Polycystic Ovary Syndrome (PCOS)

What is PCOS ? 1. Health issue for over 5 million women in U.S. 2. Cause remains unknown 3. Recent effort to rename this condition based on: – –

Combining existing criteria: Rotterdam (2003); NIH (1990); Androgen Excess & PCOS Society (2006) Renaming reflective of complex systems interaction: metabolic; hypothalamic; pituitary, ovarian, adrenal.

4. Proposed criteria: 2 of 3 – – –

Androgen excess Ovulatory dysfunction Polycystic ovaries

Lewis R. PCOS Diagnostic Criteria Clarified: Name Must Change. Medscape, January 23, 2013

PCOS: Diagnosis 1. 2. 3. 4. 5. 6. 7. 8. 9.

Weight gain / Central distribution Acne Thin scalp hair Hirsutism / male distribution Oligomenorrhea Amenorrhea Infertility Ovarian cysts Insulin resistance

PCOS: Standard Treatment • Symptomatic treatment includes: – Weight loss – Anti-androgens: targets unwanted hair & acne. • • • • •

Spironolactone Finasteride Flutamide Ketoconazole Cyproterone

• Infertility: – Clomifene, FSH (Gonal-F), Leuprorelin; hCG; Letrozole; Bromocriptine; Progesterone; Metformin. – Metformin + clomifene, a favorite combination

Symptomatic Treatment (cont’d) • Diabetes: 1. Type 2 Diabetes: • not enough insulin or cells fail to utilize it adequately. • Treatment: Metformin

2. Insulin resistance: • Most TTDB are insulin resistant. • aka “Metabolic Syndrome” • Treatment: Metformin

Symptomatic Treatment (cont’d) • Insulin resistance: comorbid conditions – Obesity, Type Two Diabetes, Hypertension, Hyperlipidemia, Heart Disease & PCOS.

• Insulin resistance: Signs – Impaired fasting BS; Hypertension; Hyperlipidemia; Heart disease; Obesity; Kidney damage.

• Insulin resistance: Diagnosis – Waist >40; Trigylcerides;  HDL; BP;  fasting blood sugar. Nestler JE. Metformin for the Treatment of the Polycystic Ovary Syndrome. New England Journal of Medicine, January 3, 2008

Case Presentation • Initial visit: 7/6/2004 • Complaints: Neck pain (since 1st grade); low back & scapular pain; popping in hip joints; dysmenorrhea. • Medications: None (initially); BCP 8/5/09 & Metformin (9/18/09) per OB-GYN. • Diagnosis: () Fatigue; () Myalgia; () Hypervitaminosis D; () Arthralgia; () Peripheral edema () Hypertension; () Hyperlipidemia; ()Asthma; () Chronic Bronchitis; () Polycystic Ovarian Disease

Before CI Diagnosed (Cont’d) • Treatment course: – From 7/13/04 – 12/21/09, Pain range = 2-9 in neck, dorsal spine, low back, knees & ankles. – Headaches began: 8/5/09 – BCP start: prior to 8/5/09 – Metformin start: prior to 9/18/09

Treatment of Chronic Inflammation

• Inflammation Therapy initiated Dec. 2009

Neck & Shoulder Pain 7

6

Axis Title

5

4 Neck/Sh/Pn

3

10 per. Mov. Avg. (Neck/Sh/Pn) Linear (Neck/Sh/Pn)

2

1

0

Fatigue 8

7

6

5

4

Fatigue

Linear (Fatigue) 3

2

1

0

10 per. Mov. Avg. (Fatigue)

Emotional 12

10

8

6

Emotional 10 per. Mov. Avg. (Emotional) Linear (Emotional)

4

2

0

Anxiety 9 8

7 6 5

Anxiety 4

10 per. Mov. Avg. (Anxiety) Linear (Anxiety)

3 2 1 0 -1

Muscle Pain 7

6

5

4

Muscle Pain 3

10 per. Mov. Avg. (Muscle Pain) Linear (Muscle Pain)

2

1

0

Brain Fog 7

6

5

4 Brain Fog 3

Linear (Brain Fog) 10 per. Mov. Avg. (Brain Fog)

2

1

0

-1

Joint Pain 4.5 4

3.5 3 2.5 Joint Pain

2 1.5 1 0.5 0

10 per. Mov. Avg. (Joint Pain) Linear (Joint Pain)

Swelling 7

6

5

4

Swelling 3

10 per. Mov. Avg. (Swelling) Linear (Swelling)

2

1

0

Short of Breath 6

5

4

3

S.O.B. 10 per. Mov. Avg. (S.O.B.) Linear (S.O.B.)

2

1

0

Symptom Resolution 12

10

8

6

Maximum

Current 4

2

0

PCOS Symptoms / Quality of Life 12

10

8

6

Max Current Linear (Max)

4

2

0 Wt/Gain

-2

Thin hair

Hirsutism

O-menorrhea

Insulin resistance

Acne

A-menorrhea

Infertility

Ovarian Cysts

Glucose 120

mg / dL

100

80

60

Glucose Linear (Glucose) 2 per. Mov. Avg. (Glucose)

40

20

0

Triglyceride 250

mg / dL

200

150 Triglyceride 2 per. Mov. Avg. (Triglyceride)

100

50

0

Linear (Triglyceride)

Cholesterol 250

mg / dL

200

150

Cholesterol

100

Linear (Cholesterol) 2 per. Mov. Avg. (Cholesterol)

50

0

There are so many other little things that have improved that I used to just accept and think that was just how it was!