Polycystic Ovary Syndrome (PCOS)

Teaching Video Link:
​youtu.be/2GddCzndgyU&list=PLOlpsJ0eDlASRw1LywI2iGfzDTqxlAYFJ

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Polycystic Ovary Syndrome (PCOS)
- Polycystic Ovary Syndrome (PCOS) affects 5-10% of women
- Leading cause of infertility in the United States
- Typically begins during puberty and worsens over time
- Early diagnosis crucial for timely intervention

Clinical Presentation
- Primary symptom: Irregular menstruation
- Other common symptoms:
  - Acne
  - Weight gain
  - Fatigue
  - Sleep disturbances
  - Mood swings
  - Depression and anxiety
- Visual cues:
  - Hirsutism (male-pattern hair growth)
  - Acanthosis nigricans (thickened, dark skin in body folds)

Diagnosis
- Rotterdam criteria (2003): Patient must have 2 of 3 features:
  1. Ovulatory dysfunction
  2. Clinical or biochemical hyperandrogenism
  3. Polycystic ovaries on ultrasound
- Initial tests:
  - Pregnancy test
  - FSH, prolactin, and TSH levels
- Transvaginal ultrasound (not for adolescents)
- Additional tests to rule out other conditions:
  - Serum androgen levels
  - Serum cortisol (to exclude Cushing syndrome)

Diagnosing PCOS in Adolescents
- Challenges: Overlap with normal puberty changes
- Criteria focus on:
  - Abnormal uterine bleeding pattern
  - Clinical or biochemical hyperandrogenism
- Pelvic ultrasound only if ovarian tumor suspected

Treatment Strategies
- Lifestyle modifications:
  - Weight loss
  - Regular exercise
- Medications:
  - Combined oral contraceptives
  - Progestin-only options
  - Metformin
  - Anti-androgen medications (e.g., spironolactone)
- Fertility treatments:
  - Ovulation induction medications
  - Assisted reproductive technologies

Long-Term Monitoring and Risks
- Regular follow-ups to assess treatment effectiveness
- Increased risk of:
  - Cardiovascular disease
  - Type 2 diabetes
  - Endometrial cancer
  - Obstructive sleep apnea
  - Nonalcoholic fatty liver disease

Patient Education and Support
- Explain PCOS, its causes, symptoms, and potential complications
- Emphasize importance of:
  - Healthy lifestyle
  - Treatment adherence
  - Regular check-ups
- Encourage participation in support groups
- Provide resources for emotional support

Conclusion
- PCOS requires comprehensive, compassionate care
- Stay informed about latest research and treatments
- Empower patients with knowledge and support
- Collaborate for best possible outcomes