多囊性卵巢綜合征polycysticovarysyndrome

1、Polycystic Ovary Syndrome,DI WEN M.D., Ph.D. Professor & Chairman Department Of Obstetrics & Gynecology

2、 Renji Hospital Affiliated to SJTU School of Medicine,Introduction,Definition: polycystic ovary syndrome (PCOS) is a generic description for a broad spectrum of clinical and morphological findings in women with an e

3、ndocrine dysfunction, specifically abnormal androgen production and metabolism.,Introduction,PCOS was first identified by Stein and Leventhal in 1935 so that it can also be known as Stein – Leventhal Syndrome.,Etiology &

4、amp; Pathopysiology,What we think we know. “Vicious cycle”Abnormal gonadotropin secretionExcess LH and low, tonic FSHHypersecretion of androgensDisrupts follicle maturationSubstrate for peripheral aromatizationNeg

5、ative feedback on pituitaryDecreased FSH secreationInsulin resistance, Elevated insulin levels,Pathology,Ovaries: enlarged and/or polycystic ovariesEndometrium: Lack of ovulation for an extended period of time may c

6、ause excessive thickening of the endometrium (the lining of the uterus).,Pathology,What Are the Symptoms of PCOS?,Irregular or Lack of Menses: Women will have “spotty” periods (1 every couple of months). Also, in some w

7、omen with PCOS they simply cease having a menses at all.,Symptoms,Hirsutism :Excessive body hair. In women with PCOS dark, coarse hair will appear on the face, neck, chest, arms, and in between the legs.,Symptoms,Weight

8、 Problems :Depending on the woman, there could be a decrease of weight or a rapid fluctuation of weight that settles around the stomach that will lead to morbid obesity.,Symptoms,Acne :Because women with PCOS are produ

9、cing more male hormone, that produces more sebum (skin oils and old tissue) and causes blocked pores and more acne around the jawline, arms and chest.,Symptoms,Alopecia or Female Pattern Baldness :This is caused by the

10、increase of male hormone in the women's body. Thinning or loss of hair is usually contained to top of the scalp, but in severe cases loss of hair in front or on the hairline has been documented.,Other Symptoms,“Dirty

11、 Skin” or Acanthosis Nigricans :This condition causes light brown to black rough patches around the neck and under arms.Migraines : Severe headaches that cause light sensitivity, nausea and dizziness.,Diagnosis,BBT (b

12、asal body temperature) B ultrasound: multiple small ovarian cysts enlarged ovaryEndometrium biopsy(Curettage ) before menses reveal to proliferative glands Determination of LH,FSH,E2,P,T,PRL，Ins，(LH:F

13、SH≧3:1)Laparoscopy,Treatment,If pregnancy is desired——cause ovulation anti-estrogens(clomiphene)Gonadotropinsinsulin-lowering agentsanti-androgens (agents that lower androgen levels)gonadotropin releasing hormone

14、 agonists (GnRHa),Treatment,If pregnancy is not desiredto reduce the risk of endometrial cancer ( birth control pills)cyclical progesterone (MPA, Provera)insulin-lowering agents (metformin ,Glucophage)anti-androgen

15、s.,Long Term Effects: Infertility,Many women experience infertility while having PCOS. Many will have to go to an fertility doctor to conceive. To conceive women with PCOS have to learn to monitor ovulation by taking t

16、heir Basal Body Temperature (BBT) and examining cervical mucus.,Long Term Effects: Heart Disease,There is new evidence that finds women with PCOS are at a higher risk for metabolic cardiovascular disease.Both diseases

17、are characterized by insulin resistance, high blood pressure, and obesity.,DI WEN M.D., Ph.D. Professor & Chairman Department of Obstetrics &