Current Management of Polycystic Ovary Syndrome.

Cover -- Title page -- Contents -- Participants -- Additional contributors -- Declarations of personal interest -- Preface -- 1 Overview and definitions of polycystic ovary syndrome and the polycystic ovary -- Introduction -- What is polycystic ovary syndrome? -- Defining the polycystic ovary: historical and histopathological considerations -- Ultrasound descriptions of the polycystic ovary -- Multicystic and polycystic ovaries -- Transvaginal ultrasound -- Stromal echogenicity -- Three-dimensional ultrasound, Doppler and MRI -- Exclusion of related disorders -- Conclusion -- Key points -- References -- 2 Genetics and pathogenesis of polycystic ovary syndrome -- Introduction -- Developmental origin of PCOS -- Genes and PCOS -- Role of the intrauterine environment -- Role of the external environment: diet, obesity and PCOS -- Summary -- References -- 3 Ethnic variations in the expression of polycystic ovary syndrome -- Introduction -- Defining race and ethnicity -- Evidence for ethnic variations in the expression of PCOS -- Historical background -- Ethnic variations of obesity, insulin resistance and the metabolic syndrome in PCOS -- The Asian perspective -- Non-Asians -- Ethnic variation of hyperandrogenism in PCOS -- East Asians -- Other ethnic groups -- Ethnic interrelationships of metabolic problems and hyperandrogenism manifestations of PCOS -- Epidemiological variations of insulin resistance and the prevalence of PCOS - are they in parallel? -- Ethnic differences in diagnostic thresholds for polycystic ovaries -- Ethnic differences in quality of life -- Summary and conclusion -- Acknowledgements -- References -- 4 Quality of life for women with polycystic ovary syndrome -- Introduction -- What is health-related quality of life? -- Measuring HRQoL -- Types of instrument available to measure quality of life in women with PCOS.

Generic questionnaires -- Overall impact of PCOS on HRQoL -- Comparisons with controls (other gynaecological populations) -- PCOS and mental health -- Impact of PCOS-associated obesity on HRQoL -- Problems with proxy assessments of HRQoL -- Impact of PCOS-associated infertility and sexual functioning on HRQoL -- Treatments for PCOS that have measured associated changes to HRQoL -- Conclusion -- Summary of key points -- References -- 5 Insulin resistance, the metabolic syndrome and polycystic ovary syndrome -- Introduction -- Definitions and diagnosis -- Mechanism of insulin resistance in PCOS -- Interactions between the metabolic syndrome and ovarian function -- Insulin as a co-gonadotrophin -- Inflammation and the ovary -- PCOS as a marker for type 2 diabetes -- PCOS as a marker for cardiovascular disease -- PCOS and non-alcoholic steatohepatitis -- PCOS and implications for family members -- Treatment of PCOS and the metabolic syndrome -- Conclusion -- References -- 6 Management of polycystic ovary syndrome through puberty and adolescence -- Introduction -- Diagnosis -- The menstrual cycle during adolescence -- Ovarian appearance on ultrasound -- Hormonal changes during puberty -- Clinical presentation -- Developmental origins of PCOS -- Differential diagnosis -- Treatment -- Oral contraceptive pills -- Metformin -- Thiazolidinediones -- Antiandrogens -- Recommendations -- Clinical evaluation -- Investigations -- Treatment -- Monitoring -- Conclusion -- References -- 7 Long-term health risks of polycystic ovary syndrome -- Increased cardiovascular risk -- Surrogates for cardiovascular disease -- Traditional measures and the metabolic syndrome -- New markers -- Waist circumference and HDL cholesterol -- PCOS as a risk factor on its own -- Recommendations -- Risk for type 2 diabetes and impaired glucose tolerance -- Complications of obesity.

Gynaecological malignancies -- Endometrial hyperplasia and cancer -- Breast cancer -- Ovarian cancer -- Conclusion -- References -- 8 Approaches to lifestyle management in polycystic ovary syndrome -- Introduction -- Prevalence of obesity and PCOS -- Evidence that early weight gain favours the development of PCOS -- Pathophysiological aspects of adipose tissue in PCOS -- Obesity worsens the PCOS phenotype and associated metabolic alterations -- Treatment of obesity improves PCOS -- Lifestyle management -- Lifestyle modification and infertility -- Conclusion -- References -- 9 Management of obesity in polycystic ovary syndrome, including anti-obesity drugs and bariatric surgery -- Introduction -- Lifestyle modification -- Anti-obesity medication -- Orlistat -- Sibutramine -- Bariatric surgery -- Background -- Bariatric surgery and PCOS -- Pregnancy after bariatric surgery -- Conclusion -- References -- 10 Definition of hyperandrogenism -- Clinical hyperandrogenism -- Biochemical hyperandrogenism -- Assessment of anovulation -- Proposal for new criteria -- Clinical hyperandrogenism -- Laboratory hyperandrogenism -- Laboratory diagnosis of anovulation -- Summary -- References -- 11 Treatment of hyperandrogenism in polycystic ovary syndrome -- Introduction -- Acne -- General advice -- Managing according to clinical sub-type -- Treatment of non-inflammatory lesions -- Treatment of mild to moderate inflammatory lesions -- Topical therapies for post-inflammatory hyperpigmentation -- Alternative therapies and procedures -- Nodular lesions -- Non-inflammatory lesions -- Skincare and use of cosmetics -- Systemic therapies -- Inhibitors of adrenal androgen production -- Inhibitors of ovarian androgen production -- Oral contraceptives -- Gonadotrophin-releasing hormone agonists -- Androgen receptor blockers -- Spironolactone -- Flutamide -- Finasteride.

