Read my PCOS Speech for class!

Pogomop · 11-05-2007, 06:13 PM

I wrote a speech about PCOS! I'm giving it on Thursday, I'll let you know what grade I get. I was very proud of myself and wanted to share with you guys! Let me know what you think

Intro

One in ten females you know has a syndrome that is the leading cause of infertility. This woman might be your best friend, your mother, or sister, and she is at risk for endometrial cancer, Insulin resistance/Type II diabetes, High blood pressure, cholesterol disorders, Cardiovascular disease, Strokes, Weight gain, and Miscarriage. Poly Cystic Ovarian Syndrom is an incredibly common, and very serious illness that not enough people know about. It impacted my life for years before I diagnosed myself through a magazine article and was able to seek treatment. Many woman struggle with the disease for years never having been diagnosed. For the next minutes we will be discussing Poly Cystic Ovarian Syndrom, or, PCOS. Time being limited we will focus on 3 areas; The first being the different symptoms of PCOS. The second being diagnosis, and the third being different treatments available.
symptoms and characteristics of PCOS include
irregular, few, or absent menstrual periods; cycles that do occur may be heavy (heavy bleeding is also an early warning sign of endometrial cancer)
Infertility, generally resulting from chronic lack of ovulation
unwanted body hair, typically in a male pattern affecting face, chest and legs.
pain during sexual intercourse.
male-pattern baldness.
Acne, oily skin
dark patches of skin, tan to dark brown or black, a sign of insulin resistance, which is associated with PCOS.
tiny flaps of skin around the neck called skin tags
Prolonged periods of PMS-like symptoms (bloating, mood swings, pelvic pain, backaches). and
of course Depression, It's not hard to imagine why an overweight, bald, acne ridden, hairy-faced girl might be sad.

Now that we know the symptoms of PCOS this brings us to the second part of our discussion; The diagnosis
Not all women with PCOS have polycystic ovaries (PCO), nor do all women with ovarian cysts have PCOS; although a pelvic ultrasound is a major diagnostic tool, it is not the only one. Diagnosis can be difficult, particularly because of the wide range of symptoms and the variability in presentation (which is why this disorder is characterized as a syndrome rather than a disease).
Standard diagnostic assessments:
History-taking, In other words, Does it run in the family? This specifically checks for menstrual pattern, obesity, hirsutism, and the absence of breast discharge.
Gynecologic ultrasounds, specifically looking for ovarian cysts. These are believed to be the result of failed ovulation, reflecting the infrequent or absent menstruation that is typical of the condition. There may be 10 or more in each ovary, and on ultrasound examination they may give the appearance of a 'string of pearls'. The numerous follicles mean that the ovaries are generally 1.5 to 3 times larger than normal.
Elevated serum (blood) levels of androgens (male hormones), including dehydroepiandrosterone sulfate (DHEAS) and testosterone: free testosterone is more sensitive than total; free androgen index is often used as a substitute. Some other blood tests can be suggestive but not diagnostic.

Because PCOS is a syndrome and not a disease, it is usually recognized by it's assosiated symptoms. diagnosing these symptoms may intail
Fasting biochemical screen and lipid profile
2-hour oral glucose tolerance test in patients with risk factors (obesity, family history, history of gestational diabetes) and may indicate impaired glucose tolerance (insulin resistance) in 15-30% of women with PCOS. Frank diabetes can be seen in 65–68% of women with this condition. Insulin resistance can be observed in both normal weight and overweight patients.
PCOS can look like several other diseases.
Other causes of irregular or absent menstruation and hirsutism, such as congenital adrenal hyperplasia, Cushing's syndrome, hyperprolactinemia, and other pituitary or adrenal disorders, should be investigated. PCOS has been reported in other insulin resistant situations such as acromegaly.

The third part of our discussion is about what treatments can be persued once a person has been diagnosed with PCOS
Medical treatment of PCOS is tailored to the patient's goals. Broadly, these may be considered under three categories:
Restoration of fertility
Treatment of hirsutism or acne
Restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial cancer

General interventions that help to reduce weight or insulin resistance can be beneficial for all these aims, because they address what is believed to be the underlying cause of the syndrome. Where PCOS is associated with a tendancy to be overweight or obese, successful weight loss is probably the most effective method of restoring normal ovulation/menstruation, but many women find it very difficult to achieve and sustain significant weight loss. Low-carbohydrate diets and sustained regular exercise may help.
Many women find insulin-lowering medications such as metformin hydrochloride (Glucophage®), pioglitazone hydrochloride (Actos®), and rosiglitazone maleate (Avandia®) helpful, and ovulation may resume when they use these agents. Many women report that metformin use is associated with upset stomach, diarrhea, and weight-loss. Such side effects usually resolve within 2–3 weeks. Starting with a lower dosage and gradually increasing the dosage over 2–3 weeks and taking the medication toward the end of a meal may reduce side effects. It may take up to six months to see results, but when combined with exercise and a low glycemic index diet up to 85% will improve menstrual cycle regularity and ovulation.

