dr.abhishek singh parihar m.s (obs & gyne) ; fellow reproductive medicine consultant : lifecare...
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DR.ABHISHEK SINGH PARIHAR M.S (Obs & Gyne) ;
FELLOW REPRODUCTIVE MEDICINE
CONSULTANT : LIFECARE IVF CENTRE, NEW DELHI
ABALONE CLINIC, NOIDA ETERNA IVF CENTER, NEW
DELHI
MANAGEMENT OF ADOLESCENT PCOS
DEFINITIONPCOS is a heterogenous endocrine
metabolic disorder characterised by hyperandrogenemia,chronic anovulation,and/or polycystic ovaries
Irving F.Stein & Michael L. Leventhal -1935
MAIN FEATURES
-Anovulation
-POLYCYSTIC OVARIES
-Hyperinsulinemia
-Hyperandrogenism
Rotterdam consensusRevised 2003 criteria (2 out of 3) 1. Oligo- or anovulation, 2. Clinical and/or biochemical signs of
hyperandrogenism, 3. Polycystic ovaries and exclusion of other etiologies
(congenital adrenal hyperplasia, androgen-secreting tumors, Cushing’s syndrome)
Exclusion of related disordersCAH-Basal morning 17-OHP,(2-3 ng/ml)WHO I &III –FSH,LH,E2Hypothyroidism,Hyperprolactenemia-
Sr.TSH,Sr.PrlSyndromes of severe insulin
resistance(HAIRAN syn)Cushing syndrome-Dexa supression testAndrogen secreting tumours /exogenous
androgens
PCOS Definition
1990 - 2009
Hyperandrogenism
(Clinical or
Biochemical )
Oligo- menorrhea
or
Oligo-Ovulation
Polycystic Ovaries on USG
NIH (1990) yes yes no
Rotterdam (2003)
yes Yes
2 of the 3 criteria
yes
AE-PCOS Society (2009)
yes Yes
1 of 2 criteria
yes
Adolescent Period
Reproductive Period
Menopausal
Menstrual Irregularity•ObesityCosmetic concerns• Acne•Hirsutism Hair Loss
Infertility Early Pregnancy loss During pregnancy
PIH GDM
Metabolic Syndrome Ca Endometrium
Most frequent endocrine problem in adolescent age group
In 5-15%women of reproductive age group (12-45 years)
Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertility and Sterility Vol. 97, No. 1, January 2012. Bart C. J. M. Fauser et.al.
Dietary intervention ( high protien, low carbohydrate , low fat diet more effective)
Energy deficit of 500-1000 Kcal/day
Goals – practical,realistic,achievable Small frequent mealsMore fruits/vegetables/fibre(bran)Decreased sugar/fried food /cola Switch to healthy oilsMore steamed /grilled cooking
American Diabetes Association recommends minimum of :-
• 150 minutes/week of moderate to vigrous exercise
for individuals with IGT.
• Should be distributed over 3 days
• For long term weight reduction – 1 hour/day of
exercise is recommended.
Ref : Kathleen Metal Clin Obst Gynecol 2007Ref : Kathleen Metal Clin Obst Gynecol 2007
Find simple ways to add physical activity in daily routine
Role of weight lossRole of weight loss
Ref : Kathleen M et al Fertility & Sterility 2004Ref : Kathleen M et al Fertility & Sterility 2004
5-7% wt. Reduction effective in restoring normal menses and fertility
PCOS can’t be cured
but the symptoms can be managed
50 % by just weight control
Fertility and Sterility, Vol. 97, No. 1, January 2012
Overall, the benefits of OCPs outweigh the
risks in most patients with PCOS (level B).
Women with PCOS are more likely to have contraindications for OCP use than normal women (level C).
There is no evidence for differences in effectiveness and risk among the various progestogens and when used in combination with a 20 versus 30 mg daily dose of estrogen
(level B).
PCOS is a major risk factor for developing IGT and Type 2 Diabetes (level A).
Obesity (by amplifying insulin resistance) is an exacerbating factor in the development of IGT and T2D in PCOS (level A).
The increasing prevalence of obesity in the population
suggests that a further increase in diabetes in PCOS is to be expected (level B).
Screening for IGT and T2D should be performed by OGTT (75 g, 0- and 2-hour values). There is no utility for measuring insulin in most cases (level C).
Screening should be performed in the following conditions: hyperandrogenism with anovulation, acanthosis nigricans,obesity (BMI >30 kg/m2, or >25 in Asian populations), in women with a family history of T2D or GDM (level C).
Metformin may be used for IGT and T2D (level A). Avoid use of other insulin sensitizing agents such as thiazolidinediones (GPP).
Prolonged (>6 months) medical therapy for hirsutism is necessary to document effectiveness (level B)
Antiandrogens should not be used without effective contraception (level B)
Flutamide is of limited value because of its dose-dependent hepatotoxicity (level B).
Drospirenone in the dosage used in some OCPs is not antiandrogenic(level B).
There are moderate quality data to support that women with PCOS have a 2.7-fold (95% confidence interval [CI],1.0–7.3) increased risk for endometrial cancer. (level B).
Limited data exist that do not support the conclusion that women with PCOS are at increased risk for ovarian cancer
(level B).
Limited data exist that do not support the conclusion that women with PCOS are at increased risk for breast cancer
(level B).
CONCLUSIONManagement of the disease begins by
building positive, supportive relationship with adolescent diagnosed with PCOS.
Positive relationship helps adolescent to share the signs and symptoms of this chronic disease which can have great impact on one’s body Image and self esteem…
Dedicated Adolescent health clinics
Optimization of lifestyle
Regular metabolic screening
Proactive fertility planning with consideration of planning for conception at an earlier age