Polycystic Ovary by Sonography
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Stein-Leventhal syndrome

Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects 5–10% of women. It occurs amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility. The symptoms and severity of the syndrome vary greatly between women. While the causes are unknown, insulin resistance (often secondary to obesity) is heavily correlated with PCOS. more...

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Nomenclature

Other names for this disorder include:

  • Polycystic ovary disease (although this is not correct, as PCOS is characterised as a syndrome rather than a disease)
  • Functional ovarian hyperandrogenism
  • Hyperandrogenic chronic anovulation
  • Ovarian dysmetabolic syndrome

Definition

There are two definitions that are commonly used:

  1. In 1990 a consensus workshop sponsored by the NIH/NICHD suggested that a patient has PCOS if she has (1) signs of androgen excess (clinical or biochemical), (2) oligoovulation, and (3) other entities are excluded that would cause polycystic ovaries.
  2. In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if 2 out of 3 criteria are met: (1) oligoovulation and/or anovulation, (2) excess androgen activity, (3) polycystic ovaries (by gynecologic ultrasonography), and other causes of PCOS are excluded.

The Rotterdam definition is wider, including many more patients, notably patients without androgen excess, while in the NIH/NICHD definiton androgen excess is a prerequisite. Critics maintain that findings obtained from the study of patients with androgen excess cannot be necessarily extrapolated to patients without androgen excess.

Signs and symptoms

Common symptoms of PCOS include:

  • Oligomenorrhea, amenorrhea - irregular/few, or absent, menstrual periods; cycles that do occur may comprise heavy bleeding (check with a gynaecologist, since heavy bleeding is also an early warning sign of endometrial cancer, for which women with PCOS are at higher risk)
  • Infertility, generally resulting from chronic anovulation (lack of ovulation)
  • Elevated serum (blood) levels of androgens (male hormones), specifically testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS), causing hirsutism and occasionally masculinization
  • Central obesity - "apple-shaped" obesity centered around the lower half of the torso
  • Androgenic alopecia (male-pattern baldness)
  • Acne / oily skin / seborrhea
  • Acanthosis nigricans (dark patches of skin, tan to dark brown/black)
  • Acrochordons (skin tags) - tiny flaps of skin
  • Prolonged periods of PMS-like symptoms (bloating, mood swings, pelvic pain, backaches)
  • Sleep apnea

Signs are:

  • Multiple cysts on the ovaries. Sonographycally they may present as a "string of pearls".
  • Enlarged ovaries, generally 1.5 to 3 times larger than normal, resulting from multiple cysts
  • Thickened, smooth, pearl-white outer surface of ovary
  • Chronic pelvic pain, possibly due to pelvic crowding from enlarged ovaries; however, the actual cause is not yet known
  • The ratio of LH (Luteinizing hormone) to FSH (Follicle stimulating hormone) is 2:1 or more, particularly in the early phase of the menstrual cycle.
  • Increased levels of testosterone.
  • Decreased levels of sex hormone binding globulin.
  • Hyperinsulinemia.

Read more at Wikipedia.org


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Metformin helps patients with polycystic ovary syndrome
From American Family Physician, 5/1/04 by Anne D. Walling

In polycystic ovary syndrome, the triad of anovulation, infertility, and hyperandrogenism manifests clinically as hirsutism, acne, and irregular menstruation. Ten percent of women of reproductive age are affected, and about 40 percent of them develop impaired glucose tolerance or overt type 2 diabetes by 40 years of age. Lord and colleagues studied the effectiveness of metformin in the treatment of polycystic ovary syndrome.

The authors searched databases of clinical trials, the Cochrane register of trials, and the reference sections of all of the identified trials to access relevant clinical studies. Two independent reviewers assessed each trial for quality and, if necessary, authors were asked to provide unpublished data or clarifying information. Of the 20 trials initially identified, 13 met the criteria for inclusion in this review.

Five trials included information on pregnancy and reported that metformin therapy did not have any advantage over placebo in rates of conception, although the combination of metformin and clomiphene was significantly more effective than therapy with clomiphene alone. This combination also was significantly more effective than clomiphene alone for inducing ovulation. Both treatments were significantly superior to placebo. Metformin therapy did not benefit body weight, body mass index, waist circumference, or waist-to-hip ratio. In the two trials that monitored blood pressure, metformin therapy was associated with significant reductions in systolic and diastolic blood pressures. In biochemical measures, metformin therapy was associated with significant reductions in fasting insulin concentrations and low-density lipoprotein concentrations. No evidence was found of any effect on total cholesterol level, triglycerides, or high-density lipoprotein concentrations.

The authors conclude that metformin therapy is effective for inducing ovulation in women with polycystic ovary syndrome, achieving results in 46 percent of patients (equivalent to a number needed to treat [NNT] of 4.4). When metformin was combined with clomiphene, 76 percent of treated women ovulated compared with 42 percent when clomiphene was used alone (NNT of 3.0). Although metformin has some beneficial effects on the metabolic syndrome, they are small. No net effect on weight loss is apparent. Gastrointestinal side effects can limit the use of metformin, but no serious long-term adverse effects are known. Metformin's effect on pregnancy is unclear, and it should not be used if any degree of renal impairment is present because of the danger of lactic acidosis.

Lord JM, et al. Metformin in polycystic ovary syndrome: systematic review and meta-analysis. BMJ October 25, 2003;327:951-6.

COPYRIGHT 2004 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

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