PCOS Presentation
-
Upload
zoe-wasserman -
Category
Documents
-
view
43 -
download
0
Transcript of PCOS Presentation
![Page 1: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/1.jpg)
Markers and Interventions for Nonobese Women with Polycystic
Ovarian SyndromeZoë Wasserman
![Page 2: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/2.jpg)
What is Polycystic Ovarian Syndrome?
![Page 3: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/3.jpg)
What is Polycystic Ovarian Syndrome?
Polycystic Ovaries Hyperandrogenism
Infrequent/Absent menses
![Page 4: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/4.jpg)
What is Polycystic Ovarian Syndrome?
Polycystic Ovaries Hyperandrogenism
Infrequent/Absent menses
5-6 Million Reproductive Age American Women
![Page 5: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/5.jpg)
What is Polycystic Ovarian Syndrome?
Polycystic Ovaries Hyperandrogenism
Infrequent/Absent menses
5-6 Million Reproductive Age American Women
Exclusionary Diagnosis
![Page 6: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/6.jpg)
PCOS = Exclusionary DiagnosisCongenital Adrenal Hyperplasia
![Page 7: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/7.jpg)
PCOS = Exclusionary DiagnosisCongenital Adrenal Hyperplasia
Adrenal Tumor
![Page 8: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/8.jpg)
PCOS = Exclusionary DiagnosisCongenital Adrenal Hyperplasia
Hypothyroidism:Low Production of Thyroid HormoneAdrenal Tumor
![Page 9: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/9.jpg)
PCOS = Exclusionary DiagnosisCongenital Adrenal Hyperplasia
Cushing Syndrome:Excessive Cortisol Production
Hypothyroidism:Low Production of Thyroid HormoneAdrenal Tumor
![Page 10: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/10.jpg)
Rotterdam Criteria: Hyperandrogenism>80% cases
Roe & Dokras, (2011).
![Page 11: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/11.jpg)
Rotterdam Criteria: Oligo-Anovulation
(Roe & Dokras, 2011).
![Page 12: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/12.jpg)
Rotterdam Criteria: Oligo-Anovulation
→ Earliest Clinical Sign
→ ~ 6-8 week cycles
→ 75% cases(Roe & Dokras, 2011).
![Page 13: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/13.jpg)
Rotterdam criteria: polycystic ovaries
![Page 14: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/14.jpg)
PCOS Phenotypes● Obese vs Nonobese (overweight, normal, lean)● Hyperandrogen + PCO● Hyperandrogen + Anovulation● Anovulation + PCO● Hyperandrogen + PCO + Anovulation
![Page 15: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/15.jpg)
Significance● 60% PCOS patients Obese in USA● 90-95% Anovulatory at fertility Clinics ● 3 x rate of miscarriage● 3x endometrial cancer● Cardiovascular DIsease & Diabetes
Lashen, (2010);Sirmans & Pate, (2013);McGowan, (2011).
![Page 16: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/16.jpg)
Are the metabolic risk Factors due to PCOS or Obesity?
![Page 17: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/17.jpg)
Are the metabolic risk Factors due to PCOS or Obesity?
?
DyslipidemiaInsulin ResistanceDiabetesGestational DiabetesHIgh blood PressureHeart Disease Chronic Inflammation
![Page 18: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/18.jpg)
Are the metabolic risk Factors due to PCOS or Obesity?
DyslipidemiaInsulin ResistanceDiabetesGestational DiabetesHIgh blood PressureHeart Disease Chronic Inflammation
RISK IS INDEPENDENTOF OBESITY!
![Page 19: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/19.jpg)
Are the metabolic risk Factors due to PCOS or Obesity?
DyslipidemiaInsulin ResistanceDiabetesGestational DiabetesHIgh blood PressureHeart Disease Chronic Inflammation
RISK IS INDEPENDENTOF OBESITY!
WHY???
![Page 20: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/20.jpg)
Are the metabolic risk Factors due to PCOS or Obesity?
DyslipidemiaInsulin ResistanceDiabetesGestational DiabetesHIgh blood PressureHeart Disease Chronic Inflammation
RISK IS INDEPENDENTOF OBESITY!
INNATE INSULINRESISTANCE
![Page 21: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/21.jpg)
WHAT IS INSULIN RESISTANCE?
Sirmans & Pate, (2014); Johnson, (2014).
![Page 22: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/22.jpg)
How does insulin resistance effect PCOS?
