Clinical Problems in the Diagnosis and Treatment of PCOS During Adolescence
|
|
- Malcolm Davidson
- 5 years ago
- Views:
Transcription
1 Clinical Problems in the Diagnosis and Treatment of PCOS During Adolescence R a c h a n a S h a h, M D M S T A s s i s t a n t P r o f e s s o r o f P e d i a t r i c s D i v i s i o n o f E n d o c r i n o l o g y a n d D i a b e t e s
2 Disclosures Off-label use of metformin in treatment of PCOS
3 OBJECTIVES Understand clinical presentation of PCOS in teens Describe the diagnostic work-up of PCOS in teenagers Understand short and long-term consequences of PCOS in teens Discuss treatment options for PCOS in teenagers
4 Case: 15 year old Menarche at 12. periods initially regular but this year has only had 4 periods Acne on face, using topical treatments; worse this year Some hair on upper lip, lower back, began at menarche Feeling anxious about school, hanging out less with friends No family history of similar Has gained 10 lbs past year, stopped playing basketball, snacking more BMI 85 th percentile. Exam normal except: flat affect, acne & mild hirsutism face, lower back
5 Questions Is this normal? Should it be evaluated? How? How can we counsel her, regardless of diagnosis?
6 PCOS in Adolescents Under diagnosed in teens, especially lean Symptoms may mimic normal puberty Weight gain Insulin resistance Irregular periods Acne Disease is often EVOLVING and girl may not meet diagnostic criteria YET or may have features of PCOS that resolve with time
7 Diagnostic Challenges Laboratory references for ADULT women Must rule out other conditions (adrenal disorders, tumors) May never have period Ultrasound findings not usually helpful PCOS-like ovaries seen in other diseases Criteria based on transvaginal ultrasounds Ovarian size/shape/cysts are different in teens Larger ovaries with more cysts may be NORMAL Need to establish age-based criteria
8 Diagnostic Challenges Symptoms of PCOS are evolving and may not be readily apparent in adolescents Because the diagnosis has significant lifelong implications including testing, treatments, and related anxiety, diagnosis is made with caution When diagnosis unclear, recommend: Education Treatment of specific symptoms if needed Follow up
9 Dermatologic Issues Hirsutism terminal hair in MALE pattern Does NOT correlate with androgen levels but with IR Found in 69% of PCOS teens Racial/ethnic differences important Acne more severe (cystic, not responding to topical treatments), different pattern (JAWLINE, back, chest), worse with periods Less specific, as 2/3 of normal teens have acne Androgenic alopecia: Scalp hair thinning in male pattern Much less common, incidence not reported Skin issues cause embarrassment, poor self-esteem
10 Hirsutism Scoring (modified Ferriman Gallwey)
11 Modified Ferriman Gallwey Rate 0-4 on 9 body areas >6-8=hirsutism in Caucasian and African American Suggested cut-off of 4 in East Asian Proposed higher cut-off in Middle Eastern/Southeast Indian and other populations Mostly helpful as a baseline and to follow effect of treatment
12 Anovulatory Cycles Can have regular periods (10-15%), increased frequency, heavy bleeding Oligomenorrhea (infrequent periods): >35 day cycles (45 in teens) or <9/year (8 in teens) Amenorrhea primary or secondary (>90 day interval) Risk of endometrial hyperplasia & uterine cancer Degree of menstrual dysfunction correlates with IR
13 The Menstrual Cycle as a Vital Sign POPULATION NORMS IN THE US Menarche (median age): years Mean cycle interval: 32.2 days in first gynecologic year Menstrual cycle interval: typically days Menstrual flow length: 7 days Menstrual product use: 3 6 pads/tampons per day ASK at well child visits and offer anticipatory guidance EVALUATE if the girl s cycles are outside these norms
14 PCOS is a Cardiometabolic Risk Factor EVEN IF NOT OBESE more likely to have: Endothelial dysfunction, increased carotid IMT & CAC Markers of chronic systemic inflammation Diseases with cardiometabolic risks Metabolic Syndrome (35% in adolescent cohorts!) Type 2 diabetes, insulin resistance Hyperlipidemia Hypertension Sleep apnea Fatty liver
15 Psychiatric Risk in PCOS Increased depression and anxiety Adult study: 35% met criteria for depression (vs 7% control population) 45% with anxiety (vs 18% control) Depression associated with BMI and insulin resistance Disordered eating (binge-eating, bulimia) more common Poor body image due to: weight, hirsutism, acne, and fertility concerns SCREEN AND REFER!! Hormonal treatment and even nutrition advice can exacerbate
16 Differential Diagnosis Normal puberty Idiopathic hirsutism (15-30%) Non-classical congenital adrenal hyperplasia (3%) Androgen-secreting adrenal/ovarian tumor Exogenous androgen exposure Cushing s syndrome Hypothyroidism Prolactinoma Other DSD: androgen-insensitivity, gonadal dysgenesis, 17-beta HSD deficiency
17 Risk Factors for PCOS Premature adrenarche Low birth weight (SGA, IUGR) Prenatal androgen exposure Genetics (Explain a very small % of heritability) gonadotropin receptor: LHCGR and FSHR, cytoplasmic function glucose homeostasis: PPARgamma, IRS-1 androgen signaling: AR
