Dr. Laxmi Shrikhandge, Nagpur, India present on The Diagnosis of Polycystic Ovary Syndrome (PCOS)

1. Dr. Laxmi Shrikhande
MD,FICOG,FICMU
• Director-Shrikhande Fertility Clinic,Nagpur
• President MenopauseSociety,Nagpur
• NationalCorrespondingEditor-TheJournalof Obstetrics& Gynecologyof India
• SeniorVice President FOGSI 2012
• Vice Chairperson IndianCollegeOB /GY
• GoverningCouncilmemberICOG2012-2017
• GoverningCouncilMemberISAR 2014-2019
• GoverningCouncilMemberIAGEfor3 terms
• Patron-VidarbhaChapterISOPARB
• Chairperson-HIV/AIDS Committee,FOGSI (2007-09)
• Received Best Committee Awardof FOGSI
• ReceivedBharat excellenceAwardforwomen’s health
• President NagpurOB/GYSociety 2005-06
• Associatememberof RCOG
• Memberof EuropeanSociety of HumanReproduction
• Visited96 FOGSI Societies as invitedfaculty
• Delivered 6 orationsand296 guest lectures
• Publications-ThirteenNational& sevenInternational
• PresentedPapers in FIGO,AICOG,SAFOG,AICC-RCOG conferences
• Conductedadolescenthealth program for more than15,000 adolescent girls

2. PCOS & Adolescence
DR LAXMI SHRIKHANDE
DIRECTOR-SHRIKHANDE FERTILITY CLINIC,
NAGPUR

3. PCOS
PCOS is one condition where people always
like to agree to disagree.
Over the years these disagreements have
continued.
The criteria for diagnosis keep on changing.
Management guidelines keep on changing

4. Latest Guidelines 2018
International evidence-based guideline for the assessment
and management of polycystic ovary syndrome 2018
By ESHRE &ASRM
Released in July 2018 during ESHRE congress at Barcelona

5. New Guidelines
designed to provide clear information to assist clinical decision
making and support optimal patient care
Is the culmination of the work of over 3000 health
professionals and consumers internationally

6. How you will diagnose PCOS in adolescent
girl

7. Criteria for diagnosis of PCOS
 NIH (1990) – include all of the following
1. Hyperandrogenism &/or hyperandrogenaemia
2. Oligo-ovulation
3. Exclusion of related disorders
 ESHRE/ASRM (Rotterdam 2003)- two of the following
1. Oligo or anovulation
2. Clinical &/or biochemical signs of Hyperandrogenism
3. Polycystic ovaries
 Androgen Excess Society (2006) - include all of the following
1. Hirsutism &/or hyperandrogenaemia
2. Oligo – anovulation &/or polycystic ovaries
3. Exclusion of androgen excess or related disorder

8. Diagnostic Criteria
Irregular menstrual cycles
Clinical hyperandrogenism
Biochemical hyperandrogenism
Ultrasound and polycystic ovarian morphology (PCOM)
Ethnic variation
Anti-müllerian hormone (AMH)

9. Ethnic variation
Consider ethnic variation in PCOS including:
relatively mild phenotypes in Caucasians.
higher BMI in Caucasians, especially North America and Australia.
more severe hirsutism in Middle Eastern, Hispanic and Mediterranean women.
increased central adiposity, insulin resistance, diabetes, metabolic risks and
acanthosis nigricans in South East Asians and Indigenous Australians.
lower BMI and milder hirsutism in East Asians.
higher BMI and metabolic features in Africa

10. What do we mean by lifestyle
interventions?
Healthy lifestyle behaviours (healthy eating and regular
physical activity) should be recommended in all women with
PCOS including those with excess weight too
achieve and/or maintain healthy weight and
to optimise health, and quality of life across the life course.

11. Lifestyle Intervention
Behavioural strategies
Dietary intervention
Exercise intervention
Obesity and weight assessment

12. Management

13. Goal setting for this weight loss ?
SMART
Specific,
Measurable,
Achievable,
Realistic and
Timely

14. How much weight loss ?
Achievable goals such as 5% to 10% weight loss in those
with excess weight yields significant clinical improvements
and
 is considered successful weight reduction
within six months

15. How to loose weight? DIET
Which diet plan is best ?
How much calorie deficit should be prescribed?

16. Immediate / Acute Issues-
◦ Hirsutism
◦ Obesity
◦ Regulation of menses
Long term issues-
◦ Insulin Resistance
◦ Cardiovascular risk
◦ Obstructive sleep apnea
◦ Malignancy risk

17. • Combined OCPs containing ---estrogen and Progesterone given
cyclically help in controlling menstrual problem , hirsutism, acne,
and extra weight.
• Estrogen salt used is- --- Ethinylestradiol in the dose 0f 20/ 30 ug /
day.
• Progeserones used are of many types and they have variable effect
on Acne, weight , hirsutism, -to be considered when prescribing
OCPs.

18. Pharmacological treatment
Menstrual Calendar
COCP
Progestin's
Metformin
Cosmetic

19. PCOS - Late sequelae
• Diabetes mellitus x7
• Hypertension x4
• Low HDL/high LDL
• Endometrial Cancer

20. Practical measures
Articles in news papers and magazines
TV shows
Adolescent health programmes in schools and colleges
Medical conferences to educate doctors, paramedics
PCOS associations in every country with regular activities
Good blogs by experts
Research

21. • Frequently seen in adolescence
• Early diagnosis is important because of the
potential long-term consequences

22. Dr. Laxmi Shrikhande
Shrikhande Fertility Clinic
Ph-8805577600 / 8805677600
shrikhandedrlaxmi@gmail.com

23. 'Spiritual blossoming' simply means
blossoming in life in all dimensions.
Being happy, at ease with yourself and
with everybody around you.
Sri Sri Ravi Shankar
The Art of Living