Polycystic ovary syndrome

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Polycystic ovary syndrome (PCOS) or Stein–Leventhal syndrome, is a set of symptoms due to a hormone imbalance in women

Check for symptoms:

Associated conditions include:

type 2 diabetes, obesity, obstructive sleep apnea, heart disease, mood disorders, and endometrial cancer.

Significance:

Common cause of infertility in 5- 10% women

May lead to endometrial cancer( estrogen excess)

Associated with cardiovascular disorders (diabetes and hypertension) if untreated(androgen excess)

Diagnosis

Presence of  any two of the following indicates PCOS.POLYCYSTIC OVARY SYNDROME

a) Serum testosterone, follicle stimulating hormone(FSH), prolactin and thyroid stimulating hormone(TSH) levels – elevated testosterone and decreased FSH and increased LH

b) Menstrual irregularity – ovulatory dysfunction

c) Presence of  more than 10 follicles per ovary ( detected by pelvic ultrasonography)

Dose and dosage     

a) Antiandrogens:

  • Spironolactone –  50 – 75 mg once/day
  • Leuprolide acetate  3.75 mg IM once / day
  • Topical hair removal agents : Eflornithine
  • Topical acne agents : Benzoyl peroxide 2.5 – 5% cream
  •                                     Tretinoin topical cream (0.02–0.1%),
  •                                     Clindamycin topical cream 1%

b) Oral contraceptive agents

  • Ethinyl estradiol – 0.02 – 0.03mg once/day
  • Medroxyprogesterone  – 5 to 10 mg once/day for 10 – 14 days every 1 to 2 months
  • Ovulation inducer –  Clomiphene citrate- 50 mg once/day for 5 consecutive days early in menstrual cycle for 3-6months
  • Metformin 500 – 1000 mg, twice / day

Contraindications:

  • Hormone therapy that has contraceptive effects is not preferred in women who desire pregnancy

Counselling on side effects:

  • Oral contraceptives – deep vein thrombosis
  • Clomiphene- ovarian hyperstimulation, nausea, abdominal pain, breast tenderness
  • Metformin –  loss of appetite, vitamin B12 deficiency, increased abdominal gas, monitor blood glucose, periodic kidney and liver function tests

Controlling triggering factors in PCOS:

  • Obesity
  • Stress

Counselling on diet, exercise, lifestyle management:

  • Weight reduction through diet and regular exercise
  • Take diet  rich in fruits, vegetables, testosterone reducing foods, Avoid stress.

RECOMMENDED MEAL PLAN FOR PCOS?

Currently there is no scientific evidence to support one particular diet for PCOS. Evidence-based recommendations suggest that women with PCOS should focus on balance and moderation. Recommended lifestyle changes include:

  • Weight loss of 5-10% if overweight or obese in 3 months.

  • Decreased caloric intake if weight loss is desired.

  • Decreased intake of enriched carbohydrates.

  • Increased fiber intake including fruits, vegetables, and beans.

  • Decreased fat intake, particularly saturated fat.

  • Smaller, more frequent meals (every 3-4 hours) to help control blood glucose levels.

  • Balanced meals including carbohydrates, protein, and fat.

  • At least 150 minutes of moderate or vigorous activity per week.

  • Strength Training

  • Sleep at the same time everyday for hormonal vibrancy

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