Presentation on The Diagnosis of Polycystic Ovary Syndrome (PCOS)
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Dr. Laxmi Shrikhande is a leading expert in PCOS and adolescent health. She is the Director of Shrikhande Fertility Clinic in Nagpur, India. She has held numerous leadership positions in national OB/GYN societies. She has published extensively on PCOS and delivered over 300 lectures. Her presentation discusses the latest 2018 guidelines for diagnosing and managing PCOS in adolescents, focusing on lifestyle interventions like diet and exercise to target obesity, irregular periods, hirsutism and long term health risks like diabetes. Early diagnosis of PCOS in adolescents is important to address both immediate issues and reduce late health sequelae.
Presentation on The Diagnosis of Polycystic Ovary Syndrome (PCOS)
- 1. Dr. Laxmi Shrikhande MD,FICOG,FICMU • Director-Shrikhande Fertility Clinic,Nagpur • President MenopauseSociety,Nagpur • NationalCorrespondingEditor-TheJournalof Obstetrics& Gynecologyof India • SeniorVice President FOGSI 2012 • Vice Chairperson IndianCollegeOB /GY • GoverningCouncilmemberICOG2012-2017 • GoverningCouncilMemberISAR 2014-2019 • GoverningCouncilMemberIAGEfor3 terms • Patron-VidarbhaChapterISOPARB • Chairperson-HIV/AIDS Committee,FOGSI (2007-09) • Received Best Committee Awardof FOGSI • ReceivedBharat excellenceAwardforwomen’s health • President NagpurOB/GYSociety 2005-06 • Associatememberof RCOG • Memberof EuropeanSociety of HumanReproduction • Visited96 FOGSI Societies as invitedfaculty • Delivered 6 orationsand296 guest lectures • Publications-ThirteenNational& sevenInternational • PresentedPapers in FIGO,AICOG,SAFOG,AICC-RCOG conferences • Conductedadolescenthealth program for more than15,000 adolescent girls
- 2. PCOS & Adolescence DR LAXMI SHRIKHANDE DIRECTOR-SHRIKHANDE FERTILITY CLINIC, NAGPUR
- 3. PCOS PCOS is one condition where people always like to agree to disagree. Over the years these disagreements have continued. The criteria for diagnosis keep on changing. Management guidelines keep on changing
- 4. Latest Guidelines 2018 International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018 By ESHRE &ASRM Released in July 2018 during ESHRE congress at Barcelona
- 5. New Guidelines designed to provide clear information to assist clinical decision making and support optimal patient care Is the culmination of the work of over 3000 health professionals and consumers internationally
- 6. How you will diagnose PCOS in adolescent girl
- 7. Criteria for diagnosis of PCOS NIH (1990) – include all of the following 1. Hyperandrogenism &/or hyperandrogenaemia 2. Oligo-ovulation 3. Exclusion of related disorders ESHRE/ASRM (Rotterdam 2003)- two of the following 1. Oligo or anovulation 2. Clinical &/or biochemical signs of Hyperandrogenism 3. Polycystic ovaries Androgen Excess Society (2006) - include all of the following 1. Hirsutism &/or hyperandrogenaemia 2. Oligo – anovulation &/or polycystic ovaries 3. Exclusion of androgen excess or related disorder
- 8. Diagnostic Criteria Irregular menstrual cycles Clinical hyperandrogenism Biochemical hyperandrogenism Ultrasound and polycystic ovarian morphology (PCOM) Ethnic variation Anti-müllerian hormone (AMH)
- 9. Ethnic variation Consider ethnic variation in PCOS including: relatively mild phenotypes in Caucasians. higher BMI in Caucasians, especially North America and Australia. more severe hirsutism in Middle Eastern, Hispanic and Mediterranean women. increased central adiposity, insulin resistance, diabetes, metabolic risks and acanthosis nigricans in South East Asians and Indigenous Australians. lower BMI and milder hirsutism in East Asians. higher BMI and metabolic features in Africa
- 10. What do we mean by lifestyle interventions? Healthy lifestyle behaviours (healthy eating and regular physical activity) should be recommended in all women with PCOS including those with excess weight too achieve and/or maintain healthy weight and to optimise health, and quality of life across the life course.
- 11. Lifestyle Intervention Behavioural strategies Dietary intervention Exercise intervention Obesity and weight assessment
- 12. Management
- 13. Goal setting for this weight loss ? SMART Specific, Measurable, Achievable, Realistic and Timely
- 14. How much weight loss ? Achievable goals such as 5% to 10% weight loss in those with excess weight yields significant clinical improvements and is considered successful weight reduction within six months
- 15. How to loose weight? DIET Which diet plan is best ? How much calorie deficit should be prescribed?
- 16. Immediate / Acute Issues- ◦ Hirsutism ◦ Obesity ◦ Regulation of menses Long term issues- ◦ Insulin Resistance ◦ Cardiovascular risk ◦ Obstructive sleep apnea ◦ Malignancy risk
- 17. • Combined OCPs containing ---estrogen and Progesterone given cyclically help in controlling menstrual problem , hirsutism, acne, and extra weight. • Estrogen salt used is- --- Ethinylestradiol in the dose 0f 20/ 30 ug / day. • Progeserones used are of many types and they have variable effect on Acne, weight , hirsutism, -to be considered when prescribing OCPs.
- 19. PCOS - Late sequelae • Diabetes mellitus x7 • Hypertension x4 • Low HDL/high LDL • Endometrial Cancer
- 20. Practical measures Articles in news papers and magazines TV shows Adolescent health programmes in schools and colleges Medical conferences to educate doctors, paramedics PCOS associations in every country with regular activities Good blogs by experts Research
- 21. • Frequently seen in adolescence • Early diagnosis is important because of the potential long-term consequences
- 22. Dr. Laxmi Shrikhande Shrikhande Fertility Clinic Ph-8805577600 / 8805677600 shrikhandedrlaxmi@gmail.com
- 23. 'Spiritual blossoming' simply means blossoming in life in all dimensions. Being happy, at ease with yourself and with everybody around you. Sri Sri Ravi Shankar The Art of Living