18 Diagnostic Criteria NIH, 1990 Rotterdam, 2003 (endorsed by Endo society, 2013) 2 of 3 Hyperandrogenism x x x Oligoovulation x x x or PCOM x x AE-PCOS, 2006 Hyperandrogenism + one other other entities are excluded that would cause excess androgen activity
19 Diagnosis in Adolescence Witchel, et al Hyperandrogenism moderate/severe hirsutism=hyperandrogenism Moderate/severe acne NOT responding to topical should be worked up Persistent elevation of total or free testosterone (cut off assay specific) Oligoovulation <21 days or >45 days (once 2 years post-menarche) >90 days any time Amenorrhea by age 15 or 3 years post thelarche No good data to define PCOM in adolescents, do not use US for dx
20 Laboratory Tests Diagnostic for PCOS: Increased bioactive T Testosterone profile total testosterone: HIGH or normal sex hormone binding globulin: LOW free testosterone: HIGH DHEAS elevated in about 35%, but only 5% with only DHEAS and no T elevation Measure T by LC/MS/MS in AM
21 Laboratory Tests, cont. Rule out other causes Pregnancy Thyroid prolactin 17-hydroxyprogesterone(CAH) LH, FSH Bleeding disorders (if heavy/frequent) Other, as indicated (cortisol, other adrenal androgens) Comorbidities Glucose, hemoglobin A1c, insulin (consider OGTT) Fasting lipid profile Liver enzymes
22 When to Ultrasound? Signs/symptoms of androgen-secreting tumor Marked testosterone elevation (>200) Rapid onset of virilization cliteromegaly/voice deepening Evaluate anatomy Primary amenorrhea Pain or palpable mass in pelvis
23 Adult Criteria for PCOS morphology on ultrasound (transvaginal) Increased ovarian volume >10 cm 3 for one or both ovaries -or- Multiple cysts Counting both ovaries, at least cysts between 2 and 9 mm (changed to reflect more sensitive methods!) No cysts >10 mm Cysts are common in teens and ovarian size is largest at menarche. Norms in adolescents have NOT been established
24 Other Causes of PCOSlike Ovaries Normal women with normal ovulatory function (16%) Hyperprolactinaemia (50%) Hypothyroidism (36.4%) Hypogonadotrophic hypogonadism (23.7%) CAH (100%) Androgen-producing adrenal tumours Prevalence in PCOS (~ 53%) Abdel Gadir et al 92
25 Insulin Resistance in PCOS Increased insulin levels and decreased sensitivity amplify the hormonal features of PCOS. Treatment of insulin resistance may improve hyperandrogenism and even restore ovulation. May be tissue-specific, such that muscle/liver is resistant and ovary/adrenals are sensitive. Or pathway specific, with metabolic pathways resistant, and steroidogenic or mitogenic pathways sensitive Even in non-pcos women, IR can cause increased T but ovaries of PCOS women may be more sensitive
26 Insulin Effects in PCOS Stimulate ovarian theca cell androgenic pathways Augment LH-stimulated androgen secretion by induction of steroidogenic enzymes Lower hepatic SHBG production Alter hypothalamic LH regulation by GnRH Increase amplitude & frequency of LH pulses Enhance AMH to cause mid-antral follicular arrest Upregulate adrenal steroidogenic enzymes and sensitivity to ACTH
27 Jayasena CN et al. Nature Rev. Endo. 2014
28 Goals of PCOS Treatment Reduce production and effects of androgens Protect endometrium from prolonged estrogen Reduce weight and cardiometabolic risk with lifestyle changes Improve insulin sensitivity Restore fertility by inducing ovulatory cycles Treatment tailored to specific symptoms
29 Hormonal Treatment Oral contraceptives; mcg of ethinyl estradiol Some progestins less androgenic (cyproterone acetate*, drospirenone, desogestrel) but higher clot risk NIH guidelines: no specific recommendations, use any combined estrogen/progesterone contraceptive Contraindications: clot risk, migraine with aura, very high risk of breast/gyn cancer (BRCA positive, personal history) Medroxyprogesterone or progesterone for 7-10 days of each cycle (or every 3-4 months if no spontaneous menses) *not FDA-approved, due to concerns of hepatotoxicity
30 Effective even without IR Metformin Biguanide insulin sensitizer, inhibits hepatic GNG and increases peripheral glucose uptake Results INDEPENDENT of weight loss. Side effects: GI (common): nausea, diarrhea, gas (resolve with time) Vitamin B12 deficiency Lactic acidosis (negligible in non-dm) Titrate: start 500 mg/day and increase to max 2500 mg/day
31 Dermatologic Acne: topical treatments, antibiotics, retinoids Hirsutism: topical eflornithine (Vaniqa), slows growth Laser, electrolysis, waxing, shaving, depilatories, etc.. Even with androgen control, can only slow growth & prevent new growth already present follicles will not regress If considering permanent option, control androgens FIRST Alopecia: Minoxidil (Rogaine) to affected areas
32 Anti-androgens Spironolactone (competitive inhibitor of androgen receptor and inhibits 5a reductase); reduction in hirsutism and acne Monitor: K, BP Teratogenic! finasteride (5a reductase inhibitor) only blocks type 2 enzyme, and type 1 & 2 activated in PCOS; less effective for hirsutism Flutamide (non-steroidal anti-androgen) restore ovulation, reduce androgen. Risk of fatal hepatitis, anemia
33 Treatment Challenges in Teens Oral contraceptives: growth suppression social stigma (parents/child) side effects (mood, weight, headaches) compliance Metformin: side effects often not tolerated Effect takes time! Compliance even harder, twice a day!
