Polycystic ovary syndrome

Polycystic ovary syndrome is a disorder of unknown cause characterized by anovulation, hyperandrogenism, and gonadotropin secretory abnormalities producing oligo-ovulation or anovulation. Hyperinsulinemia and insulin resistance are important features of this syndrome. Because other causes of androgen excess may produce similar clinical and biochemical findings, PCO remains a diagnosis of exclusion. Treatment is directed toward relieving symptoms of hyperandrogenemia in order to stimulate ovulation, correcting obesity, and inducing regular menses to reduce the risk of endometrial cancer.     

Polycystic ovary syndrome

Polycystic ovary syndrome is a complex endocrine disorder of hypothalamic-pituitary dysfunction that presents with anovulation, hirsutism and infertility. Women with PCOS have increased risk for developing NIDDM, dyslipidemia and premature cardiovascular disease. Because of its vague presentation and potential for numerous complications, PCOS should be evaluated carefully. Unfortunately, there is no cure for PCOS, and the treatment has numerous limitations. Weight loss in an obese patient may greatly improve the patient's response to treatment and should be encouraged.     

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with levels of between 4 and 10 per cent reported (Dunaif 1995, Norman et al 2002). However, figures for its prevalence vary considerably and estimates of 'true' prevalence must be made with caution since there is no overall consensus on the diagnostic criteria that must be satisfied to make a diagnosis (Ledger and Clark 2003). Giving information and patient education are integral to many nursing roles and as more women are being diagnosed with PCOS, patients are seeking information from nurses as well as other health professionals. This article provides an overview of PCOS, including its clinical features, pathophysiology, long-term health consequences and possible treatments.     

Polycystic ovary syndrome

Polycystic ovary syndrome comprises a group of chronic, progressive diseases of the female reproductive system. Clinical characteristics include disorders of ovulation and menstruation, hirsutism, infertility and obesity. Recommended treatment of the unacceptable manifestations includes the use of oral contraceptives or progestins. Fertility can often be achieved with clomiphene citrate and/or other agents. Rarely is surgical therapy indicated.     

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by chronic unovulation, hyperandrogenism and polycystic change in ovary. Hyperinsulinemia is so often accompanied with PCOS that insulin resistance may play important roles in pathogenesis of PCOS. Recent studies reported the effectiveness of insulin-sensitizing drugs on treatment of patients with PCOS. Thiazolidinedione, an agonist of PPARgamma receptor, improves not only insulin sensitivity but also hyperandrogenism and ovulatory dysfunction in patients with PCOS. Insulin-sensitizing drugs such as thiazolidinediones are expected to be a novel therapy for PCOS, although further studies on the effectiveness and safety should be required.     

Heart failure: it's not just for men

Heart failure is end-stage cardiac disease, developing in 46% of women within 6 years of having a myocardial infarction, and is the leading cause of all hospitalizations and readmissions in women over the age of 65 years. Since women present with atypical symptoms leading to inaccurate diagnosing of heart disease, education becomes a key component in increasing women's ability to self-manage heart failure symptoms and to become proactive in health-promoting behaviors. Health care providers are responsible for communicating discharge education including risk factors, causes, classification and staging, clinical presentation, diagnostic testing, and management of heart failure to assist women in managing this terminal disease and improving their quality of life.     

Polycystic ovary syndrome: clinical and imaging features

Polycystic ovary syndrome is the most common endocrine disorder occurring in reproductive-age women. The syndrome is complex, multifactorial, and not always easily defined. Diagnosis is based upon a combination of clinical and biochemical criteria and ovarian morphology. The following review describes the clinical features, pathophysiology, diagnosis, and the role of imaging. Diagnostic imaging techniques are discussed, with emphasis on ultrasound as the main modality used worldwide. Contributions of 3-dimensional and Doppler ultrasound are addressed in addition to potential indications for magnetic resonance imaging in the evaluation of patients with suspected polycystic ovary syndrome.     

