PCOS Long Term Sequelae BY Mohammad Emam Prof
PCOS : Long Term Sequelae BY Mohammad Emam Prof. OB& GYN Mansoura Faculty of Medicine Mansoura Integrated Fertility Center EGYPT 2009
PCOS : An Epidemic An epidemic in developing countries ( ED & PCOS !!!!). About 20% of reproductive age women demonstrate the ultrasound picture of polycystic ovaries. About 5 - 10 % have clinical or biochemical signs of Anovulation androgen excess. (These data were collected prior to Rotterdam diagnostic consensus).
PCOS : Cause Complex interaction of genetic , epigenetic, metabolic , neurologic and environmental factors. PCOS, starts in adolescence But not always diagnosed at that age.
Rationale women with PCOS cluster risky consequences leading to increased morbidity and mortality.
Rationale § Long term consequences of this syndrome are forgotten by clinicians. § Treatment is directed only for symptoms without digging into deeper
Aim To heighlight to the different clinicians : ○ The long-term health consequences of PCOS ( other than infertility ). ○ How to minimize or prevent the development of these consequences.
Methods Randomised controlled trials, systematic reviews and metaanalyses in: The Cochrane Library , RCOG , Medline and Pub. Med (between 1986 and January 2009).
Long term Consequences Of PCOS Definite Possible Controversial
Definite Long term Consequences Of PCOS Type 2 diabetes Dyslipidemia Endometrial cancer.
Possible: Long term Consequences Of PCOS Metabolic : Obesity &IR & Ms &Gall bladder disease Cerbrovascular disease : Coronary & Cerbral & Depression & anxiety & loss of self esteem Obstructive Sleep Apnea Pregnancy complications: Epilepsy? !!! Hypertension Gestational Diabetes Gestaional hypertension
Controversial Long term Consequences Of PCOS PIH Miscarriage ovarian cancer Breast carcinoma
Long Term Risks Of PCOS CVD pregnancy Endometrial Cancer Gout PCOS NIDDM Infertility Obesity Gallbladder Disease
Prevalence Of MS In PCOS MS is present in 2/3 of the PCOS (2 -fold higher than women in the general population).
Link between Metabolic S & PCOS MS PCOS IR
Epilepsy &PCOS ( what is the culprit? PCOS Epilepsy
RCOG GREENTOP GUIDELINE (DECEMBER 2007)
Counseling �Women diagnosed with PCOS: ○ Should be informed of the possible long- term risks. ○ Should be advised regarding weight control and exercise (B).
Metabolic consequences of PCOS Women presenting with PCOS: BMI >30 + age > 40 years + +ve Family history of diabetes. Are at increased risk of type 2 diabetes and should be offered a glucose tolerance test. (B)
PCOS and obstructive sleep apnoea Women diagnosed with PCOS should be asked (or their partners) about : Snoring and daytime fatigue Informed of the possible risks of sleep apnea
PCOS and cardiovascular risk Hypertension should be treated. Lipid-lowering drugs should only be prescribed by a specialist
PCOS &pregnancy Women should be screened for gestational diabetes Before 20 weeks of gestation, with referral to a specialist if diabetes is detected ( B). Metformin is currently not licensed for use in pregnancy in the UK !!!! and is not recommended for use in pregnancy ( D)………Contraversial
Cancer And PCOS Amenorrhoeic or severely oligomenorrhoeic women with PCOS should have induced withdrawal bleeding at regular intervals to reduce the risk of developing endometrial hyperplasia(B). There is no association with breast or ovarian cancer and no additional surveillance is required (C).
Exercise and weight control All overweight PCOS should be provided with dietary and lifestyle advice.
How to minimize or prevent long term consequences?
Concept The genetic expression of PCOS can be optimized and modulated by prevention the interactions between genes and epigenetic factors.
1) Early Detection And treatment of PCOS during adolescence
Screening for PCOS in Adolescents PCOS should be considered when an adolescent presents with: Irregular menses, hirsutism, acne, alopecia, central adiposity, AN, and/or hyperinsulinemia
2)Prevention of peripupertal obesity
MORE THAN 1 IN 4 CHILDREN IS OVERWEIGHT or OBESE!!
Peripupertal obesity Weight gain: Energy In Energy Out
peripupertal obesity & PCOS Peripubertal obesity IR & ghrelin & Leptin PCOS
3)The Target Of ttt Should Be Causative Rather Than Symptomatic
Targets For ttt PCOS IR Causative ttt +or- Adjunctive None IR Symptomatic ttt : Anovulation , Acne, Hirsutism, Insulin sensitizers : Prevent Hyperandrogenemia – IR Vicious circle.
Targets for treatment PCOS
Conclusion Treating “the whole state” rather than “the disease” should be the principal on dealing with PCOS
Conclusion Infertility and oligohypomenorhea represent only the tip of ice-berg of PCOS , but late Sequelae are the hidden serious base
Conclusion Management of PCOS should be started by prevention of obesity in peripupertal kids.
Conclusion Screening for PCOS in adolescents is mandatory for early diagnosis and minimizing long term Sequelae
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