34 Treatment Challenges in Teens Spironolactone: birth defects if pregnancy (feminization of male fetus) dizziness/orthostatic hypotension, high K Lifestyle interventions (diet/exercise): need family support financial barriers social barriers MOTIVATION
35 Is this normal? Back to our case NO, irregular menses >2 years post-menarche warrants evaluation Should it be evaluated? How? Laboratory testing for cause of symptoms (T, 17OHP, thyroid, gonadotropins, prolactin pregnancy test), metabolic screen if PCOS How can we counsel her, regardless of diagnosis? Lifestyle management for weight gain, psychological counseling for mood
36 Summary PCOS is common in teens, yet diagnosis may be challenging Clinical history and basic laboratory evaluation are sufficient for diagnosis in most cases Treatment is aimed at presenting symptoms and prevention of cardiometabolic disease Counseling on lifestyle modification (Nutrition) and regular metabolic screening are standard of care Screening for depression and other psychiatric disorders should also be done routinely
37 CHOP Endocrine PCOS Clinic Multidisciplinary, all pediatric providers Endocrinologist (Dr. Rachana Shah) Dermatologist (Dr. Marissa Perman) Nutritionist (Sarah Barnes, RD) Patients/families meet with multiple providers at one clinic visit to have all their needs met Laser hair removal offered through Dermatology; may be able to get insurance coverage
PCOS IN ADOLESCENTS: EARLY DETECTION AND INTERVENTION
PCOS IN ADOLESCENTS: EARLY DETECTION AND INTERVENTION R A C H A N A S H A H, M D M S T R A S S I S TA N T P R O F E S S O R O F P E D I AT R I C S D I V I S I O N O F E N D O C R I N O L O G Y A N D D
More informationPolycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018
Polycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018 Learning Objectives At the conclusion of this lecture, learners should: 1) Know the various diagnostic
More information12/13/2017. Important references for PCOS. Polycystic Ovarian Syndrome (PCOS) for the Family Physician. 35 year old obese woman
Polycystic Ovarian Syndrome (PCOS) for the Family Physician Barbara S. Apgar MD, MS Professor or Family Medicine University of Michigan Ann Arbor, Michigan Important references for PCOS Endocrine Society
More informationPolycystic Ovary Syndrome
Polycystic Ovary Syndrome Definition: the diagnostic criteria Evidence of hyperandrogenism, biochemical &/or clinical (hirsutism, acne & male pattern baldness). Ovulatory dysfunction; amenorrhoea; oligomenorrhoea
More information12/27/2013. Kristen Cain, MD FACOG Reproductive Medicine Institute Sanford Health, Fargo ND
Kristen Cain, MD FACOG Reproductive Medicine Institute Sanford Health, Fargo ND 7% of all women 18-45 Obesity 1/3 of all US women Incidence of PCOS is increasing with increase obesity Obesity Irregular
More informationDr Stella Milsom. Endocrinologist Fertility Associates Auckland. 12:30-12:40 When Puberty is PCO
Dr Stella Milsom Endocrinologist Fertility Associates Auckland 12:30-12:40 When Puberty is PCO Puberty or Polycystic Ovary Syndrome? Stella Milsom Endocrinologist Auckland DHB, University of Auckland,
More information13 th Annual Women s Health Day PCOS. Saturday 02/09/2017 Dr Mathias Epee-Bekima O&G Consultant KEMH
13 th Annual Women s Health Day PCOS Saturday 02/09/2017 Dr Mathias Epee-Bekima O&G Consultant KEMH Learning objectives Perform the appropriate investigations in women where there is a clinical suspicion
More informationPolycystic Ovarian Syndrome. Heidi Hallonquist, MD Concord Hospital Concord Obstetrics and Gynecology
Polycystic Ovarian Syndrome Heidi Hallonquist, MD Concord Hospital Concord Obstetrics and Gynecology Outline Definition Symptoms Causal factors Diagnosis Complications Treatment Why are we talking about
More information2-Hypertrichosis:- Hypertrichosis is the
Hirsutism And Virilization Hirsutism:- Is the development of androgen-dependent dependent terminal body hair in a woman in places in which terminal hair is normally not found, terminal body hairs are the
More informationPolycystic Ovary Syndrome
Polycystic Ovary Syndrome Kathleen Colleran, MD Professor of Medicine University of New Mexico HSC Presented for COMM-TC May 4, 2012 Objectives Understand the pathophysiology of PCOS Understand how to
More informationCase. 24 year old female presented to your office complaining of excess hair growth on her face and abdomen. Questions?
