We cannot guarantee that Polycystic Ovary Syndrome book is available in the library, click Get Book button to download or read online books. Join over Women's healthcare regarding polycystic ovarian syndrome remains challenging.
Patients often go from one specialist to another trying to fully understand and management the disorder. Women often go years before a diagnosis, seeing three or more doctors before a confirmed diagnosis.
Such a multidisciplinary clinical and scientific approach integrates obstetrics and gynecology, pediatric and medical endocrinology, internal medicine, genetics, psychology and laboratory medicine into relevant translational clinical and scientific discussions that update both the scientific understanding of PCOS and the diagnosis and management of all aspects of the syndrome.
The impact of PCO on the onset of puberty is subdivided in sub sections to get a better understanding of this condition and the management at different stages in a woman's life. Represents an unparalleled compilation of chapters from experts in the field relevant to contemporary polycystic ovarian syndrome Covers aspects such as obesity, metabolic changes, and emotional changes associated with PCOS Highlights contemporary management and the current understanding of this unique syndrome with a comprehensive and fresh approach.
Our knowledge about infertility has expanded and improved significantly in recent years and Polycystic Ovary Syndrome PCOS is now recognised as a major cause. PCOS is a term which covers a variety of symptoms, and in this new volume the editors have compiled a wide ranging collection of studies dealing.
Gynecology is frequently changing due to extensive implementation of high technology in both, the diagnosis and management of gynecologic problems. General gynecologists, gynecologic endocrinologists, infertility specialists, gynecologic endoscopists, and gynecologic oncologists will find attractive, new information in this book. This book is a comprehensive guide to the diagnosis and management of polycystic ovarian syndrome PCOS for clinicians.
Researchers and health care providers know that genetic and environmental factors contribute to the development of polycystic ovary syndrome PCOS , but do not know exactly what causes PCOS. Because the symptoms of PCOS tend to run in families, the syndrome is probably caused, at least in part, by a change, or mutation, in one or more genes.
Recent research conducted in animal models suggests that in some cases PCOS may be caused by genetic or chemical changes that occur in the womb. Most of the symptoms of PCOS are caused by higher-than-normal levels of certain hormones, called androgens. The ovaries produce hormones, which are chemicals that control functions in the body.
One of the hormones that the ovaries make is estrogen—sometimes called the "female hormone" because women's bodies make more of it than men's bodies do. The ovaries also make androgens—sometimes called "male hormones" because men's bodies make more of them than women's bodies do. Men and women need certain levels of both hormones for normal health. In women with PCOS, the hormones are out of balance: these women have higher-than-normal levels of androgens and may have lower-than-normal levels of estrogen.
High levels of androgens can:. Other symptoms of PCOS result from problems with insulin, another of the body's hormones. Insulin helps move sugar also called glucose from the bloodstream into cells to use as energy. When cells don't respond normally to insulin, the level of sugar in the blood rises. In addition, the level of insulin goes up as the body produces more and more of it to try to get glucose into the cells. Too much insulin increases the production of androgens,5 which then cause symptoms of PCOS.
High levels of insulin can also increase appetite and lead to weight gain. Health care providers look for three characteristic features of polycystic ovary syndrome PCOS : absence of ovulation, high levels of androgens, and cysts on the ovaries.
Having one or more of these features could lead to a diagnosis of PCOS. If your medical history suggests that you might have PCOS, your health care provider will rule out other conditions that may cause similar symptoms.
After ruling out other conditions and before making a diagnosis of PCOS, your health care provider will do the following: 1 , 2. Because there is currently no universal definition of PCOS, different expert groups use different criteria to diagnose the condition. However, all the groups look for the following three features: 3.
Your health care provider will use one of three different methods to diagnose PCOS. One method requires only features 1 and 2 above for a PCOS diagnosis; another requires any two of the three features above for a PCOS diagnosis; and the last one requires feature 1, plus one other feature listed above for a PCOS diagnosis.
There is currently no cure for polycystic ovary syndrome PCOS , and it does not go away on its own. Even after menopause, women with PCOS often continue to have high levels of androgens as well as insulin resistance. This means that the health risks associated with PCOS are lifelong. Because polycystic ovary syndrome PCOS has a broad range of symptoms, health care providers may use a variety of treatments for this condition and its symptoms.
