PCOS : Long Term Sequelae

1
PCOS Long Term Sequelae

• BY
• Mohammad Emam
• Prof. OB GYN
• Mansoura Faculty of Medicine
• Mansoura Integrated Fertility Center
• EGYPT 2009

2
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 and androgen excess.
• (These data were collected prior to Rotterdam
  diagnostic consensus).

3
PCOS Cause

• Complex interaction of genetic ,epigenetic,
  metabolic , neurologic and environmental factors.
  
• PCOS, starts in adolescence But not always
  diagnosed at that age .

4
Rationale

• women with PCOS cluster risky consequences
  leading to increased morbidity and mortality.

5
Rationale

• Long term consequences of this syndrome are
  forgotten by clinicians.
• Treatment is directed only for symptoms without
  digging into deeper

6
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.

7
Methods

• Randomised controlled trials, systematic reviews
  and meta-analyses in
• The Cochrane Library ,RCOG ,Medline and PubMed
  (between 1986 and January 2009).

8
Long term Consequences Of PCOS

• Definite
• Possible
• Controversial

9
DefiniteLong term Consequences Of PCOS

• Type 2 diabetes
• Dyslipidemia
• Endometrial cancer .

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PossibleLong term Consequences Of PCOS

• Metabolic Obesity IR Ms Gall bladder
  disease
• Cerbrovascular disease Coronary Cerbral
  Hypertension
• Depression anxiety loss of self esteem
• Obstructive Sleep Apnea
• Pregnancy complications
• Gestational Diabetes
• Gestaional hypertension
• Epilepsy?!!!

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ControversialLong term Consequences Of PCOS

• PIH
• Miscarriage
• ovarian cancer
• Breast carcinoma

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Long Term Risks Of PCOS
CVD
pregnancy
Gout
Endometrial Cancer
PCOS
NIDDM
Infertility
Obesity
Gallbladder Disease
13
Prevalence Of MS In PCOS

• MS is present in 2/3 of the PCOS (2-fold higher
  than women in the general population).

14
Link between Metabolic S PCOS
MS
PCOS
IR
15

Epilepsy PCOS ( what is the culprit?

16
RCOG Green-top Guideline (December 2007)
17
Counseling

• Women diagnosed with PCOS
• Should be informed of the possible long-term
  risks.
• Should be advised regarding weight control and
  exercise
• (B).

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Metabolic consequences of PCOS

• Women presenting with PCOS BMI gt30 age gt 40
  years
• ve Family history of diabetes .
• Are at increased risk of type 2 diabetes and
  should be offered a glucose tolerance test. (B)

19
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

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PCOS and cardiovascular risk

• Hypertension should be treated.
• Lipid-lowering drugs should only be prescribed
  by a specialist

21
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

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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).

23
Exercise and weight control

• All overweight PCOS should be provided with
  dietary and lifestyle advice.

24
How to minimize or prevent long term
consequences?
25
Concept

• The genetic expression of PCOS can be optimized
  and modulated by prevention the interactions
  between genes and epigenetic factors.

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1) Early Detection And treatment of PCOS during
adolescence
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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

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2)Prevention of peripupertal obesity
29

• MORE THAN 1 IN 4 CHILDREN IS OVERWEIGHT or OBESE!!

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Peripupertal obesity
Weight gain
Energy Out
31
peripupertal obesity PCOS
PCOS
Peripubertal obesity
IR ghrelin Leptin
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3)The Target Of ttt Should Be Causative Rather
Than Symptomatic
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Targets For ttt
PCOS
IR
None IR
Causative ttt or- Adjunctive
Symptomatic ttt Anovulation , Acne,
Hirsutism, Insulin sensitizers Prevent
Hyperandrogenemia IR Vicious circle .
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Targets for treatment PCOS
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Conclusion

• Treating the whole state rather than the
  disease should be the principal on dealing with
  PCOS

36
Conclusion

• Infertility and oligohypomenorhea represent only
  the tip of ice-berg of PCOS , but late Sequelae
  are the hidden serious base

37
Conclusion

• Management of PCOS should be started by
  prevention of obesity in peripupertal kids .

38
Conclusion

• Screening for PCOS in adolescents is mandatory
  for early diagnosis and minimizing long term
  Sequelae

39
Thank you
Prof. MOHAMMAD EMAM
Telfax 0020502319922 0020502312299 Email.
mae335_at_hotmail.com