Hirsutism Case 24 year old female presented to your office complaining of excess hair growth on her face and abdomen Questions? Started around puberty with gradual progression Irregular menstrual cycle
More informationPolycystic Ovary Syndrome (PCOS):
Polycystic Ovary Syndrome (PCOS): Current diagnosis and treatment Anatte E. Karmon, MD Disclosures- Anatte Karmon, MD No financial relationships to disclose 2 Objectives At the end of this presentation,
More informationHyperandrogenism. Dr Jack Biko. MB. BCh (Wits), MMED O & G (Pret), FCOG (SA), Dip Advanced Endoscopic Surgery(Kiel, Germany)
Hyperandrogenism Dr Jack Biko MB. BCh (Wits), MMED O & G (Pret), FCOG (SA), Dip Advanced Endoscopic Surgery(Kiel, Germany) 2012 Hyperandrogenism Excessive production of androgens Adrenal glands main source
More informationCase Questions. Polycystic Ovarian Syndrome: Treatment Goals and Options. Differential Diagnosis of Hyperandrogenic Anovulation
Polycystic Ovarian Syndrome: Treatment Goals and Options Marc Cornier, MD Division of Endocrinology, Metabolism and Diabetes Colorado Center for Health and Wellness University of Colorado School of Medicine
More informationPolycystic Ovarian Syndrome (PCOS) LOGO
Polycystic Ovarian Syndrome (PCOS) Ma qianhong Ob/Gyn Department LOGO Contents Epidemiology and Definition Pathophysiology, Endocrinological Features Diagnostic Criteria Treatment Prognosis Introduction
More informationPCOS and Obesity DUB is better treated by OCPs
PCOS and Obesity DUB is better treated by OCPs Dr. Ritu Joshi Senior consultant Fortis escorts Hospital, Jaipur Chairperson Family welfare com. FOGSI (20092012) Vice President FOGSI 2014 Introduction One
More informationAmenorrhoea: polycystic ovary syndrome
There is so much we don't know in medicine that could make a difference, and often we focus on the big things, and the little things get forgotten. To highlight some smaller but important issues, we've
More informationProf.Dr. Nabil Lymon Head of Internal Medicine Department
By Prof.Dr. Nabil Lymon Head of Internal Medicine Department Definitions: Hirsutism: Is the presence of terminal hair in androgendependent sites where hair does not normally grow in women. This hair growth
More informationPolycystic Ovary Syndrome
What is the polycystic ovary syndrome? Polycystic Ovary Syndrome The polycystic ovary syndrome (PCOS) is a clinical diagnosis characterized by the presence of two or more of the following features: irregular
More informationREI CASE(S) Laura L. Tatpati, MD Division of REI, Dept of OB/GYN KUSM - W
REI CASE(S) Laura L. Tatpati, MD Division of REI, Dept of OB/GYN KUSM - W CASE #1 46 year old female presents with complaint of increased facial and abdominal hair growth for 6-8 months. She has had increased
More informationAbnormal Uterine Bleeding Case Studies
Case Study 1 Abnormal Uterine Bleeding Case Studies Abigail, a 24 year old female, presents to your office complaining that her menstrual cycles have become a problem. They are now lasting 6 7 days instead
More informationPOLYCYSTIC OVARIAN SYNDROME WHERE WE ARE AT IN 2018
POLYCYSTIC OVARIAN SYNDROME WHERE WE ARE AT IN 2018 PCOS: WHERE WE ARE AT IN 2018 Nancy Arquette, MD Premier Women s Health 6135 Trust Drive #114 Holland, OH 43528 February 3, 2018 Kalahari Resorts ME
More informationPCOS. Kirtly Parker Jones MD
PCOS Kirtly Parker Jones MD OBJECTIVES The participant will be able to use knowledge about ovarian physiology to council perimenarchal women about irregular periods The participant will be able to evaluate
More informationFemale Reproductive Endocrinology
Female Reproductive Endocrinology Dr. Channa Jayasena PhD MRCP FRCPath Clinical Senior Lecturer & Consultant Endocrinologist Department of Gynaecology, Hammersmith Hospital Anovulation is a common cause
More information16 YEAR-OLD OBESE FEMALE WITH OLIGOMENORRHEA
16 YEAR-OLD OBESE FEMALE WITH OLIGOMENORRHEA Katie O Sullivan, MD Adult/Pediatric Endocrinology Fellow University of Chicago ENDORAMA Thursday, September 4th, 2014 Disclosures No financial interests. Will
More informationWhat is PCOS? PCOS THE CONQUER PCOS E-BOOK. You'll be amazed when you read this...