Because PCOS has a broad range of symptoms, health care providers may use a variety of treatments for this condition and its symptoms. Because some of the common treatments for PCOS symptoms can prevent pregnancy or may harm the fetus during pregnancy, it's important to discuss your fertility goals with your health care provider while discussing treatment options. Be sure you fully understand your treatment options and their effects on pregnancy before deciding on a course of treatment.
You should also discuss the risks of treatments with your health care provider. All treatments have risks, and some of them can be serious.
Also, some unhealthy lifestyle factors such as smoking can increase these risks, and thus you should discuss with your health care provider the best way to eliminate these practices.
In most cases, fertility problems in women with polycystic ovary syndrome PCOS result from the absence of ovulation anovulation , but anovulation may not be the only reason for these problems. Before beginning treatment for infertility possibly related to PCOS, be sure that your health care provider rules out other causes.
Lifestyle changes, such as losing weight, can trigger body changes that facilitate conception in women with PCOS. Research shows that lifestyle changes can help restore ovulation and improve pregnancy rates among women with PCOS. If you have PCOS-related infertility, your health care provider may prescribe one of the following medications to help you get pregnant.
If you do not get pregnant with the treatments listed above, your health care provider may suggest in vitro fertilization , or IVF. Then a doctor places the fertilized egg into the uterus.
IVF may offer women with PCOS the best chance of getting pregnant, and it may give health care providers better control over the risk of multiple births. But it can be expensive and may not be covered by health care insurance. In many cases, the first action that health care providers recommend for women with polycystic ovary syndrome PCOS is that they make specific lifestyle changes.
In many cases, the first action that health care providers recommend for women with PCOS is that they make specific lifestyle changes, such as following a lower-calorie diet, losing weight, and getting more physical activity. Losing weight and being more physically active can minimize many PCOS symptoms and related conditions.
A recent NICHD-funded study found that a diet low in dairy and carbohydrates helped women with PCOS lose weight, reduce excess testosterone, and improve insulin sensitivity. Also called birth control pills or "the Pill," hormonal contraceptives can be used for the long-term treatment of women with PCOS who do not wish to become pregnant, 1 and in fact they are the primary treatment for these women.
Oral contraceptive pills contain a combination of the hormones estrogen and progestin. In women with PCOS, these hormones: 1. Oral contraceptives can help lower the risk of certain types of cancers, but they may also raise the risk of other types of cancers. Discuss all possible risks and side effects with your health care provider before making a final decision on a treatment. These types of medications make the body more responsive to insulin and keep glucose levels more stable.
After 4 to 6 months of using these medications, women with PCOS may start ovulating naturally. The U. Even so, your health care provider may use these medications to treat your symptoms. Talk to your health care provider about any concerns you may have about these medications. These medications either prevent the body from making androgens or limit the activities or effects of those hormones. In women with PCOS, anti-androgens can:. Because anti-androgens can cause birth defects, they are often taken with oral contraceptives to prevent pregnancy.
At this time the best type of anti-androgen for treating PCOS symptoms is not known. There are many ways to remove excess or unwanted hair or to hide this hair without actually removing it. Women with PCOS can use the methods below instead of or in combination with other approaches: Retinoids pronounced RET-n-oids , antibacterial agents, and antibiotics may be used to treat acne. These products may be available in pills, creams, or gels.
The specific treatment depends on the severity of the acne and how long it has been visible. Because retinoids can cause birth defects, you should not use them if you want to become pregnant.
NICHD conducts and supports a wide range of research activities to learn more about the causes of polycystic ovary syndrome PCOS , its risk factors, and its possible treatments. Short descriptions of this research are included below. The Institute's research focuses on genetic, molecular, and cellular mechanisms underlying PCOS as well as studies to determine precursors or predictors of PCOS in adolescents. One of the long-term goals of the FI Branch is to find more effective treatments for the symptoms of PCOS as well as other conditions associated with the disorder.
Treatments of interest include both pharmacological and non-pharmacological interventions. The FI Branch is also interested in how individual factors like genetics affect responses to treatment.
Other research includes demographic and risk information related to PCOS. Some FI Branch—supported findings include:. For example, a recent finding from researchers in the Section on Genetics and Endocrinology found that a subgroup of women who were diagnosed with PCOS may actually have an adrenal gland disorder instead.
Women with polycystic ovary syndrome PCOS are at higher risk for several other health conditions, some of them serious. Insulin is a hormone that helps move sugar glucose from the bloodstream into cells to use as energy.
