Causes:
Weight gain during puberty (leptin produced by fat cells may induce hypersecretion of LH. High insulin stimulates androgen secretion by the ovarian stroma, thus restricting folicular growth, and leads to suppression of liver production of sex hormone-binding globulin). In PCOS patients a gain in weight will worsen the symptomes. PCOS is familial.
Frequency:
33% of all females
Risk factors:
Symptoms:
No symptoms else:
Obesity
Hirsutism (har growth in a male pattern of distribution in females, incuding chin, upper lip, chest, upper and lower back, upper and lower abdomen, upper arm, tigh and buttocks)
Alopecia (loss of head hair in a male pattern of distribution)
Acne (puberty pimples)
Oligomenorrhoea (menstruate rarely. Occurs in 50%. Because of high LH)
Amenorrhoea (no menstruation. Occurs in 20%. Because of high LH)
Infertility (especially if LH is high. High proactin and fasting insulin)
Miscarriages
Complications:
DM (11%)
Cardiovascular disease
Hypertension
Dyslipidaemia
Endometrial carcinoma
Breast cancer
Ovarian cancer
Ovarian hyperstimulation syndrome (OHSS)
Diagnostics:
Transvaginal ultrasound
Treatment:
Obese woman (BMI>30kg/m2) should loose weight (this improves the endocrine profile and rises the chance on succesfull ovulation and pregnancy)
In case of irregular menstruation: low dose combined oral anticonceptive drugs
Treatment of hirsutism:
-medical therapy (combined contraceptive pill + cyproterone acetate 50-100mg. Oestrogen during the first 21 days and cyproterone during the first 10 days of a cycle. Takes 6 months before effective)
-cosmetic treatment (waxing, electrolysis, bleaching)
Treatment of the complications (like DM and hypertension)
Fertility can be restored by:
-clomiphene citrate 500-100mg, days 2-6 of a natural or artificial induced bleeding (success rate 40%. Chance on multiple pregnancies is 10%))
-ovarian diathermy