妇产科学课件：多囊卵巢综合征（英文版)

1、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

2、 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,PC

3、OS.,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

4、:,(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 wit

5、h 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:,Anovulat

6、ion,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,(clin

7、ical 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 ris

8、ks,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 patient

9、s,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:,Met

10、formin,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%),

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