PCOS What is PCOS? You'll be amazed when you read this... What is PCOS?. Who is at risk? How to get tested? What are the complications. Is there a cure? What are the right ways to eat? What lifestyle changes
More informationOverview of Reproductive Endocrinology
Overview of Reproductive Endocrinology I have no conflicts of interest to report. Maria Yialamas, MD Female Hypothalamic--Gonadal Axis 15 4 Hormone Secretion in the Normal Menstrual Cycle LH FSH E2, Progesterone,
More informationWhat every dermatologist should know about Polycystic Ovary Syndrome (PCOS)
What every dermatologist should know about Polycystic Ovary Syndrome (PCOS) Kanade Shinkai, MD PhD University of California, San Francisco Associate Professor of Dermatology I have no conflicts of interest
More informationPolycystic Ovary Syndrome diagnosis & management
Polycystic Ovary Syndrome diagnosis & management Dr Roisin Worsley, FRACP Endocrinologist, Jean Hailes at Epworth https://jeanhailes.org.au/contents/docume nts/resources/tools PCOS is a chronic condition
More informationPCOS Awareness Symposium Atlanta September 24 th, Preventing Diabetes & Cardiovascular Disease in PCOS
PCOS Awareness Symposium Atlanta September 24 th, 2016 Preventing Diabetes & Cardiovascular Disease in PCOS Katherine Sherif, MD Professor & Vice Chair, Department of Medicine Director, Jefferson Women
More informationPolycystic Ovary Syndrome
Polycystic Ovary Syndrome An Individualized Approach Alice Y. Chang, MD, MSc Assistant Professor Mayo Clinic Division of Endocrinology, Diabetes, Nutrition and Metabolism Learning Objectives: To Individualize
More informationROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU)
ROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU) In 1935, Stein and Leventhal described 7 women with bilateral enlarged PCO, amenorrhea or irregular menses, infertility and masculinizing
More informationNew PCOS guidelines: What s relevant to general practice
New PCOS guidelines: What s relevant to general practice Dr Michael Costello Fertility Specialist IVF Australia UNSW Royal Hospital for Women Sydney How do we know if something is new? Louvre Museum, Paris
More informationLaura Stewart, MD, FRCPC Clinical Associate Professor Division of Pediatric Endocrinology University of British Columbia
Precocious Puberty Laura Stewart, MD, FRCPC Clinical Associate Professor Division of Pediatric Endocrinology University of British Columbia Faculty Disclosure Faculty: Laura Stewart No relationships with
More informationPolycystic Ovary Syndrome
Polycystic Ovary Syndrome Polycystic ovary syndrome (PCOS) is common. It can cause period problems, reduced fertility, excess hair growth, and acne. Many women with PCOS are also overweight. Treatment
More informationPOTION OR POISON? MEDICAL TREATMENT ALTERNATIVES TO THE PILL. Lester Ruppersberger, D.O., FACOOG,CNFPI NFP only Gynecologist
POTION OR POISON? MEDICAL TREATMENT ALTERNATIVES TO THE PILL Lester Ruppersberger, D.O., FACOOG,CNFPI NFP only Gynecologist THE PILL Released to US market in 1960 10-15 x dose of hormones in HRT Over 10-14
More informationTitle of Guideline (must include the word Guideline (not protocol, policy, procedure etc)
Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Guideline for the Investigation and Management of Polycystic Ovary Syndrome Author: Contact Name and Job Title
More informationBy Jennifer F. Teskey, MD; Heather J. Dean, MD, FRCPC; and Elizabeth AC Sellers, MSc, MD, FRCPC. amenorrhea. Following menarche 3. How to treat PCOS.
PCOS & teens: The need for early detection By Jennifer F. Teskey, MD; Heather J. Dean, MD, FRCPC; and Elizabeth AC Sellers, MSc, MD, FRCPC A 15-year-old girl is referred In this article: to the pediatric
More informationDisclosure. Outline. Obesity: Endocrine Issues as the Cause and as the Effect 4/5/2016
Obesity: Endocrine Issues as the Cause and as the Effect Angela Lennon MD Assistant Professor, Pediatrics University of Kansas Medical Center April 22, 2016 Disclosure I have no relevant financial relationships
More informationCREATING A PCOS TREATMENT PLAN. Ricardo Azziz, M.D., M.P.H., M.B.A. Georgia Regents University
CREATING A PCOS TREATMENT PLAN Ricardo Azziz, M.D., M.P.H., M.B.A. Georgia Regents University PCOS: CREATING A TREATMENT PLAN Good treatment plans are based on sound and complete evaluations History of
More informationPolycystic Ovary Syndrome Therapy Dr. Pilar Vigil MD, PhD, FACOG
Polycystic Ovary Syndrome Therapy Dr. Pilar Vigil MD, PhD, FACOG What is an ovulatory dysfunction? Mrs. Susana Godoy, Nurse-Midwife San José, Costa Rica Abril 2018 PONTIFICIA UNIVERSIDAD CATÓLICA DE CHILE
More informationApproach to ovulation induction and superovulation in women with a history of infertility. Anatte E. Karmon, MD
Approach to ovulation induction and superovulation in women with a history of infertility Anatte E. Karmon, MD Disclosures- Anatte Karmon, MD No financial relationships to disclose 2 Objectives At the
More informationObjectives 1. Be able to describe the classic presentation and diagnostic criteria 2. Be able to explain long-term health concerns associated with the diagnosis 3. Understand what basic treatment options
More informationDiagnosis and Management of Polycystic Ovary Syndrome During Adolescence: Questions and Controversies
Diagnosis and Management of Polycystic Ovary Syndrome During Adolescence: Questions and Controversies 2017 Illinois-AACE 2017 Annual Meeting October 14, 2017 Learning Objectives 1) Understand the challenges
More informationPOLYCYSTIC OVARIAN SYNDROME Laura Tatpati, MD Reproductive Endocrinology and Infertility. Based on: ACOG No. 108 Oct 2009; reaffirmed 2015
POLYCYSTIC OVARIAN SYNDROME Laura Tatpati, MD Reproductive Endocrinology and Infertility Based on: ACOG No. 108 Oct 2009; reaffirmed 2015 NO DISCLOSURES PATIENT 26 years old presents with complaint of
