Polycystic Ovarian Syndrome: Difference between revisions
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<div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox"> | <div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox"> | ||
'''Original Editors '''- Amanda Tieken from [[Pathophysiology of Complex Patient Problems|Bellarmine University's Pathophysiology of Complex Patient Problems project.]] | '''Original Editors '''- [http://www.physio-pedia.com/index.php5?title=Polycystic_Ovarian_Syndrome Amanda Tieken] from [[Pathophysiology of Complex Patient Problems|Bellarmine University's Pathophysiology of Complex Patient Problems project.]] | ||
'''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | ||
</div> | </div> | ||
== Definition/Description == | == Definition/Description == | ||
Polycysitc Ovarian Syndrome (PCOS), fomerly known as Stien-Leventhal Syndrome, is a disorder affecting the hormones of women of child bearing age. Ovaries are enlarged secondary to multiple cyst formations within the ovaries. | Polycysitc Ovarian Syndrome (PCOS), fomerly known as Stien-Leventhal Syndrome, is a disorder affecting the hormones of women of child bearing age. Ovaries are enlarged secondary to multiple cyst formations within the ovaries. | ||
| | ||
== Prevalence == | == Prevalence == | ||
PCOS affects 4-12% of childbearing aged women<ref name="sheehan">Sheehan MT. Polycystic ovarian syndrome: diagnosis &amp; management. Clinical Medicine &amp; Research 2004;2:13-27.</ref> | PCOS affects 4-12% of childbearing aged women<ref name="sheehan">Sheehan MT. Polycystic ovarian syndrome: diagnosis &amp;amp; management. Clinical Medicine &amp;amp; Research 2004;2:13-27.</ref> | ||
*50% of these women have amenorrhea<ref name="goodman">Goodman CC, Fuller KS, editors. Pathology: implications for the physical therapist. 3rd ed. St Louis: Saunders Elsevier, 2009.</ref> | *50% of these women have amenorrhea<ref name="goodman">Goodman CC, Fuller KS, editors. Pathology: implications for the physical therapist. 3rd ed. St Louis: Saunders Elsevier, 2009.</ref> | ||
*30% of these women have abnormal menstrual bleeding<ref name="goodman" /> | *30% of these women have abnormal menstrual bleeding<ref name="goodman" /> | ||
*60% of these women are obese<ref name="daniilidis">Daniilidis A, Dina K. Long term health consequesnces of polycystic ovarian syndrome: a review analysis. Hippokratia 2009; 13:90-92.</ref> | *60% of these women are obese<ref name="daniilidis">Daniilidis A, Dina K. Long term health consequesnces of polycystic ovarian syndrome: a review analysis. Hippokratia 2009; 13:90-92.</ref> | ||
*40% of women with PCOS have type 2 diabetes<ref name="goodman" /> | *40% of women with PCOS have type 2 diabetes<ref name="goodman" /> | ||
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Signs and symptoms include a collection of the following: | Signs and symptoms include a collection of the following: | ||
*Enlarged polycystic ovaries<ref name="callahan" /> | *Enlarged polycystic ovaries<ref name="callahan" /> | ||
*Obesity<ref name="callahan">Callahan TL, Caughey AB, editors. Blueprints: obstetrics &amp;amp; gynecology. 5th ed. Baltimore: Lippincott Williams &amp;amp; Wilkins, 2009.</ref> | *Obesity<ref name="callahan">Callahan TL, Caughey AB, editors. Blueprints: obstetrics &amp;amp;amp; gynecology. 5th ed. Baltimore: Lippincott Williams &amp;amp;amp; Wilkins, 2009.</ref> | ||
*Hirsutism - hair growth in male pattern on the face, back, chest, lower abdomen, and inner thighs <ref name="callahan" /> | *Hirsutism - hair growth in male pattern on the face, back, chest, lower abdomen, and inner thighs <ref name="callahan" /> | ||
*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<ref name="callahan" /> | *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<ref name="callahan" /> | ||
*Anovulation - failure of the ovaries to release an oocyte<ref name="callahan" /> | *Anovulation - failure of the ovaries to release an oocyte<ref name="callahan" /> | ||
*Amenorrhea - abscence of a menstrual period in women of childbearing age<ref name="callahan" /> | *Amenorrhea - abscence of a menstrual period in women of childbearing age<ref name="callahan" /> | ||
*Oligomenorrhea - presence of menstrual cycles greater than 35 days apart<ref name="callahan" /> | *Oligomenorrhea - presence of menstrual cycles greater than 35 days apart<ref name="callahan" /> | ||
*Acne related to hyperandrogenism<ref name="merck">Merck manual of medical information. 2nd ed. New York: Merck &amp;amp; Co., Inc, 2003. p 1234-35.</ref> | *Acne related to hyperandrogenism<ref name="merck">Merck manual of medical information. 2nd ed. New York: Merck &amp;amp;amp; Co., Inc, 2003. p 1234-35.</ref> | ||
*Infertility<ref name="sheehan" /> | *Infertility<ref name="sheehan" /> | ||
*First timester miscarriage<ref name="sheehan" /> | *First timester miscarriage<ref name="sheehan" /> | ||
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*Type 2 diabetes<ref name="daniilidis" /> | *Type 2 diabetes<ref name="daniilidis" /> | ||
*Obesity<ref name="daniilidis" /> | *Obesity<ref name="daniilidis" /> | ||
*Cardiovascular disease<ref name="daniilidis" /> | *Cardiovascular disease<ref name="daniilidis" /> | ||
*HTN<ref name="daniilidis" /> | *HTN<ref name="daniilidis" /> | ||
*Ovarian cancer<ref name="daniilidis" /> | *Ovarian cancer<ref name="daniilidis" /> | ||
*Breast cancer<ref name="daniilidis" /> | *Breast cancer<ref name="daniilidis" /> | ||
*Endometrial cancer<ref name="daniilidis" /> | *Endometrial cancer<ref name="daniilidis" /> | ||
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== Medications == | == Medications == | ||
Treatment for infertility may include the following for inducing ovulation: | Treatment for infertility may include the following for inducing ovulation: | ||
*Clomiphene citrate<ref name="callahan" /> | *Clomiphene citrate<ref name="callahan" /> | ||
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*Metaformin increases spontaneous ovulation for women with insulin resistance/increased insulin production<ref name="callahan" /> | *Metaformin increases spontaneous ovulation for women with insulin resistance/increased insulin production<ref name="callahan" /> | ||