Polycystic ovary syndrome and female reproduction

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. The presentation is diverse. There is no single, unified definition of PCOS, no single diagnostic test and no consensus on the diagnostic criteria. Currently, PCOS is most commonly defined by the 2003 Rotterdam criteria, which requires at least two of three features for diagnosis--chronic anovulation, clinical and/or biochemical signs of hyperandrogenism, or polycystic ovaries. The aetiology is unknown, but the principal underlying disorder is thought to be reduced insulin sensitivity in peripheral tissue, and hence hyperinsulinaemia (high levels of insulin in the blood). Some affected women may have hyperandrogenism and polycystic ovaries with normal ovulatory function; however, like women with classic PCOS, they still have an increased risk of type 2 diabetes and cardiovascular events. Some women with PCOS have no symptoms or signs and live a normal life with normal childbearing status, but it is very difficult to predict which cases will follow this pattern. It is important to investigate women with menstrual irregularity when they first present, because they might have mild PCOS, which could otherwise be missed. It is therefore essential to educate the public, nurses and other healthcare professionals to identify affected women, so that strategies can be put in place to avoid or minimize the complications and consequences of PCOS.     

Polycystic ovary syndrome: a review for primary providers

PCOS is a metabolic syndrome that exists throughout the world with much clinical heterogeneity. PCOS is now appreciated as encompassing two interrelated metabolic phenomena--insulin resistance and hyperandrogenism. Patients present with oligo-amenorrhea and clinical hyperandrogenism, and the diagnosis is based on clinical grounds with few laboratory tests necessary. Because patients are at higher than normal risk for diabetes, glucose intolerance, and hyperlipidemia, and perhaps at higher risk for coronary heart disease, newly diagnosed patients with PCOS should be evaluated for glucose intolerance and hyperlipidemia. The cornerstone of therapy today includes weight management, and further therapeutic intervention is focused on reproductive and cardiovascular health and treatment of insulin resistance. Clinical case continued The 17-year-old mentioned in the beginning of this article probably does have PCOS. She fits the clinical criteria: oligo-ovulation and hyper-androgenism (the acne and hirsutism). In addition, she is obese, which is also associated with PCOS. Her TSH and prolactin were normal, and as her presentation was not suggestive of an adrenal tumor or congenital adrenal hyperplasia (she had mild hirsutism, and those diagnoses are associated with more severe hyperandrogenism), no further laboratory evaluation was deemed necessary. Once the diagnosis was made, she was screened for lipid abnormalities and for glucose intolerance. Her LDL was 150, HDL 35; oral glucose tolerance test (OGTT) was normal. A pregnancy test was negative, and she was started on OCPs. Devoting herself to exercise and dietary change, she lost 10 pounds in her first 3 months after diagnosis. Her hirsutism and acne have improved with the OCPs and weight loss, and her menses are regular. She has elected to defer oral insulin sensitizers until her weight loss has stabilized. Findings PCOS is common in reproductive-aged women. Diagnosis is clinical and is supported by lab findings; there is significant clinical heterogeneity. Insulin resistance is likely central to the pathophysiology along with androgen excess. Health implications include infertility, diabetes, endometrial cancer, hyperlipidemia, and possibly coronary heart disease. Treatment is evolving and includes weight loss, OCPs, and insulin sensitizers.     

Basic infertility including polycystic ovary syndrome

Infertility in women has many possible causes and must be approached systematically. The most common cause of medically treatable infertility is the polycystic ovary syndrome (PCOS). This syndrome is common in young women and is the cause of anovulatory infertility in 70% of cases. It is therefore an important condition to screen and manage in primary care medical settings. In the past 10 years, insulin sensitization with weight loss or metformin has been shown to be a safe and effective treatment for PCOS infertility that eliminates the risk of multiple pregnancy and may reduce the risk of early pregnancy loss as compared with ovulation-inductor drugs. The authors believe metformin should be considered as first-line therapy because it has the advantage to allow for normal single ovulation, for reduced early pregnancy loss, and, most importantly, lifestyle modifications and weight loss before pregnancy. Losing weight not only improves fertility but also reduces adverse pregnancy outcomes associated with obesity.     

Polycystic ovary syndrome: new perspective on an old problem

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age. New treatment approaches resulting from a refined understanding of the pathophysiology are evolving. The literature shows that PCOS is an endocrinopathy resulting from insulin resistance and the compensatory hyperinsulinemia. This results in adverse effects on multiple organ systems and may result in alteration in serum lipids, anovulation, abnormal uterine bleeding, and infertility. In addition, PCOS may place the patient at long-term risk for the development of type 2 diabetes, hypertension, endometrial cancer, and cardiovascular disease. Oral contraceptives, progestins, antiandrogens, and ovulation induction agents remain standard therapies. However, insulin-sensitizing agents are now being shown to be useful alone or combined with standard therapies. Early identification of patients at risk and prompt initiation of therapies, followed by long-term surveillance and management, may promote the patient's long-term health.