Polycystic Ovary and Myoinositol

Polycystic ovary  syndrome – A clinical  and public  health problem affecting up to one in five  women of reproductive age .

Basics:--Polycystic ovary   syndrome  is a frustrating  experience for women   often complex  for managing   clinicians and is  a scientific challenge for  researchers , PCOS  is a complex condition  with psychological   reproductive and metabolic    manifestations  that impacts on health across  the lifespan    PCOS is   one  of the most common hormonal disorders  affecting women . it  has   multiple   components  - reproductive metabolic  and cardiovascular – with  health    implications for the patient’s   entire life   span. PCOS has  a significant effect  on adult women  resulting in diminished quality  of life  altered  feminine  identity and dysfunction in the family  and work  environment .

Diagnostic Criteria for PCOS

Part 1: The History & Geography:-PCOS  was   originally  described in 1935  by Stein  and Leventhal   who reported  a  group  of women with   amenorrhea   and polycystic  ovaries  of whom some  were hirsute and / or   obese   in 1990 a National Institutes of Health   consensus   conference defined  PCOS as a combination of hyperandrogenism  menstrual  dysfunction  and exclusion of known   disorders   such as  congenital adrenal  hyperplasia    leading to the above.

Part 2: A fight between almost all academic bodies,. Millions of dollars spent for Recommendations & committee Opinions  with level 1-4 evidences : As a result  We GP & pts too are frightened when diff  PCO societies fight with swords, daggers, canons, fighter planes , missile  for an uniform & exact defn which will encompass latent & overt PCO and pick up caxes which are destined to develop PCO or Metab syb vy one deacde .Till 2003  diagnostic  criteria for PCOS   were varied  and often   confusing  However   the joint  European  Society  of Human   Reproduction and Embryology and The American Society     for Reproductive Medicine   ESHRE/ ASRM sponsored  consensus  meeting in Rotterdam in 2003  accepted  that CPSO consists of the presence  of any 2 of the 3 criteria.

 Oligo and / or  anovulation

Clinical and / or  biochemical evidence of hyperandrogenism  and

The  presence  of polycystic ovaries  on ultrasound examination

Part 4: Orther etiogy?? Other etiologies like  congenital   adrenal hyperplasia  Cushing’s  syndrome  and androgen secreting tumours  need to be   excluded. Ultrasonographic scanning of women with  unexplained  hyperandrogenic  chronic  anovulation frequently  reveal  ovaries that  are polycystic    Sonography   shows ovarian enlargement multiple  small follicles at the periphery with increased echogenecity. 

Part 5: Prevalence L:: Incidence  :: How believable

The  incidence  is influenced by the nature  of the population being   assessed studies   in which ultrasound   examination   for presence   of polycystic  ovaries    were conducted reveal a   prevalence    rate of approximately    20 to 30%  in Caucasian  women in the  reproductive age There are    significant   racial  difference and  as  compared to  PCOS is found to be  higher  in the  ethnic groups  in the south  Asians living  in the UK the prevalence   reported was 52%  in Indian   the incidence  of adolescent  PCOS  were found to be 36%

PCO  Part 6::  Catch them young:-PCOS in adolescence – a future fertility problem

Polycystic  ovary  syndrome   is a common disorder  among reproductive age women yet the diagnosis may be overlooked  during adolescence Although   the clinical and metabolic features are similar   to those  found in adult women  it can be difficult to distinguish the young woman with  PCOS  from a normal     adolescent. Adolescent patients  with PCOS who  are at the height of identity   development  and awareness of body   image may  have  a more significant  disturbance  in quality  of life .

Adolescent girls with PCOS were 3.4 times  more lively to be worried  about their  ability to become  pregnant than   comparisons and concern about  future fertility was associated  with significant  reductions in quality  of life.

In addition polycystic ovary  morphology  affects  20-30 %  of reproductive aged  women and  10%  of regularly menstruating girls . As in  adults current  therapy of adolescent  PCOS focuses  primarily on symptomatic management of the reproductive metabolic and cosmetic  manifestations of the disorder

A cross sectional study    of adolescent girls   with PCOS and healthy   comparisons was conducted by Trent et al at an urban  hospital  based adolescent medicine  practice. Healthy subjects  were 2.8  times more   likely to have had  sexual  intercourse  than PCOS participants though the mean age at initiation of sexual intercourse   among sexually active girls   was not significantly  different between the two groups. Girls   with PCOS    were 3.4  times more likely to be worried   about their ability  to become pregnant  than comparisons and concern   about future fertility   was associated with significant   reductions  in quality  of life. Adolescents with PCOS are more concerned about fertility than  their  healthy  peers and this  concern  may affect their overall quality  of life.

Part 7:--The dilemma & confusion is here.. Diagnosis of PCOS – The clinical features May or may not have symptoms in varying combination just bto beffol physician

Although  adolescent patients with PCOS   can present  with a range of  symptoms and laboratory  abnormalities typical   complaints are acne  hirsutism irregular  menses  and obesity

PCO & association with Irregular  menses

Ovarian dysfunction   usually manifests as oligomenorrhea / amenorrhoea   resulting from chronic oligo ovulation /  anovulation  . Oligomenorrhea  occurs usually in  adolescence  with onset  later   in life often associated  with weight  gain.

Menstrual irregularity is a common   features  of CPSO 995 of CPSO  patients  present  with menstrual disorders.

99%  of CPSO patients   present  with menstrual disorders

This  menstrual pattern can be  difficult to distinguish form anovulation  associated with puberty  because   the hypothalamicpituitary   - ovarian  axis matures  preogressively   over a period  of several years  after  menarche. Although   many adolescents establish regular   cycles  by 2 years  post menarche  irregularity may continued beyond  that time period often without   cause for   clinical  concern. Although   irregular menstrual cycles   cannot be the sole crieterion  for PCOS they  comprise an important   symptom  that should be followed  in the adolescent. When   oligomenorrhea is persistent or presents  in conjunction with  symptoms   of androgen   excess  further   evaluation for PCOS  in  recommended. `

 Amenorrheic women with PCOS  usually have the most  severe   hyperandrogenism and higher antral  follicle counts  as compared   with women   presenting   with oligomenorrhea or regular menstrual  cycles.

Acne  vulgaris

Patients with PCOS complain of inflammatory acne   minimally responsive   to  conventional  line of  treatment   . Even if responsive  lesions promptly recur on stopping  treatment  . An important   feature  seen is the  development of multiple closed  comedones which   rapidly  transform    into tender  lumpy nodules distributed   in the lower  half of face   ad jaw line A pre menstrual   flare is  also common . Acne lesions  may not only by localized  to the face  but may   also be present  on the chest  shoulders  and  back  prompt  relapse  after stopping the treatment   strongly  suggests a hormonal  basis . The   prevalence of  acne in women   with   PCOS has been estimated  to be  10-34% .