Glucose in the blood is the body's main source of fuel. When cells don't respond to insulin, the level of glucose in the blood rises. High levels of insulin can increase appetite and lead to weight gain. This syndrome occurs when the body is not able to balance all the chemicals and processes it needs to create and use energy. Its features include insulin resistance, high blood sugar, obesity, high cholesterol, and high blood pressure.
In people with diabetes, the body has stopped producing insulin or does not use it properly. As a result, the glucose level in the blood rises, but the cells don't get the glucose they need for energy. If the blood glucose level is high for prolonged periods of time or on a regular basis, the condition is called diabetes.
Obesity is a condition in which the body stores more fat than is healthy based on a person's height and body type. Obesity in women with PCOS may result from imbalanced hormone levels, increased deposition of fat due to higher insulin levels, metabolic dysfunction problems with how the body stores and uses energy , or a combination of these factors.
Several factors related to PCOS, including insulin resistance, metabolic syndrome, and obesity, increase a woman's risk of cardiovascular disease. Heart disease is the leading killer of women in the United States, 5 and several studies have found that women with PCOS are at increased risk for cardiovascular disease. When people sleep, the muscles that keep the airway open relax. In some people, the relaxed muscles allow the airway to narrow or close for a short time.
As a result, breathing stops for several seconds. Often, when the person starts breathing again, he or she makes a snorting or choking sound. Women with PCOS are more likely to have mood disorders, such as depression or anxiety, or to engage in out-of-control or binge eating.
Certain features of PCOS may contribute to the increased risk of mood disorders. For example:. Inflammation is the body's normal protective response to infection or injury.
However, inflammation is also involved in several dangerous conditions, such as hardened arteries, which are a major risk factor for heart attack and stroke. Some evidence suggests that women with PCOS experience long-term, low-level inflammation.
Currently, it's not clear whether this inflammation results from obesity and metabolic dysfunction, which are also common among women with PCOS, or whether it is an independent symptom of the disorder. It's also not clear whether chronic, low-level inflammation might have long-term health consequences for women with PCOS. Ongoing research on these questions should help to clarify the role of inflammation in PCOS.
For instance, some research has shown that risk of cancer of the endometrium pronounced en-doh-MEE-tree-uhm , the inside lining of the uterus, may be higher for women with polycystic ovary syndrome PCOS than it is for women without PCOS. This thickening can lead to endometrial cancer. Data on links between breast cancer, ovarian cancer, and PCOS are limited. While some small studies have suggested that a lack of ovulation, as occurs with PCOS, is linked with an increased risk of breast cancer, other studies have not shown an association.
Women with PCOS can and do still get pregnant—sometimes naturally, sometimes with help. Women with polycystic ovary syndrome PCOS are at higher risk for certain problems or complications during pregnancy. In addition, infants born to mothers with PCOS are at higher risk of spending time in the neonatal intensive care unit or dying before, during, or right after birth. Complications of pregnancy commonly associated with PCOS could be a reason for these risks.
Also, conditions common to PCOS like metabolic syndrome and increased androgens may increase the risks affecting infants. Researchers are studying whether treatment with insulin-sensitizing drugs such as metformin can prevent or reduce the risk of pregnancy problems in women with PCOS. If you have PCOS and get pregnant, work with your health care provider to promote a healthy pregnancy and delivery.
What is PCOS? Women with PCOS usually have at least two of the following three conditions: 1 Absence of ovulation, leading to irregular menstrual periods or no periods at all High levels of androgens a type of hormone or signs of high androgens, such as having excess body or facial hair Cysts fluid-filled sacs on one or both ovaries—"polycystic" literally means "having many cysts" Some women diagnosed with PCOS have the first two conditions listed above as well as other symptoms of PCOS but do not have cysts on their ovaries.
Women with PCOS are also at higher risk for: 2 Obstructive sleep apnea , a disorder that causes pauses in breathing during sleep Insulin resistance Metabolic syndrome , a group of risk factors for heart disease and type 2 diabetes Type 2 diabetes Obesity Heart disease and high blood pressure cardiovascular disease Mood disorders Endometrial hyperplasia pronounced en-doh-MEE-tree-uhl hahy -per-PLEY-zhuh , a condition in which the lining of the uterus becomes too thick, and endometrial cancer Learn more about disorders and conditions associated with PCOS.
