Polycystic Ovarian Disease

DESCRIPTION

Polycystic ovarian disease (PCOD) is characterized by a state of chronic oligo-ovulation and/or anovulation culminating in oligomenorrhea and/or amenorrhea

System(s) affected: Reproductive, Endocrine/Metabolic, Skin/Exocrine
Genetics: Probably transmitted genetically, especially if associated with 21-hydroxylase deficiency or other enzyme deficiencies
Incidence/Prevalence in USA: Unknown, but is a common cause of oligomenorrhea and/or amenorrhea
Predominant age: Women of reproductive age
Predominant sex: Female only

SIGNS AND SYMPTOMS

Amenorrhea
Oligomenorrhea
Obesity
Hirsutism
Acne
Dysfunctional uterine bleeding
Infertility
Acanthosis nigricans
Hypertension
Virilism
Enlarged ovaries
Enlarged clitoris
Deep voice

CAUSES

Disruption of hypothalamic-pituitary-ovarian axis (high normal luteinizing hormone and low normal follicle stimulating hormone leading to ovarian hyperandrogenism and follicular atresia and anovulation) or secondary to increased levels of insulin or increased sensitivity to normal levels of insulin

RISK FACTORS

Endometrial hyperplasia
Endometrial carcinoma
Obesity
Hypertension
Diabetes mellitus
Breast cancer
Infertility

LABORATORY

Luteinizing hormone/follicle stimulating hormone (LH/FSH) ≥ 2.5-3.0/1
Testosterone increased, but less than 200 ng/dL (6.94 nmol/L)
Dehydroepiandrosterone sulfate (DHEA-S) increased, but less than 800 µg/dL (20.8 µmol/L)
Dehydroepiandrosterone (DHEA) increased
17-OH progesterone increased
Estrone increased
Androstenedione increased
Sex hormone binding globulin decreased
Prolactin increased slightly

Drugs that may alter lab results:

Oral contraceptives
Steroids
Antidepressants

Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Ovary usually enlarged with a smooth white glistening capsule
Ovarian cortex lined with follicles in all stages of development but most are atretic
Theca cell proliferation with an increase in the stromal compartment

SPECIAL TESTS

Fasting serum glucose and insulin level to rule out insulin resistance and glucose intolerance
Overnight dexamethasone suppression test (Decadron 1 mg po at 11:00PM and fasting serum cortisol at 8:00AM the next morning) to rule out Cushing's syndrome

IMAGING

Pelvis ultrasound revealing enlarged ovaries with multiple small follicular cysts

DIAGNOSTIC PROCEDURES

History and physical examination
Endometrial biopsy to rule out hyperplasia and or carcinoma

APPROPRIATE HEALTH CARE

Outpatient
Inpatient, if surgery for wedge resection recommended

GENERAL MEASURES

No ideal treatment exists. Treatment must be individualized according to the needs and desires of the patient.

SURGICAL MEASURES

N/A

ACTIVITY

Full activity

DIET

Regular (weight loss recommended, if overweight)

PATIENT EDUCATION

Counsel the patient regarding the risk of endometrial and breast carcinoma, insulin resistance and diabetes mellitus, obesity and infertility

PREVENTION/AVOIDANCE

Prevent endometrial and breast carcinoma

POSSIBLE COMPLICATIONS

Multiple pregnancies
Ovarian hyperstimulation syndrome (OHS)
Oral contraceptives are not without risk

EXPECTED COURSE AND PROGNOSIS

Prognosis for fertility is excellent depending upon other fertility factors
Proper treatment and followup of chronic anovulation, can prevent endometrial hyperplasia and/or carcinoma

ASSOCIATED CONDITIONS

Obesity
Hypertension
Endometrial hyperplasia and/or carcinoma
Breast carcinoma
Diabetes mellitus
Hairan syndrome
Infertility
Hyperthecosis

AGE-RELATED FACTORS

Pediatric: May begin at puberty
Geriatric: N/A
Others: N/A

PREGNANCY

Does not cure the syndrome

OTHER NOTES

Drug costs high
Monitoring (ultrasounds, estradiols) costs high

ABBREVIATIONS

OHS = ovarian hyperstimulation syndrome
HMG = human menopausal gonadotropins
FSH = follicle stimulating hormone

Clinical Investigations

ROLE OF HOMOEOPATHY

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