Transcript PCOS - University of Peradeniya

Dr. Eranthi Samarakoon
 Is the time a girl becomes sexually
mature and functionally able to
reproduce .
 The changes which occur at puberty are
the development of secondary sexual
characteristics and onset of menstruation
 Puberty is the physical & mental
development of the girl child to reach
womanhood.
Begins around 09 years of age.
Includes the following aspects of physical development,
 Formation of the breast buds which go on to complete
development of the breasts.
 Growth spurt.
 Development of axillary & pubic hair.
 Occurrence of menstrual periods.
 Mental development from a child to an adolescent teenager &
a woman. ( Interest in personal appearance, cosmetics,
clothes & opposite sex.)
TIME SCALE (YEARS)
9½ - 13
Breast buds appear
13 – 14
Growth of axillary & pubic hair
10 – 14
Growth spurt
11½ - 15 Developed feminine contours
13 – 16
Ovulation
Menarche is the occurrence of the first
menstrual period, known in our society as
“attaining of age”. It is one aspect of the
pubertal process. In Sri Lanka the normal age of
menarche is between 9 to 15 years.
The occurrence of puberty and menstruation
require proper functioning of,
 Hypothalamus
 Pituitary
 Ovary
 Uterus
 And the out flow tract
SOME TRUE FACTS REGADING MENARCHE
 It is a natural occurrence & is only another mile
stone in the girl’s life.
 It should not be allowed to change the life style of
the girl who should be allowed to blossom out in
to a young woman gradually during the ‘teenage’
period.
 There are no taboos associated with menarche or
subsequent menstrual periods.
 Any type of food can be consumed.
 Athletes, swimmers & dancers can continue
training at menarche & during subsequent
menstrual periods.
 Social & cultural festivities should be kept to
minimum & the child should be made to feel
important and happy.
 She should resume schooling in 2-3 days after
menarche.
 Bathing can be continued
 Pregnancy can occur at any time after
menarche
 Regular monthly periods may or may not
occur soon after menarche
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Menstruation
Occur once in 25 – 32 days
Is not a cleansing or an excretory process of
the body
It only indicates a cycle during which an
ovum (egg) is released on the 14th day by
the ovary and ends with the uterus
shedding its endometrial lining (which
becomes thick during the menstrual cycle
due to the hormones) with the release of
about 60ml of blood
It is not essential for life but indicates that
ovulation has occurred ( an egg has been
released) during the month
Problems associated with puberty &
adolescence
 Primary amenorrhoea
 precocious puberty
 Irregular & excessive bleeding
 Primary dysmenorrhoea
 Vaginal discharge
 Secondary amenorrhoea
 Oligomenorrhoea
Medical attention should be sought if
menarche occurs before 09 years or does
not occur till 16 years
Irregular & excessive bleeding
 Increased bleeding and short cycles are common
in teenagers and is not due to an illness but due
to lack of maturity of the hormones.
 Immediate medical treatment is necessary to
avoid anaemia
 Abdominal examination, FBC and USS should be
done
 The diagnosis is dysfunctional uterine bleeding
unless proved otherwise
Treatment for Irregular & excessive bleeding
 Combined oral contraceptive pills for 01 -03 cycles
 Norethisterone 05mg b.d for 21 days (01-03 cycles)
 Tranexemic acid and /or mefenemic acid is used
only to reduce bleeding in regular menorrhagia
 Oral iron therapy
Primary dysmenorrhoea
 First day pain is normal
 May be accompanied by vomiting and fainting
 May start a few years after menarche
 Cannot be cured but should be controlled with
analgesics which should be commenced with the
onset of the period before the pain begins
 Paracetamol 500mg 06 hourly and/or mefenemic acid
500 mg 06 hourly are used
Vaginal discharge
 Increased vaginal discharge is normal
 it does not require treatment, if not blood
stained or associated with itching or burning.
 It does not cause weight loss, abdominal pain
or backache
ABSENCE OF MENSTRUATION
 Absence of menstruation for several
months is common in teenagers. it is not
due to an illness.
