Polycystic Ovary Syndrome
Steven R. Bayer, Michael M. Alper, Alan S. Penzias in The Boston IVF Handbook of Infertility, 2017
For infertility, ovulation induction with clomiphene citrate (CC) has been the traditional treatment for PCOS. CC is a nonsteroidal selective estrogen-receptor modulator (SERM) that acts on the pituitary to increase endogenous production of FSH. It was the first ovulation induction agent utilized in patients with oligomenorrhea and still remains the agent of choice for anovulatory infertility. The most recent joint ESHRE/ASRM recommendations suggest CC for up to six ovulatory cycles. When administered to anovulatory PCOS patients, it results in a 60%–80% ovulation rate and a 30%–40% pregnancy rate. The dose of CC is usually started at 50 mg for 5 days in the follicular phase and increased up to 150 mg as needed to achieve ovulation. The main side effects associated with CC include multiple gestation (5%–10%), hot flashes, and mood changes. Visual changes owing to pituitary edema are rarely encountered but warrant immediate discontinuation of the medication for symptom resolution.
Gestational Age Estimation
Asim Kurjak in CRC Handbook of Ultrasound in Obstetrics and Gynecology, 2019
Accurate assessment of fetal age and evaluation of fetal growth are fundamental to obstetric care. Gestational age can be calculated according to the date of conception, ovulation, first day of the last menstrual period, or first fetal movements. Conceptual age, i.e., the time elapsed from conception, is an absolute value with a single unambiguous definition.1 Unfortunately, the actual date of conception is usually not known. For that reason menstrual dating, i.e., the time elapsed from the first day of the last menstrual period, has been established in clinical practice. Although satisfactory in studies of large populations, clinical assessment of fetal age based on menstrual history is rather unreliable for individual patients. A questionable menstrual history has been found in 20 to 40% of pregnancies.2,3 Even when the menstrual history seems reliable, ultrasound dating in early pregnancy more accurately predicts the date of delivery.3,4 Ovulation can be delayed more than 2 weeks in patients with oligomenorrhea. Moreover, wide variation ( −6 d to +4 d) has also been reported between the expected time of ovulation predicted by last menstrual period and the actual ovulation time in normal women monitored ultrasonically for assessment of follicular growth.5 Conception may occur early after birth control medication.6,7 Bleeding during the time of the first missing period may also cause error in dating the pregnancy.
Female Methods
Sujoy K. Guba in Bioengineering in Reproductive Medicine, 2020
In properly selected patients pulsatile GnRH infusion leads to increase in serum LH and FSH and the levels of these hormones exhibit a pulsatile character44 as is shown in Figure 11.19. Actual ovulation induction is more difficult to assess. Knowledge and experience in this area of therapy is still growing and success rates, as judged on the basis of pregnancies, is likely to improve. Currently very good outcomes are seen in cases of hypogonadotrophic hypogonadism and this abnormality is one of the principal indications of the therapy. At the other extreme, results in cases of idiopathic oligomenorrhea is quite poor.
Demographic, clinical and hormonal characteristics of patients with premature ovarian insufficiency and those of early menopause: data from two tertiary premature ovarian insufficiency centers in Greece
Published in Gynecological Endocrinology, 2020
Maria Sotiria Bompoula, Georgios Valsamakis, Spyridoula Neofytou, Pantelis Messaropoulos, Nikolaos Salakos, George Mastorakos, Sophia N. Kalantaridou
Archived information of 139 women of Greek origin (age range: 14- to 45-year old) followed in the departments of menopause of Aretaieion and Attikon Hospital between 2015 and 2019 were retrospectively retrieved by the same observer (MSB). These women consulted for menstrual disturbances (oligo/amenorrhea), subfertility or a positive family POI history. Oligomenorrhea was defined as presence of eight or less menstrual cycles during a year. Amenorrhea was defined as primary (absence of menstrual cycles till the age of 16 years) or secondary (absence of menstrual cycles for six months or longer in a previously normally cycling woman) [13]. Subfertility was defined as any form of reduced fertility with prolonged time of unwanted non-conception [14]. Diagnosis of POI was based on ESHRE definition (women <40-year old; oligo/amenorrhea for at least 4 months and elevated FSH levels > 25 IU/L on two occasions >4 weeks apart) [9]. Early menopause was diagnosed in women, who presented the aforementioned symptoms at the age between 40 and 45. In our study, we excluded patients with iatrogenic POI (after chemotherapy, radiotherapy, gynecological surgery). All patients were informed about the study and gave their consent.
Prevalence of polycystic ovary syndrome in Thai University adolescents
Published in Gynecological Endocrinology, 2018
Jetsadaporn Kaewnin, Orawin Vallibhakara, Sakda Arj-Ong Vallibhakara, Penpun Wattanakrai, Benjamaporn Butsripoom, Ekasith Somsook, Sirichai Hongsanguansri, Areepan Sophonsritsuk
The Rotterdam criteria were used to diagnose PCOS and require that two of the following features be present: OA, HA, or polycystic ovaries [2]. Oligomenorrhea was defined as absence of menstruation for ≥45 days and/or ≤8 cycles per year. Secondary amenorrhea was defined as the absence of menstruation for >90 days after menarche [2]. Clinical HA was defined by having any of the following features: a Ferriman–Gallwey (FG) score >6 [8], moderate-to-severe acne based on the Global Acne Grading System (GAGS), or androgenic alopecia. The GAGS scores the severity of acne as none (0 points), mild (1–18 points), moderate (19–30 points), severe (31–38 points), or very severe (>38 points). Biochemical HA was defined as testosterone >63 ng/dL (2.8 nmol/L) [9]. Ovaries were considered to have polycystic ovarian morphology (PCOM) with the presence of >12 cysts measuring 2–9 mm in diameter and/or ovarian volume >10 cm3. Transabdominal pelvic ultrasonography was performed by one operator (JK) using the Voluson ®E8 Ultrasound (GE Healthcare, (Chicago, IL) with a 4- to 8-mHz convex array probe.
Single nucleotide polymorphisms in treatment of polycystic ovary syndrome: a systematic review
Published in Drug Metabolism Reviews, 2019
Ritu Deswal, Smiti Nanda, Amita Suneja Dang
PCOS appear to underlie menstrual dysfunction in approximately 80% of patients. Abnormal menses manifests as oligomenorrhoea and primary/secondary amenorrhea resulting from oligo or anovulation. About 80–90% of women with PCOS have oligomenorrhoea and 10–20% have amenorrhea (Teede et al. 2010). Classes of drugs used to treat menstrual irregularities are (i) oral contraceptive pills (OCPs), (ii) insulin-sensitizing drugs, (iii) aromatase inhibitors, (iv) glucocorticoids, (v) gonadotropins, and (vi) sSelective estrogen receptor modulators (SERMs) (Williams and Creighton 2012). Most of the differences in treatment regimens among individuals were just because of genetic polymorphisms (Khrunin et al. 2010). The important genetic predictors related to MI have been discussed in Table 1. The drug of choice for treating MI in PCOS is clomiphene citrate, metformin, and oral contraceptives.
Related Knowledge Centers
- Menstruation
- Adenoma
- Pituitary Gland
- Hyperthyroidism
- Menopause
- Prader–Willi Syndrome
- Graves' Disease
- Amenorrhea
- Polycystic Ovary Syndrome
- Androgen