Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects a woman's menstruation, fertility, and hormone levels. PCOS has heterogeneous clinical manifestations including irregular periods, hirsutism, obesity, and infertility. It is a multifactorial condition with both genetic and environmental contributors. While the exact causes are still unknown, theories involve abnormalities in the hypothalamic-pituitary-ovarian axis. Diagnosis involves ruling out other conditions and confirming symptoms with laboratory tests and ultrasound. Treatment aims to manage symptoms and may include lifestyle changes, oral contraceptives, fertility drugs, or anti-androgen medications.

1. Polycystic Ovary Syndrome
Krishna B. Singh, MD
Department of Obstetrics & Gynecology
LSU Health Sciences Center
Shreveport, LA

2. PCOS: Learning Objectives
After viewing this slide show, you’ll be able to
understand that...
-PCOS is a common endocrine disorder
-Multifactorial, heterogeneous condition
-Clinical manifestations affect menses, fertility
-Multiple hormonal, biochemical changes
-Long-term implications are important

3. PCO Syndrome: Topics
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Historical review
Incidence
Clinical features
Diagnosis
Management
Summary

4. PCOS: Literature Review
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Sclerocystic ovaries were described by Chereau
(1844); Pozzi (1894); Waldo (1895)
Stein/Leventhal first described seven cases of
infertility associated with enlarged polycystic
ovaries (1935)
The NIH Consensus Conference (1990)
The Rotterdam PCOS Consensus Group (2003)

5. Incidence: PCO Syndrome
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The incidence varies: 5-10% (~5% USA)
About 25% normal women may have PCO
by ultrasound criteria (BMJ 1986)
Ultrasound findings don’t correlate with
serum hormone levels

6. Features of PCO Syndrome
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Symptoms present since puberty: Cyclic menses
with luteal-phase progesterone deficiency;
hirsutism; hyperandrogenemia; infertility; chronic
anovulation/miscarriages
Irregular menses in 25-75% women
Obesity (60%); also non-obese women
Hirsutism and/or acne (virilization rare)

7. Polycystic Ovarian Disease
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PCO disease can be seen in women with pituitary
neoplasms, hypo- or hyperthyroidism, diabetes,
adrenal and pelvic neoplasms
Rule out PCOD to diagnose PCO syndrome
Long-term care is important. Studies have shown
increased incidence of hypertension, hyperlipidemia
and diabetes. Risk for CVD increased

8. PCO Syndrome: Facts/correlates
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Genetic factors: autosomal or X-linked
Positive correlations of androgen and insulin
levels in some studies
Ultrasound findings don’t correlate with serum
hormone levels

9. Theories of PCO Syndrome
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PCO syndrome is a multifactorial disorder
Theories are based on data in selected women
Brain and limbic system control the hypothalamuspituitary-ovarian axis needed for reproductive cycle
initiation and maintenance
Feedback CNS abnormality results in PCOS

10. CNS theories of PCO
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Beta-endorphin theory: Higher plasma levels are
found in women with PCO syndrome
Progesterone deficiency/estrogen excess is the
key component
Hyperandrogenism also important in PCO women
Hyperprolactinemia may cause breast symptoms,
diminish libido, and alter moods in some women

11. More PCO Theories...
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Rat PCO model: Persistent-estrus syndrome
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Constant-light exposure; androgenized rat
model; hypothalamic lesions
 Other methods (DHEAS model)
Monkey model: testosterone injections
Human model: transvestites given androgens

12. Diagnosis of PCO Syndrome
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History and physical examination important;
selected laboratory and hormonal tests during
several visits are needed for confirmation
Both structured and descriptive notes are
evaluated by the physician
Follow-up visits arranged @ regular intervals

13. PCOS: Differential Diagnosis
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Laboratory tests for confirmation: LH/FSH, T
Baseline values: Chem-22 @ morning
Baseline serum hormones @ morning
Pelvic ultrasound in some cases required
Consider PCOD versus PCO syndrome

14. PCOS: Key to Diagnosis
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Rule out conditions which may require referral;
focus on the presenting signs and symptoms
Beware of misdiagnosis “on the fly”
Beware of differential diagnosis
History and physical exam; selected tests
Know when to refer patients and where

15. PCOS: Management Options
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Principal components: Confirm diagnosis and
identify category; identify and manage concurrent
illness; identify and manage patient needs
There are numerous options for successful PCO
management

16. PCOS: Treatment Options
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General measures: diet, exercise, relaxation for
stress management
Contraception: OCP; DMPA
Hormones/drugs: Provera; Parlodel; Clomiphene;
hMG/hCG; IVF in selected women
Newer drugs for treatment of obesity,
hyperinsulinemia, hyperandogenemia and
hirsutism

17. PCO Syndrome and Infertility
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About 60% PCO patients will have ovulatory cycles
and pregnancy on clomiphene alone
About 50% PCO patients will respond to the
combined clomiphene and dexamethasone within
six months of treatment

18. PCO Syndrome: Summary
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PCO syndrome remains an enigma despite many
scientific studies done during the last three
decades
Theories of PCO abound; terminology used may
be confusing and definitions are not standardized
There are many treatment options

19. What This Means...
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Polycystic ovary syndrome is a common disorder
among reproductive age group of women; these
women generally have irregular menstrual cycles
PCO has many facets of clinical presentation
PCO can be successfully managed and treated
by conventional means