Treatment of Infertility
Clomiphene citrate and metformin are the principal treatments used to help infertility. Both have been shown to be effective.
However, many specialists continue to recommend metformin which has, separately, been shown to increase ovulation rates and reduce miscarriage rates. Metformin may be a rational choice in women in whom significant insulin resistance is diagnosed or suspected, as clomiphene works through a different mechanism and does not affect insulin resistance.
Diet adjustments and weight loss also increase rates of pregnancy. The most drastic increase in ovulation rate occurs with a combination of diet modification, weight loss, and treatment with metformin and clomiphene citrate. It is currently unknown if diet change and weight loss alone have an effect on live birth rates comparable to those reported with clomiphene and metformin.
For patients who do not respond to clomiphene, metformin, other insulin-sensitizing agents, diet and lifestyle modification, there are options available including assisted reproductive technology procedures such as controlled ovarian hyperstimulation and in vitro fertilisation. Ovarian stimulation has an associated risk of ovarian hyperstimulation in women with PCOS — a dangerous condition with morbidity and rare mortality. Thus recent developments have allowed the oocytes present in the multiple follicles to extracted in natural, unstimulated cycles and then matured in vitro, prior to IVF. This technique is known as IVM (in-vitro-maturation)
Though surgery is usually the treatment option of last resort, the polycystic ovaries can be treated with surgical procedures such as
laparoscopy electrocauterization or laser cauterization
ovarian drilling

Treatment of Hirsutism and Acne
Cyproterone acetate is an anti-androgen, which blocks the action of male hormones that are believed to contribute to acne and the growth of unwanted facial and body hair. Cyproterone acetate is also contained in the contraceptive pill Dianette®. Spironolactone also has some benefits, again through anti-androgen activity, and metformin can also help. Eflornithine is a drug which is applied to the skin in cream form (Vaniqa®), and acts directly on the hair follicles to inhibit hair growth. It is usually applied to the face.
Although all of these agents have shown some efficacy in clinical trials, the average reduction in hair growth is generally in the region of 25%, which may not be enough to eliminate the social embarrassment of hirsutism, or the inconvenience of plucking/shaving. Individuals may vary in their response to different therapies, and it is usually worth trying other drug treatments if one does not work, but drug treatments do not work well for all individuals. Alternatives include electrolysis and various forms of laser therapy.

Treatment of Menstrual Irregularity and Prevention of Endometrial Cancer
If fertility is not the primary aim, then menstruation can usually be regularised with a contraceptive pill. Most brands of contraceptive pill result in a withdrawal bleed every 28 days. Dianette® (a contraceptive pill containing cyproterone acetate) is also beneficial for hirsutism, and is therefore often prescribed in PCOS.
If a regular menstrual cycle is not desired, then a standard contraceptive pill is not appropriate. Women who are having irregular menses do not necessarily require any therapy; most experts consider that if a menstrual bleed occurs at least every three months, then the endometrium (womb lining) is being shed sufficiently often to prevent an increased risk of endometrial abnormalities or cancer. If menstruation occurs less often or not at all, some form of progestogen replacement is recommended. Some women prefer a uterine progestogen implant such as the Mirena® coil, which provides simultaneous contraception and endometrial protection for years, though often with unpredictable minor bleeding. An alternative is oral progestogen taken at intervals (e.g. every three months) to induce a predictable menstrual bleed.
Without treatment the symptoms of PCOS can be disturbing, and can become permanent or even fatal. It is important to know that PCOS can present in any age. Many can be diagnosed as young children, some might not present until after menopause. It is vital to find a PCOS knowledgeable doctor to catch this disorder as many miss the diagnoses - sometimes for years. Armed with information a woman with PolyCystic Ovarian Syndrome can live a normal happy life.

Jashobeam · 11-05-2007, 07:46 PM

I hope your speech goes well!