Insulin-sensitising drugs -- Conclusion on acne management in PCOS -- Hirsutism -- Topical therapy -- Eflornithine hydrochloride -- Systemic therapy -- COC pills -- Cyproterone acetate -- Spironolactone -- Gonadotrophin-releasing hormone agonists -- Finasteride -- Flutamide -- Insulin-sensitising drugs -- Female-pattern hair loss -- Minoxidil -- Antiandrogens -- Reductase inhibitors -- Conclusion -- References -- 12 Choices in the treatment of anovulatory polycystic ovary syndrome -- Introduction -- Weight loss -- Clomifene citrate -- Mode of action -- Dose -- Results -- Clomifene citrate treatment failure -- Monitoring -- Adjuvant treatment -- Aromatase inhibitors -- Mode of action -- Indications -- Dose -- Evidence -- Safety -- Metformin -- Mode of action -- Dose -- Evidence -- Safety -- Low-dose gonadotrophin therapy -- Principle -- Regimen -- Evidence -- Variations -- References -- 13 Predictors of ovarian response to ovarian stimulation: progress towards individualised treatment in ovulation induction -- Introduction -- Predictors of ovarian response in ovulation induction -- Predicting response to anti-estrogen therapy -- Predicting response to gonadotrophins -- Might genetic predictors be useful? -- Conclusion -- References -- 14 Surgical management of anovulatory infertility in polycystic ovary syndrome -- Introduction -- History -- Methods and dose -- Risks of adhesion formation and ovarian failure -- Endocrine changes after laparoscopic ovarian surgery -- Pregnancy rates -- Transvaginal approach -- Summary -- Key points -- Clinical practice points -- Future avenues for research -- References -- 15 The role of insulin-sensitising drugs in the treatment of polycystic ovary syndrome -- Introduction -- Metformin -- Premature pubarche -- Infertility -- Miscarriage and pregnancy complications -- Hirsutism -- Diabetes prevention.

Endometrial cancer prevention -- Conclusion -- Acknowledgements -- References -- 16 The role of in vitro maturation of oocytes for anovulatory polycystic ovary syndrome -- In vitro maturation of immature oocytes -- Variations -- Patient selection -- hCG priming -- Gonadotrophin ovarian stimulation -- ICSI -- Endometrial priming -- Metformin co-treatment -- Timing of immature oocyte retrieval in relation to follicular diameter -- Results -- Safety -- Summary -- References -- 17 Acupuncture and/or herbal therapy as an alternative or complement for relief of polycystic ovary syndrome-related symptoms -- Introduction -- Treatment of PCOS -- The physiological basis for acupuncture -- How may acupuncture act in women with PCOS? -- Evidence for the use of acupuncture in PCOS -- Effects on ovulation -- Effects on metabolic abnormalities -- Effects on mental health -- Effects on the sympathetic nervous system -- Continuing or completed RCTs on the effects of acupuncture in PCOS-related symptoms -- Herbal therapy for the relief of PCOS-related symptoms -- Herbs for ovulation induction -- Vitex agnus-castus -- White peony -- Sairei-to -- Mentha spicata Labiatae -- Herbs for metabolic abnormalities -- Berberine -- Cinnamon -- Labisia pumila -- Future perspectives -- Conclusion -- References -- 18 Consensus views arising from the 59th Study Group: Current Management of Polycystic Ovary Syndrome -- Diagnosis/pathophysiology -- Management -- Lifestyle and metabolic aspects -- Treatments -- Research -- Index.

This book presents the findings of the RCOG Study Group on polycystic ovary syndrome - the most common endocrine disturbance of women in the UK. PCOS has a significant effect on quality of life and psychological morbidity and, as many specialists are involved in its management, a multidisciplinary approach is required.

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Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, 2024. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries.