Polycystic Ovarian Syndrome
Original Editors - Amanda Tieken from Bellarmine University's Pathophysiology of Complex Patient Problems project.
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Definition/Description[edit | edit source]
Polycysitc Ovarian Syndrome (PCOS), fomerly known as Stien-Leventhal Syndrome, is a disorder affecting the hormones of women of child bearing age.
Signs and symptoms include a collection of the following:
- Obesity1
- Hirsutism - hair growth in male pattern on the face, back, chest, lower abdomen, and inner thighs1
- Virilization - development of male features including balding of the frontal portion of the scalp, voice deepening, atophy of breast tissue, increased muscle mass, and clitoromegaly1
- Anovulation - failure of the ovaries to release an oocyte1
- Amenorrhea - abscence of a menstrual period in women of childbearing age1
Prevalence[edit | edit source]
PCOS affects 4-12% of childbearing aged women[1]
- 50% of these women have amenorrhea[2]
- 30% of these women have abnormal menstrual bleeding[2]
- 60% of these women are obese[3]
- 40% of women with PCOS have type 2 diabetes[2]
Characteristics/Clinical Presentation[edit | edit source]
Signs and symptoms include a collection of the following:
- Obesity[4]
- Hirsutism - hair growth in male pattern on the face, back, chest, lower abdomen, and inner thighs [4]
- Virilization - development of male features including balding of the frontal portion of the scalp, voice deepening, atophy of breast tissue, increased muscle mass, and clitoromegaly[4]
- Anovulation - failure of the ovaries to release an oocyte[4]
- Amenorrhea - abscence of a menstrual period in women of childbearing age[4]
- Acne related to hyperandrogenism[5]
- Infertility[1]
- First timester miscarriage[1]
Associated Co-morbidities[edit | edit source]
- Type 2 diabetes[3]
- Obesity[3]
- Cardiovascular disease[3]
- HTN[3]
- Ovarian cancer[3]
- Breast cancer[3]
- Endometrial cancer[3]
Medications[edit | edit source]
Treatment for infertility may include the following for inducing ovulation:
- Clomiphene citrate[4]
- Corticosteroids[4]
- Metaformin increases spontaneous ovulation for women with insulin resistance/increased insulin production[4]
Treatment for those not interested in conceiving a child may include:
- Depo-Provera injections to decrease endometrial hyperplasia[4]
- Oral progestin[5]
- Oral combination contraceptive containing estrogen and progestin[5]
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
There is no one difinitive test for the diagnosis of PCOS, but rather a ruling out of other possible disorders.
- Ultrasounography - abdominal or transvaginal[2]
- Pelvic Examination[2]
- Laproscopy[2]
- Laboratory testing including CBC and CA-125[2]
- Screenings for glucose intolerance[2]
Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
Physical therapists should be aware of the clinical presentation of PCOS. Women with PCOS may experience low back pain, sacral pain, and lower quadrant abdominal pain. However, a thorough patient history can provide information of a gynocologic/metabolic connection. Concern of possible presence of PCOS requires immediate referral to a physcian.[2]
In treating patient's with a PMH of PCOS for a non-related condition, be aware of related medical concerns that may affect the patient's ability to participate in activities including glucose intolerance and insulin resistance.[2]
Side effects of medications need to also be taken into account. For example, the side effects of clomiphene citrate, an ovulation inducer, includes insomnia, nausea/vomiting, blurry vision, and frequent urination.[2]
Alternative/Holistic Management (current best evidence)[edit | edit source]
Recomendations:
- Weight loss because of storage of estrogen in adipose tissue[5]
- Regular exercise (30min/day) lowering insulin levels[5]
- Reduction of carbohydrates consumed to reduce insulin levels[5]
Differential Diagnosis[edit | edit source]
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Case Reports[edit | edit source]
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 Sheehan MT. Polycystic ovarian syndrome: diagnosis & management. Clinical Medicine & Research 2004;2:13-27.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Goodman CC, Fuller KS, editors. Pathology: implications for the physical therapist. 3rd ed. St Louis: Saunders Elsevier, 2009.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Daniilidis A, Dina K. Long term health consequesnces of polycystic ovarian syndrome: a review analysis. Hippokratia 2009; 13:90-92.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 Callahan TL, Caughey AB, editors. Blueprints: obstetrics & gynecology. 5th ed. Baltimore: Lippincott Williams & Wilkins, 2009.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Merck manual of medical information. 2nd ed. New York: Merck & Co., Inc, 2003. p 1234-35.