Polycystic Ovarian Disease

  • Extra thecal cells produce testosterone which is converted to estrogen in adipose tissue, and also decreases sex hormone binding globulin (increasing free estrogen).  Increased estrogen stimulates LH which stimulates the stroma to produce androgens, thus continuing the cycle.
  • Stroma is responsive to inculin-like growth factor → metformin may break the cycle
  • Most common ages: 15-35
  • Characterized by anovulation, hirsutism, infertility, obesity, virilization, acanthosis nigricans (HAIR-AN – hyperandrogenism, insulin resistance, acanthosis nigricans)

Investigations

  • Transvaginal ultrasound – polycystic ovaries
  • LH:FSH > 2
  • Increased DHEAS, increased free T



 

Treatment

  • Cycle control: lifestyle (lose weight), OCP
  • Infertility: clomid
  • Hirsuitism: Diane 35 (antiandrogen)

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