More informationPrevalence of Polycystic Ovarian Syndrome among urban adolescent girls and young women in Mumbai
Prevalence of Polycystic Ovarian Syndrome among urban adolescent girls and young women in Mumbai Principal Investigator Co- Investigators Consultant Collaborating Hospital Dr. Beena Joshi Dr. Srabani Mukherji
More informationThe Impact of Insulin Resistance on Long-Term Health in PCOS
Saturday, April 16 th, 2016 PCOS Challenge & Thomas Jefferson University PCOS Awareness Symposium Philadelphia The Impact of Insulin Resistance on Long-Term Health in PCOS Katherine Sherif, MD Professor
More informationPCOS guidelines: What s relevant to general practice
PCOS guidelines: What s relevant to general Dr David Molloy Medical Director, Queensland Fertility Group International evidence based PCOS guidelines 1st ever internationally endorsed & evidence based
More informationDifference Between PCOS and Endometriosis
Difference Between PCOS and Endometriosis www.differencebetween.com Key Difference PCOS vs Endometriosis Ovaries play an important role in the reproduction and the maintenance of the female body. They
More informationReproductive Health and Pituitary Disease
Reproductive Health and Pituitary Disease Janet F. McLaren, MD Assistant Professor Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology jmclaren@uabmc.edu Objectives
More informationINSULIN RESISTANCE, POLYCYSTIC OVARIAN SYNDROME An Overview
INSULIN RESISTANCE, POLYCYSTIC OVARIAN SYNDROME An Overview University of PNG School of Medicine & Health Sciences Division of Basic Medical Sciences PBL MBBS III VJ Temple 1 Insulin Resistance: What is
More informationPCOS The intersection of sex hormones & metabolism. Educational Objectives. Presenter Disclosure Information. Polycystic Ovary Syndrome
7:45 8:45 am Polycystic Ovary Syndrome: Diagnosis & Management SPEAKER Katherine Sherif, MD Presenter Disclosure Information The following relationships exist related to this presentation: Katherine Sherif,
More informationPolycystic ovary syndrome
Polycystic ovary syndrome Overview Polycystic ovary syndrome (PCOS) is a condition most often characterized by irregular menstrual periods, excess hair growth and obesity, but it can affect women in a
More informationPolycystic Ovarian Syndrome: Diagnosis, Preconceptional Management and Health Risks
Polycystic Ovarian Syndrome: Diagnosis, Preconceptional Management and Health Risks Kate D. Schoyer, M.D. May 6, 2016 Objectives To review how to make the diagnosis of Polycystic Ovarian Syndrome (PCOS)
More informationF REQUENTLY A SKED Q UESTIONS
Polycystic heart, blood vessels, and appearance. Women with PCOS have these characteristics: Ovarian high levels of male hormones, also called androgens an irregular or no menstrual cycle Syndrome may
More informationOVERVIEW. FEMM (Fertility Education & Medical Management) is headquartered in New York City, NY. 1
OVERVIEW FEMM (Fertility Education & Medical Management) is headquartered in New York City, NY. 1 FEMM is a three-tiered women s healthcare project. Grounded in revolutionary, peer-reviewed research in
More informationS. AMH in PCOS Research Insights beyond a Diagnostic Marker
S. AMH in PCOS Research Insights beyond a Diagnostic Marker Dr. Anushree D. Patil, MD. DGO Scientist - D National Institute for Research in Reproductive Health (Indian Council of Medical Research) (Dr.
More informationPolycystic Ovarian Syndrome: Diagnosis, Preconceptional Management and Health Risks. Kate D. Schoyer, M.D. May 6, 2016
Polycystic Ovarian Syndrome: Diagnosis, Preconceptional Management and Health Risks Kate D. Schoyer, M.D. May 6, 2016 Objectives To review how to make the diagnosis of Polycystic Ovarian Syndrome (PCOS)
More informationVol-4 No.-2 July-September 2011
"Women's Health" is also available at www.squarepharma.com.bd Vol-4 No.-2 July-September 2011 Editorial Board Dr. Omar Akramur Rab MBBS, FCGP, FIAGP Mohammad Hanif M. Pharm, MBA A.H.M.Rashidul Bari M.
More informationSCHOOL OF MEDICINE AND HEALTH SCIENCES DIVISION OF BASIC MEDICAL SCIENCES DISCIPLINE OF BIOCHEMISTRY & MOLECULAR BIOLOGY
1 SCHOOL OF MEDICINE AND HEALTH SCIENCES DIVISION OF BASIC MEDICAL SCIENCES DISCIPLINE OF BIOCHEMISTRY & MOLECULAR BIOLOGY PBL SEMINAR: SEX HORMONES PART 1 An Overview What are steroid hormones? Steroid
More informationAdolescent Gynecology: Evaluation and Management of Adnexal Mass, PCOS, and Endometriosis. Shanna M. Combs, MD
Adolescent Gynecology: Evaluation and Management of Adnexal Mass, PCOS, and Endometriosis Shanna M. Combs, MD Adolescent Visit and Exam Adolescent Reproductive Health Visit Initial visit should take place
More informationPOLYCYSTıC OVARY SYNDROME (PCOS) New Perspectives. Michel Abou Abdallah, MD. Reproductive Endocrinology
POLYCYSTıC OVARY SYNDROME (PCOS) New Perspectives Michel Abou Abdallah, MD. Reproductive Endocrinology At the conclusion of this presentation, participants should be able to: Appreciate the spectrum of
More informationAchieving Pregnancy: Obesity and Infertility. Jordan Vaughan, MSN, APN, WHNP-BC Women s Health Nurse Practitioner Nashville Fertility Center
Achieving Pregnancy: Obesity and Infertility Jordan Vaughan, MSN, APN, WHNP-BC Women s Health Nurse Practitioner Nashville Fertility Center Disclosures Speakers Bureau EMD Serono Board of Directors Nurse
More informationEstrogen Dominant Conditions Part I
Estrogen Dominant Conditions Part I Why So Many Conditions? All estrogen dominant conditions have an imbalance of estrogen as part of the hormones issues the client has Different conditions have different
More informationDr Mary Birdsall. Fertility Associates Auckland
Dr Mary Birdsall Fertility Associates Auckland Period Problems Mary Birdsall Medical Director Fertility Associates Auckland Period Problems Basic Physiology No Periods Irregular Periods Heavy Periods
