Management of Poly-cystic ovarian disease (Made Easy)

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Management Medical treatment of PCOS is tailored to the patient’s goals in four main categories:

  1. lowering of insulin levels,
  2. restoration of fertility,
  3. treatment of hirsutism or acne,
  4. restoration of regular menstruation with prevention of endometrial hyperplasia and cancer.

There is considerable debate as to the optimal treatment. • General interventions that help to reduce weight or insulin resistance can be beneficial for all these aims and interrupt the self-perpetuating cycle of hyperandrogenic chronic anovulation.

Medical therapy

1 Oral contraceptives have been the mainstay of long-term management of PCOS by decreasing LH and FSH secretion and ovarian production of androgens, increasing hepatic production of SHBG, decreasing levels of DHEA (dehydroepiandrosterone) and preventing endometrial neoplasia. Cyproteroneacetate(Dianette/Diane), spironolactone, or topical eflornithine may be especially helpful in patientswith excessive hirsutism.

2 Progestins have been shown to suppress pituitary LH and FSH and circulating androgens, but breakthrough bleeding is common.

3 Insulin-sensitizing agents (metformin) decrease circulating androgen levels, improve the ovulation rate, and improve glucose tolerance.

4 Clomiphene citrate has traditionally been the firstline treatment for women desiring pregnancy.

Surgical therapy

1 Ovarian drilling with laser or diathermy has few advantages over medical therapy for infertility and does not appear to have significant long-term benefits in improving metabolic abnormalities.

2 Mechanical hair removal (laser vaporization, electrolysis, depilatory creams) is often the front line of treatment for hirsutism.

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