妇产科学课件：多囊卵巢综合征（英文版).ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Polycystic Ovarian Syndrome(PCOS),What is PCOS?,Polycystic ovarian syndrome(PCOS),also called Stein-Leventhal syndrome,，,is,a multisystem reproductive metabolic disorder.,Clinical characteristics:,1.Irregular menstruation,2.Hyperandrogenism,3.Polycystic ovaries or ovary,4.Metabolic dysfunction:,insulin resistance,dyslipidemia,obesity,Epidemiology,The,prevalence,of PCOS in Chinese women aged 19-45 years is,5.6%,.,A large-scale epidemiological study,October 2007 to September 2011,15,924 Han Chinese women of reproductive,age from the 10 provinces and municipalities,in China,Hum Reprod.,2013,Sep;28(9):2562-9,Etiology,It is not clear.,Familial Occurrence:,PCOS tends to aggregate,within families.First-degree relatives of women,with PCOS are at significant risk for PCOS.,Environment Factors:,body weight,life style,intrauterine environment are associated with,PCOS.,Pathophysiology,Clinical Manifestation,s,Menstrual,dysfunction,Hyperandrogenism,Polycystic ovaries,Insulin resistance,Infertility,Clinical Manifestation,s,1.Menstrual,dysfunction,:,due to chronic anovulation,or oligo-ovulation,(1)Amenorrhea,Oligomenorrhea,(,menstrual cycle,35,d,),(2)Hypomen,o,rrhea,Menorrhagia,Irregular bleeding,Clinical Manifestation,s,2.Hyperandrogenism:,(1)Hirsutism,(,多毛）,Clinical Manifestation,s,2.Hyperandrogenism:,(2)Acne,（痤疮）,Clinical Manifestation,s,2.Hyperandrogenism:,(3)Obesity,:,BMI 30,(kg/m,2,),present in 50%-60%of patients with PCOS,The body fat is usually deposited centrally(android obesity),and a higher waist-to-hip ratio indicates an increased risk of diabetes mellitus and cardiovascular disease.,Clinical Manifestation,s,3.Polycystic ovaries:,(1)the presence of at least 12 antral follicles per,ovary,(The diameter of antral follicle is 2-9mm),(2)ovarian volume10ml,(1)or(2),Clinical Manifestation,s,3.Polycystic ovaries:,A,bilateral enlarged ovaries with a smooth and thicked capsule,B,on cut section,multiple follicular cystssurroundedby abundant ovarianstromaare found throughout thecortexof theovary,Clinical Manifestation,s,Insulin resistance:,20%to 40%,may worsen the clinical manifestations of PCOS,(1)Compensatory hyperinsulinemia,(2),In obese PCOS patients:i,mpaired glucose tolerance(33%),type 2 diabetes,mellitus(7.5%to 10%),(3)Acanthosisnigricans:,darkened,velvetyplaque,alongthenapeofthe neck,Clinical Manifestation,s,5.Infertility:,Anovulation,would appear to be the primary,defect responsible for the failure to achieve,pregnancy in this disorder.,Besides,PCOS have a higher incidence of,spontaneous pregnancy loss,.,Laboratory Evaluation,1.Hyperandrogenemia:,serum total testosterone,free testosterone,2.Hyperinsulinemia:,normal values do not preclude insulin resistance,3.LH/FSH ratio:2-3,has little additive value in determining the,diagnosis,Diagnosis,Rotterdam criteria,（,2003,）,:,(1)Oligo-and/or anovulation,(2)Hyperandrogenism,(clinical and/or biochemical),(3),Polycystic ovaries,：,either 12 or more follicles,measuring 2-9mm in diameter or increased,ovarian volume(10ml,）,on a ultrasound scan,Note:accordance with two of the three above items,with an exclusion of other aetiologies,such as,congenital adrenal hyperplasia and Cushing disease,Differential Diagnosis,Congenital adrenal hyperplasia,Cushing disease,Ovarian hyperthecosis,Androgen-producing tumors of the ovary and adrenal gland,Functional uterine bleeding,Long-term risks,1.Endometrial carcinoma,Chronic anovulation persistently elevated estrogen levels,uninterrupted by progesterone risk of endometrial carcinoma,2.Breast cancer,H,yperestrogenic state risk of breast cancer,3.Diabetes mellitus,Women with insulin resistance are at risk for diabetes mellitus.,4.Dyslipidemia,hypertension,cardiovascular disease,Treatment,1.,Weight reduction in obese patients,2.,Drug therapy,3.,Surgery,4.,Assisted reproductive technologies,Treatment,1.Weight reduction in obese patients,The initial recommendation,It reduces insulin,SHBG,and androgen levels,May restore ovulation either,used,alone or combined with ovulation-induction agents,Weight loss of as little as 5%to 7%over a 6-month period,can reduce the,serum,testosterone significantly and restore,ovulation and fertility in some women.,Treatment,2.Drug therapy,(1)Oral contraceptives:,Diane-35,Marvelon,Progestin component:suppresses LH ovarian androgen,Estrogen:increases SHBG free testosterone,(2)Insulin sensitizers:,Metformin,Lead to a drop in insulin and androgen levels,Improve reproductive function,(3)Ovulation induction:,Clomiphene,Gonadotropin,For those patients desiring pregnancy,(4)Progesterone,To induce withdraw,al,bleeding and avoid hyperplasia of endometrium,Treatment,3.Surgery,(1)Ovarian wedge resection,It is not popular nowadays.,(2)Laparoscopic electrocautery(ovarian drilling),For,Severe PCOS,whose condition is,resistant to clomiphene,After operation,Androgen and LH ,FSH,Spontaneous ovulation(73%),。