More informationTreatment of hirsutism with a gonadotropin-releasing hormone agonist and estrogen replacement therapy*
Gynecology-endocrinology FERTILITY AND STERILITY Copyright 1994 The American Fertility Society Printed on acid-free paper in U S. A. Treatment of hirsutism with a gonadotropin-releasing hormone agonist
More informationHormonal Treatment of Acne and Hirsutism. Julie C Harper MD
Hormonal Treatment of Acne and Hirsutism Julie C Harper MD none Conflict of Interest Androgen blockade Decrease androgen production by the gonads or adrenal gland Decrease circulating free testosterone
More informationAddressing Practice Gaps in PCOS
Addressing Practice Gaps in PCOS PCOS Challenge September 21, 2014 Ricardo Azziz, MD, MPH, MBA President, Georgia Regents University CEO, Georgia Regents Health System Introduction PCOS research began
More informationEvaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society* Clinical Practice Guideline
CLINICAL PRACTICE GUIDELINE Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society* Clinical Practice Guideline Kathryn A. Martin, 1 R. Rox Anderson, 1 R. Jeffrey Chang, 2 David
More informationPolycystic Ovary Syndrome: Cardiovascular Disease risk
PCOS Challenge Atlanta September 16 th, 2017 Polycystic Ovary Syndrome: Cardiovascular Disease risk Katherine Sherif, MD Professor & Vice Chair, Department of Medicine Director, Jefferson Women s Primary
More informationManagement of polycystic ovarian syndrome
14 Disorders of male and female sex hormones Management of polycystic ovarian syndrome LI-WEI CHO AND STEPHEN L. ATKIN Patients with polycystic ovarian syndrome can be challenging as they usually present
More informationPolycystic Ovary Syndrome
Page 1 of 5 Polycystic Ovary Syndrome Polycystic ovary syndrome (PCOS) is common. It can cause period problems, reduced fertility, excess hair growth, and acne. Many women with PCOS are also overweight.
More informationReproductive physiology
Reproductive physiology Sex hormones: Androgens Estrogens Gestagens Learning objectives 86 (also 90) Sex Genetic sex Gonadal sex Phenotypic sex XY - XX chromosomes testes - ovaries external features Tha
More informationCynthia Morris DO, FACOOG, FACOS Medical Director, Women s Wellness Center Fayette County Memorial Hospital
Cynthia Morris DO, FACOOG, FACOS Medical Director, Women s Wellness Center Fayette County Memorial Hospital Touchdown to CME Eighth District Academy of Osteopathic Medicine & Surgery October 8. 2017 Goals
More informationAbout PCOS. About PCOS
About PCOS About PCOS Polycystic Ovarian Syndrome (PCOS) is the most common hormonal reproductive problem in women of childbearing age. It can affect a woman s menstrual cycle, fertility, hormones, insulin
More informationPolycystic Ovary Disease: A Common Endocrine Disorder in Women
Polycystic Ovary Disease: A Common Endocrine Disorder in Women Paul Kaplan, M.D. Clinical Professor of Reproductive Endocrinology - OHSU Courtesy Senior Research Associate, Human Physiology University
More informationwww.iffs-reproduction.org @IntFertilitySoc Int@FedFertilitySoc Conflict of interest none Outline Causes of ovulatory dysfunction Assessment of women with ovulatory dysfunction Management First line Second
More informationPUBERTY. Preetha Krishnamoorthy. Division of Pediatric Endocrinology
PUBERTY Preetha Krishnamoorthy Division of Pediatric Endocrinology Case 1 8-year-old girl referred for breast development noted by mom What do you want to know? Normal or abnormal? What if this was an
More informationPedsCases Podcast Scripts
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Puberty and Pubertal Disorders Part 2: Precocious Puberty. These podcasts are designed to give medical students an overview
More informationEndocrine control of female reproductive function
Medicine School of Women s & Children s Health Discipline of Obstetrics & Gynaecology Endocrine control of female reproductive function Kirsty Walters, PhD Fertility Research Centre, School of Women s
More informationFrom the editors desk
From the editors desk Dear all, We are happy to introduce the first issue of our magazine on hormonal health. This magazine will focus on updates related to common clinical problems in diabetes, thyroid,
More informationPOLYCYSTIC OVARY SYNDROME INA S. IRABON,MD, FPOGS,FPSRM,FPSGE OBSTETRICS AND GYNECOLOGY REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY
POLYCYSTIC OVARY SYNDROME INA S. IRABON,MD, FPOGS,FPSRM,FPSGE OBSTETRICS AND GYNECOLOGY REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY TO DOWNLOAD LECTURE DECK MAIN REFERENCE Comprehensive Gynecology 7 th
More informationOn Diseases Of Menstruation And Ovarian READ ONLINE
On Diseases Of Menstruation And Ovarian READ ONLINE If you are searching for the ebook On Diseases of Menstruation and Ovarian in pdf format, in that case you come on to the right website. We present the
More informationINFERTILITY CAUSES. Basic evaluation of the female
INFERTILITY Infertility is the inability to conceive after 12 months of unprotected intercourse. There are multiple causes of infertility and a systematic way to evaluate the condition. Let s look at some
More informationHirsutism: Diagnosis and Treatment. Roger A. Lobo M.D. Columbia University
Hirsutism: Diagnosis and Treatment Roger A. Lobo M.D. Columbia University Signs of hyperandrogenism Acne, Hirsutism, Alopecia All explained by increased androgen production and/or increased sensitivity
More informationGONADAL FUNCTION: An Overview
GONADAL FUNCTION: An Overview University of PNG School of Medicine & Health Sciences Division of Basic Medical Sciences Clinical Biochemistry BMLS III & BDS IV VJ Temple 1 What are the Steroid hormones?