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Need an account? Click here to sign up. Download Free PDF. Polycystic ovary syndrome: dynamic contrast-enhanced ovary MR imaging European Journal of Radiology, Aykut Barut. A short summary of this paper. Download Download PDF. Translate PDF. Dynamic images were acquired before and after injection of a contrast bolus at 30 s and the min of 1, 2, 3, 4 and 5.
On postprocessing examination: i the ovarian volumes; ii the signal intensity value of each ovary per dynamic study; iii early-phase enhancement rate; iv time to peak enhancement Tp ; and v percentage of washout of 5th min were determined. Examination of the mean signal intensity—time curve revealed the ovaries in women with PCOS showed a faster and greater enhancement and wash-out. In our experience, it is a valuable modality to highlight the vascularization changes in ovarian stroma with PCOS.
All rights reserved. Keywords: Ovary; Polycystic ovary syndrome; Dynamic contrast-enhanced magnetic resonance imaging 1. Introduction normal ovary [13] and breast cancers [14,15].
The diagnos- tic value of the early-phase enhancement rate, percentage of Polycystic ovary syndrome PCOS is one of the most washout and time to peak enhancement Tp parameters have common endocrine disorders affecting female fertility [1]. The recent transvaginal color The present study was, therefore, conducted for quantative Doppler studies showed hemodynamic changes of ovaries in analysis of enhancement behaviour of the ovaries in women these women [4—12].
Dynamic contrast-enhanced magnetic with PCOS: Is there any difference between the early-phase resonance DCE-MR imaging is a noninvasive imaging enhancement rate, Tp , and percentage of washout out of technique that can be used to assess vascular function of bi- the ovaries of the women with PCOS and normal controls. DCE-MR imaging has been studied for ac- Early-phase enhancement rate is given by the percentage curate noninvasive assessment of vascular physiology of the of increase in signal intensity with respect to the signal in- tensity before the administration of contrast material [14].
Erdem et al. The study design an imaging time of Using axial T2-weighted B-FFE images, five slice lo- institutional review board; all cases gave informed consent cations were collected to encompass both ovaries. Dynamic to be examined after the nature of the procedure had been studies were then acquired at the same slice locations.
The fully explained. Patients and inclusion criteria intravenous injection of 0. The in- A total of 36 nulliparous reproductive age women were in- jection time was approximately 5—7 s.
After the rapid bolus cluded in the study. These 36 12 controls and consecutive 24 intravenous injection dynamic images were performed at 30 women with PCOS were classified as patients and controls, s and min of 1, 2, 3, 4 and 5. Postprocessing of MR imaging data were performed on menstrual cycle day 2 or 3. The signal in- with normal ovulatory cycles who had no clinical or labora- tensity values of the ovaries were measured by using the tory evidence of medical, gynecologic, or hormonal anoma- region of interest ROI to determine the tissue concen- lies.
ROI clinical and biochemical findings that suggested PCOS, but included the whole ovarian region from the slice demon- no history of hormonal therapy. PCOS patients had polycys- strating the greatest cross-sectional area of ovarian tissue tic ovaries on the transvaginal ultrasonograhy scan on day 2 on T2-weighted axial B-FFE images using manual tracing.
Then, the early-phase enhancement rate 2. Pelvic MR imaging technique was determined. There- spectively [14]. In our study, enhancement rates were calcu- fore, prior to initiation of the study, 21 women 13 women lated for the 30th postcontrast second. Finally, the percentage with PCOS and of 8 women with normal ovulatory cycles of washout of the 5th min—the change of the relative ovarian who were not included for the study were tested to approx- enhancement related to the maximum ovary enhancement imately determine the useful time intervals.
This Netherlands using a four-element phased array pelvic coil formula has been modified from Siegmann et al. DCE-MR imaging was performed on By plotting the mean ovarian signal intensities over time, menstrual day 2 or 3. Intravenous access was obtained the mean signal intensity —time graphics was obtained to in the hand or arm prior to starting the examination. The depict the ovarian enhancement behaviour over the entire MR imaging protocol consisted of an initial scout view, dynamic period, for both groups Fig.
The mean signal intensity—time graphics showing that the ovaries in women with PCOS have a tendency for faster enhancement and wash-out PCOS: polycystic ovary syndrome. Statistical methods with women with normal ovaries Table 1.
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