Overview Polycystic ovary syndrome is a common, lifelong condition that appears to be increasing in prevalence with increasing obesity, and is more common in Indigenous and southeast Asian women. PCOS is the presence of multiple follicular cysts in the ovaries (>12 cysts). PCOS results in hormonal imbalance resulting in the associated signs and symptoms (ie. infertility, androgenism)
Definition Cyst: A cyst is a sac or pocket in your body filled with fluid, semi-solid material or air Ovarian cyst: Sac filled with liquid or semi-liquid material arising in an ovary. There are many differential diagnosis of ovarian cysts and majority are benign Polycystic Ovarian Syndrom |
The Ovary
Ligaments associated with the Ovary
Blood supply
Lymphatics
Innervation
Family history of PCOS
Premature adrenarche – development of PCOS in 50% of cases
Side note Early adrenarche differs to puberty. Puberty is when body becomes capable of sexual reproduction, development of testes and ovaries → secondary sex characteristics |
Clinical Presentation is often of a young women who experiences irregular periods +/- weight gain/hirsutism
Hyperandrogenism
Menstrual disturbance
Obesity
Insulin resistance
Cardinal Triad of PCOS: hyperandrogenism, presence of cysts in ovaries (>12) and anovulation |
Congenital adrenal hyperplasia refers to enlarged adrenal glands. It is due to inherited enzyme deficiency. Congenital adrenal hyperplasia is the most common adrenal disorder of infancy and childhood.Congenital adrenal hyperplasia results excessive androgens (male hormones). There is also a severe salt-losing form of the condition. |
Differential Diagnosis for Ovarian Cysts
Endometriomatous cysts of the ovary are cysts filled with blood arising from the ectopic endometrium. They usually enlarge pre and during menses and slightly shrink thereafter. The ovary is the commonest site of pelvic endometriosis |
Diagnosis
Other aetiologies must be excluded such as congenital adrenal hyperplasia, androgen secreting tumours, cushing syndrome, thyroid dysfunction and hyperprolactinaemia
Obesity - Weight loss
Amenorrhoea
Hyperandrogenism and hirsutism
Infertility
Pharmacology Clomifene is used mainly in female infertility due to anovulation to induce ovulation. Clomifene has both estrogenic and anti-estrogenic properties, but its precise mechanism of action has not been determined. Clomifene should only prescribed with ultrasound monitoring available to minimise the 10% risk of multiple pregnancy |
Ovarian diathermy
Insulin sensitising agents - Metformin
Overview Infertility is defined as inability to become pregnant after 12 months of regular, unprotected intercourse. It is important to remember that infertility can arise from female factors, male factors or a combination of both. Approximately 85% of couples spontaneously conceive within 12 months. Those who are unable, warrant evaluation. Older women with risk factors for infertility may warrant evaluation at 6 months.
Risk Factors of Infertility
Aetiology of Infertility
More information on Infertility
Watch video Female infertility |