<br> | <br> | ||
Treatment for those not interested in conceiving a child may include: | Treatment for those not interested in conceiving a child may include: | ||
*Depo-Provera injections to decrease endometrial hyperplasia<ref name="callahan" /> | *Depo-Provera injections to decrease endometrial hyperplasia<ref name="callahan" /> | ||
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== Causes == | == Causes == | ||
PCOS is believed to be a genetically inherited metabolic and gynocologic disorder. It is believed to be the consequence of an over production of luteinizing hormone (LH) by the pituitary gland. Excess LH results in increased androgen levels by the ovaries and adrenal cortex. Surplus androgen is converted into estrogen in adipose tissue where is is then stored. The surplus estrogen results in irregular formation of the follicle, anovulation, and increased production of androgens resulting in a vigorus cycle.<ref name="callahan" /><br> | PCOS is believed to be a genetically inherited metabolic and gynocologic disorder. It is believed to be the consequence of an over production of luteinizing hormone (LH) by the pituitary gland. Excess LH results in increased androgen levels by the ovaries and adrenal cortex. Surplus androgen is converted into estrogen in adipose tissue where is is then stored. The surplus estrogen results in irregular formation of the follicle, anovulation, and increased production of androgens resulting in a vigorus cycle.<ref name="callahan" /><br> | ||
== Systemic Involvement == | == Systemic Involvement == | ||
PCOS affects multiple systems including both metabolic and gynocologic systems, as well as the endocrine system.<ref name="goodman" /> | PCOS affects multiple systems including both metabolic and gynocologic systems, as well as the endocrine system.<ref name="goodman" /> | ||
== Medical Management (current best evidence) == | == Medical Management (current best evidence) == | ||
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== Physical Therapy Management (current best evidence) == | == Physical Therapy Management (current best evidence) == | ||
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.<ref name="goodman" /> | 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.<ref name="goodman" /> | ||
<br> | |||
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.<ref name="goodman" /> | |||
<br> | |||
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.<ref name="goodman" /> | |||
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.<ref name="goodman" /> | |||
== Alternative/Holistic Management (current best evidence) == | == Alternative/Holistic Management (current best evidence) == | ||
Recomendations: | Recomendations: | ||
*Weight loss because of storage of estrogen in adipose tissue<ref name="merck" /> | *Weight loss because of storage of estrogen in adipose tissue<ref name="merck" /> | ||
*Regular exercise (30min/day) lowering insulin levels<ref name="merck" /> | *Regular exercise (30min/day) lowering insulin levels<ref name="merck" /> | ||
*Reduction of carbohydrates consumed to reduce insulin levels<ref name="merck" /> | *Reduction of carbohydrates consumed to reduce insulin levels<ref name="merck" /> | ||
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== Case Reports == | == Case Reports == | ||
add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | ||
== Resources <br> == | == Resources <br> == | ||
add appropriate resources here | add appropriate resources here | ||
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see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]] | see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]] | ||
<div class="researchbox"> | <div class="researchbox"> | ||
<rss>Feed goes here!!|charset=UTF-8|short|max=10</rss> | <rss>Feed goes here!!|charset=UTF-8|short|max=10</rss> | ||
</div> | </div> | ||
== References == | == References == | ||
see [[Adding References|adding references tutorial]]. | see [[Adding References|adding references tutorial]]. | ||
<references /> | <references /> | ||
[[Category:Bellarmine_Student_Project]] | [[Category:Bellarmine_Student_Project]] | ||
Revision as of 23:20, 8 April 2010
Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
Original Editors - Amanda Tieken from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
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. Ovaries are enlarged secondary to multiple cyst formations within the ovaries.
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:
- Enlarged polycystic ovaries[4]
- 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]
- Oligomenorrhea - presence of menstrual cycles greater than 35 days apart[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]
PCOS is believed to be a genetically inherited metabolic and gynocologic disorder. It is believed to be the consequence of an over production of luteinizing hormone (LH) by the pituitary gland. Excess LH results in increased androgen levels by the ovaries and adrenal cortex. Surplus androgen is converted into estrogen in adipose tissue where is is then stored. The surplus estrogen results in irregular formation of the follicle, anovulation, and increased production of androgens resulting in a vigorus cycle.[4]
Systemic Involvement[edit | edit source]
PCOS affects multiple systems including both metabolic and gynocologic systems, as well as the endocrine system.[2]
Medical Management (current best evidence)[edit | edit source]
add text here
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]
add text here
Case Reports[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
see adding references tutorial.
- ↑ 1.0 1.1 1.2 Sheehan MT. Polycystic ovarian syndrome: diagnosis &amp; management. Clinical Medicine &amp; 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 2.11 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.
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 Callahan TL, Caughey AB, editors. Blueprints: obstetrics &amp;amp; gynecology. 5th ed. Baltimore: Lippincott Williams &amp;amp; Wilkins, 2009.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Merck manual of medical information. 2nd ed. New York: Merck &amp;amp; Co., Inc, 2003. p 1234-35.