 It occurs because ovulation is irregular in
young girls.
 Medical attention may be sought to relieve
the anxiety of the parents.
 The possibility of a pregnancy can not be
ignored.
 Attention should be paid if the child is
overweight as it may be due to PCOS.
Polycystic Ovarian
Syndrome
(PCOS)
PCOS is a syndrome of ovarian dysfunction
with the cardinal features of
 Obesity
 Hyperandrogenism
 Polycystic ovarian morphology
Diagnosis
 Presence of two of the three following criteria is
diagnostic of the condition.
 Polycystic ovaries(either 12 or more peripheral
follicles) or increased ovarian volume (greater than
10 cm).
 Oligo or anovulation.
 Clinical and/ or biochemical evidence of
hyperandrogenism.
 A raised luteinising hormone/follicle-stimulating
hormone ratio is no longer a diagnostic criteria
for PCOS owing to its inconsistency.
Differential diagnosis
Diagnosis of PCOS require exclusion of
 Hyperprolactinaemia
 Androgen secreting ovarian or adrenal
tumours
 Cushing’s syndrome
Clinical Features
 Obesity
 Oligomenorrhoea/amenorrhoea
 Episodes of excessive bleeding after a
period of amenorrhoea
 Hirsutism
 Subfertility
 Recurrent miscarriage
 Acanthosis nigricans
Laboratory tests
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Elevated testosterone.
Decreased sex hormone binding globulin.
Elevated LH.
Elevated LH : FSH ratio.
Increased fasting insulin.
Increased prolactin .
Increased oestrodiol , oestrone
Ultra sound scan
The USS criteria for the diagnosis of PCOS are,
 8 or more subcapsular follicular cysts ~ 10mm in
diameter
 increased ovarian stroma.
 Ovarian volume greater than 10 cm3.
Treatment
 There is no specific treatment for PCOS.
 Treatment is directed at the symptoms.
Exercise & weight control
 Is the most important aspect of
treatment.
 Causes spontaneous resumption of
ovulation
 Improves fertility.
 Increases sex hormone binding globulin
levels.
 Reduces insulin resistance.
 Normalizes the glucose metabolism.
Menstrual disturbances
 Progesterone for the last 10 days of the
cycle.
 Cyclical treatment with progesterone.
 Cyclical treatment with combined oral
contraceptive pills.
Role of Metformin
 Improves obesity.
 Increases ovulation rates.
 Improves hirsutism.
 Improves fertility.
Hirsutism
 Cyproterone acetate
 Metformin
 Cosmetic treatment
Anovulation & Infertility
 Weight reduction
 Metformin
 Ovulation induction
- Clomiphene citrate
- hCG injections
 Ovarian drilling
Long-term metabolic consequences
 Diabetes mellitus
 Dyslipidaemia
 Hypertension
 Cardiovascular disease
 Endometrial carcinoma
 Gestational diabetes mellitus
NUTRITIONAL REQUIREMENTS OF THE
ADOLESCENT
Adequate nutrition should be provided to the girl
child for,
 Growth
 To restore the blood loss during menstruation
 To prepare her to deliver a healthy baby
without any complications during the
pregnancy
The following dietary items are nutritious, cheap
and readily available. Each meal should be rich in
carbohydrates, protiens, vitamins and minerals
Rice (carbohydrates)
* dhall, greengram(mung), gram(kadala), cowpea, soya,
eggs, sprats, fish, meat (proteins and minerals) – fish and
meat should be added where economically possible.
* Green vegetables, bananas and other fruits. (vitamins
and minerals) – even common cheap fruits such as jambu
and lime are rich in vitamin C.
* Milk is not essential
* School snacks & tiffings should be prepared at home.
* Avoid sausages, other artificial & tinned food.
* Encourage to eat fruits for dessert.
* Drink plenty of water. Avoid sweetened artificial drinks.
Prepare fruit juices at home.
* Advertisements which appear in the TV regarding food
items are better disregarded