dose FSH injection + Metformin 7. Ovarian drilling 8. IVF

37. Thank you