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]
Polycystic Ovarian Syndrome (PCOS), formerly 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, atrophy of breast tissue, increased muscle mass, and clitoromegaly[4]
- Anovulation - failure of the ovaries to release an oocyte[4]
- Amenorrhea - absence 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 trimester 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 definitive test for the diagnosis of PCOS, but rather a ruling out of other possible disorders.
- Ultrasounography - abdominal or transvaginal[2] [6]
- Pelvic Examination[2]
- Laparoscopy[2] [6]
- 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 gynecologic 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 then stored. The surplus estrogen results in irregular formation of the follicle, anovulation, and increased production of androgens resulting in a vigorous cycle.[4]
Systemic Involvement[edit | edit source]
PCOS affects multiple systems including both metabolic and gynecologic systems, as well as the endocrine system.[2]
Medical Management (current best evidence)[edit | edit source]
Cystectomy
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 gynecologic/metabolic connection. Concern of possible presence of PCOS requires immediate referral to a physician.[2]
In treating patients 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]
Recommendations:
- 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
[edit | edit source]
Case Report: Polycystic Ovarian Syndrome: Diagnosis and Management
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 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 & 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.
- ↑ 6.0 6.1 Polycystic Ovarian Syndrome, PCOS and Infertility and Pregancy: What is PCOS Syndrome? Advanced Fertility Center of Chicago; Gurnee, IL. 1996-2010; 04-2010. Available from: (http://www.advancedfertility.com/pcos.htm)