More informationlactotrophs 120 min- FSH 60 min- LH Hypothalamus GnRH pituitary Estradiol +/- Progesterone _ FSH L H Ovary Uterus Ovulation Antral follicle >2mm
lactotrophs Hypothalamus GnRH 120 min- 60 min- LH Progesterone _ pituitary L H + Ovary + Estradiol +/- Uterus Antral follicle >2mm Ovulation Preovulatory follicles atresia Follicular phase Luteal phase
More informationHormonal Control of Human Reproduction
Hormonal Control of Human Reproduction Bởi: OpenStaxCollege The human male and female reproductive cycles are controlled by the interaction of hormones from the hypothalamus and anterior pituitary with
More informationDRAFT SUMMARY AND RECOMMENDATIONS OF International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018
DRAFT SUMMARY AND RECOMMENDATIONS OF International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018 For public consultation and will be submitted to NHMRC for
More informationPaul Hofman. Professor. Paediatrician Endocrinologist Liggins Institute, The University of Auckland, Starship Children Hospital, Auckland
Professor Paul Hofman Paediatrician Endocrinologist Liggins Institute, The University of Auckland, Starship Children Hospital, Auckland 14:00-14:55 WS #108: Common pubertal variants how to distinguish
More informationUPDATE: Women s Health Issues
UPDATE: Women s Health Issues Renee B. Alexis, MD, MBA, MPH, FACOG Associate Professor Department of OBGYN Kiran C. Patel College of Osteopathic Medicine Disclosure of Conflicts of Interest I have no financial
More informationPolycystic Ovary Syndrome (PCOS)
Mr Nabil Haddad M. OBSTET, GYNAEC, FRCOG Consultant Gynaecologist Patient Information Polycystic Ovary Syndrome (PCOS) Mr Nabil Haddad Consultant Gynaecologist What is Polycystic Ovary Syndrome (PCOS)?
More informationPrecocious Puberty. Disclosures. No financial disclosures 2/28/2019
Precocious Puberty Bracha Goldsweig, MD Pediatric Endocrinologist Children s Hospital and Medical Center, Omaha, NE University of Nebraska Medical Center Disclosures No financial disclosures 1 Objectives
More informationUniversity of Cape Town
P a g e 1 The Polycystic Ovary Syndrome a comparison of the presentation in adolescents compared to women aged 35 years and older attending the Gynaecological Endocrine clinic at Groote Schuur Hospital.
More informationOBJECTIVES. Rebecca McEachern, MD. Puberty: Too early, Too Late or Just Right? Special Acknowledgements. Maryann Johnson M.Ed.
1 Puberty: Too early, Too Late or Just Right? Maryann Johnson M.Ed., BSN, RN Special Acknowledgements Rebecca McEachern, MD OBJECTIVES Illustrate basic endocrine system and hormonal pathways Define the
More informationSAMPLE REPORT. Order Number: PATIENT. Age: 40 Sex: F MRN:
Patient: Age: 40 Sex: F MRN: SAMPLE PATIENT Order Number: Completed: Received: Collected: SAMPLE REPORT Progesterone ng/ml 0.34 0.95 21.00 DHEA-S mcg/dl Testosterone ng/ml 48 35 0.10 0.54 0.80 430 Sex
More informationInfertility DR. RAHUL BEVARA
Infertility DR. RAHUL BEVARA Definitions Infertility is defined as the inability to conceive after one year of unprotected coitus. Affects 10-15% of couples Primary Infertility, that is inability to conceive
More information2.0 Synopsis. Lupron Depot M Clinical Study Report R&D/09/093. (For National Authority Use Only) to Part of Dossier: Name of Study Drug:
2.0 Synopsis Abbott Laboratories Individual Study Table Referring to Part of Dossier: Name of Study Drug: Volume: Abbott-43818 (ABT-818) leuprolide acetate for depot suspension (Lupron Depot ) Name of
More informationHirsutism - Management
Hirsutism - Management Scenario: Diagnosis of hirsutism How do I know my patient has it? Look for excessive terminal hair in androgen-dependent areas including the face, chest, linea alba, lower back,
More informationInfertility for the Primary Care Provider
Infertility for the Primary Care Provider David A. Forstein, DO FACOOG Clinical Associate Professor Obstetrics and Gynecology University of South Carolina School of Medicine Greenville Disclosure I have
More information