Kilic et al,(2010)
![Page 23: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/23.jpg)
Polycystic Ovaries: ● No dominant
follicle chosen● Follicles don’t
undergo cell death
![Page 24: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/24.jpg)
Treatments studied:
![Page 25: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/25.jpg)
MetforminStop Gluconeogenesis:Lower Glucose Levels
Decrease Insulin Production
(Genazzani et al, 2004).
Increase Production of Sex hormone Binding Globulin (SHBG)
![Page 26: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/26.jpg)
MetforminStop Gluconeogenesis:Lower Glucose Levels
Decrease Insulin Production
(Genazzani et al, 2004).
Increase Production of Sex hormone Binding Globulin Hyperandrogenism
Ovulation
![Page 27: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/27.jpg)
Oral Contraceptives● Great at creating Menstrual cyclicity &
Preventing Pregnancy● Decrease androgens (increase SHBG)● Decrease hirsutism in 80%● Decreased glucose tolerance● Increase chronic inflammation and BMI● Worsen dyslipidemia Morin-Papunen et al., (2003);Elter, Imir, & Durmusoglu, (2002).
![Page 28: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/28.jpg)
Oral Contraceptives and Metformin● Reduction in:
○ Hyperandrogenism○ Waist: Hip○ BMI○ Pregnancy
Increases in:
○ Insulin Sensitivity○ SHBG Elter, Imir, & Durmusoglu, (2002)
![Page 29: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/29.jpg)
Clomiphene Citrate● Antiestrogenic: normalizes FSH & LH● faster than metformin● Does not Decrease long term morbidity and Mortality risks
○ Ovarian hyperstimulation syndrome, multiple birth pregnancies & Endometrial thinning
○ Pregnancy rate increased 3.5X when used with metformin
Palomba et al., (2005).; Johnson, (2014)
Ovulation
![Page 30: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/30.jpg)
Supplements: Inositol
Oner & Muderris, (2013).
![Page 31: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/31.jpg)
Supplements: Inositol ● 1200 mg of D-chiro-inositol, ~ 2 months
○ Serum Androgen
○ Triglycerides
○ 86% Ovulated!
● 2-4g, Myo-Inositol
○ Oocyte quality
○ Ovulation
○ Dyslipidemia & Hyperandrogenism Nestler et al, (1999). & Unfer et al, (2012).
Hyperandrogenism Infrequent/Absent menses
![Page 32: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/32.jpg)
Supplements: Vitamin D
Oner & Muderris, (2013).
![Page 33: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/33.jpg)
Supplements: Vitamin D ● Deficiency common in PCOS Obese &
Nonobese● Insulin resistance is an independent
predictor of Deficiency● Increase [SHBG]
Velija-Ašimi, (2014).
Hyperandrogenism
![Page 34: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/34.jpg)
Supplements: Omega-3
Oner & Muderris, (2013).
![Page 35: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/35.jpg)
Supplements: Omega-3 1500 mg/day/6 months
● Hirsutism● BMI● LH ● Testosterone● SHBG Oner & Muderris, (2013).
Hyperandrogenism
![Page 36: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/36.jpg)
In Vitro Fertilization & MEtformin● Decrease Ovarian Hyperstimulation
Syndrome: ovaries painful & swollen● Increase oocyte quality● Increase Embryo viability
Kumbak & Kahraman, (2009); Lashen, (2010)
![Page 37: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/37.jpg)
Laparoscopic Ovarian DrillingBest Predictor Of Success:● BMI● Androgen Levels● Normal & Overweight
○ 81% Ovulation○ 57% pregnancy
*Lower Variables = Higher Success*Li, & Ledger, W.L., (2004)
![Page 38: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/38.jpg)
Gestational Diabetes and Metformin
![Page 39: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/39.jpg)
Diet & Exercise
McGowan, (2011) ; Parker, (2015).
![Page 40: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/40.jpg)
Diet & Exercise
McGowan, (2011) ; Parker, (2015).
LOw carbohydrate Diets:○ HDL-c○ Triglycerides○ Systolic Blood Pressure○ Weight
Exercise○ Insulin○ Glucose○ Weight
![Page 41: PCOS Presentation](https://reader034.fdocuments.es/reader034/viewer/2022042907/588073851a28ab64028b5b51/html5/thumbnails/41.jpg)
Public Health Implications● Holistic Approach to health● Direct health Care costs > $4.36 billion (2005).
○ Diagnosis○ Treatment○ comorbidities
● 7 x suicide rates● Diabetes occurs in 40% < 50 years old● Persistence of Obesity
Parker, (2015); Caglar et al, (2013); McGowan, (2010).