2. Non tumorous dysfunction of ovary
Affecting 5 to 10 % of all reproductive age
group in women

3. Hyperandrogenism
Untimely secretion of LH
LH : FSH > 2 - 3 : 1(50 % of
cases)
Oligomenorrhoea
Anovulatory infertility
Hirsutism
Hyperinsulunemia
Hyper prolactinemia
Obesity
C.V.D.
Diabetes

4. Signs / Symptoms
Frequency in PCOS
Patients (%)
Infertility
55 – 75
Oligomenorrhea
50 – 90
Amenorrhea
26 – 51
Abnormal uterine bleeding
30
Normal Menstrual Pattern
22
Hirsutism
60 – 90
Acne
24 – 27
Virilization
0 – 28
Obesity
40 – 60
Polycystic Ovaries on USG
50 – 75

5. Hyperandrogenism
Ovary

6. pathogenesis
Hypothalamus
and Pituitary
FSH
New
follicular
growth
continous
LH
Defective follicular maturtion
Atretic follicle
Chronic anovulation
⇑
Andorgens
by Thea
cells

7. pathogenesis
Large
20 – 100
cystic
follicles
Surface
area
doubled
Volume ⇑
2–8
times
Stroma
thickness
Tunica
thickened

8. pathogenesis
Insulin Resistance [IR]
Hyperinsulinemia [HI]
Genetic
⇑ Serine
phosphorylation
Insulin
Receptor
⇓ Tyrosin acetophosphorylation
Reduced glucose transport
Hyperinsulinemia

9. ADRENAL CORTEX
25%
50%
Testosteron
e
Almost
100%
90%
50%
Androstenedion
e
DHEA
50%
10%
25%
OVARY
DHEAS

10. PCOS - Important cause of Hirsutism
GnRH
ESTROGEN
PERIPHERAL FAT
DECREASED SHBG
PITUITARY
INCREASED LH
ANDROGEN
5α reductase
INCREASED DHT
INCREASED FREE
TESTOSTERONE
HIRSUTISM

11. Insulin Resistance and Hyperinsulinaemia
↓ SHBG
Insulin with IGF 1
Receptors
Hyperestrogeneamia
Altered Pulsatile LH
release
↑ Free Estrogens
↑ Free Testosterone
↑ Ovarian
Androgens
HYPERANDROGENISM
HIRSUTISM
↑ Serum LH

12. Excessive growth
of androgen
dependent
sexual hair
HIRSUTISM
Upper Lip
Chin
Ear
Cheek
Lower Abdomen
Periareolor region

13. Genetic
• Number of pilosebaceous
units
Amount of
androgen
production
• Racial and ethnic factors
5α – reductase
level and activity
Sensitivity of pilosebaceous
unit to DHT
VELLUS HAIR – Short, fine , less pigmented
TERMINAL HAIR => (1) Anagen (2) Catagen (3) Telagen

14. Day 2
1
LH : FSH > 2 – 3 : 1
2
Serum testesterone – twice the upper
normal (Normal 20 – 80 ng / dl)
3
SHBG ⇓
4
Prolactin – mild elevation < 50 ng / dl
5
Serum Insulin ⇑
6
(normal fasting 20 – 24 µIU / ml)
Fasting glucose : Insulin ratio < 4.5
7
USG – 10 – 15 cysts of 2 to 10 mm

15. Bharati Hospital
Jan 2003 – Dec 2004
Total worked up cases
154
PCOS
20
Hirsutism
29
PCOS + Hirsutism
7

16. Anovulation
Hyperandrogenis
m

17. Therapy
Mechanism of Action
OCPs
Medroxyprogesterone acetate
Gn RH – analogues
Hormonal suppression
Glucocorticoids
Spirinolactone
Cryproterone Acetate
Anti androgens
Flutamide
Ketoconazole
Finasteride
Enzyme inhibitors
Depilatory creams
Electrolysis
Laser hair removal
Mechanical methods

18. Desogestrel + E2
(0.15mg + 20 µgm)
Levonorgestrel + E2
(0.1mg + 20 µgm)
Cyprotene acetate + E2
Dianette (2 + 35 µgm)

19. Clomiphene citrate
Gonadotropins

20. Metformin – 500 mg twice / thrice a day
Metformin + Clomiphene citrate
Troglitazone 400 mg daily
Not used – hepatic dysfunction