11616nam 2200601Ia 450 991081902900332120200520144314.01-107-71102-91-107-71445-197866132690651-283-26906-61-906985-51-01-107-47834-0(CKB)2670000000560882(MiAaPQ)EBC3399991(Au-PeEL)EBL3399991(CaPaEBR)ebr10491819(OCoLC)816863530(UkCbUP)CR9781107478343(PPN)261302973(EXLCZ)99267000000056088220110510d2010 uy 0engur|||||||||||txtrdacontentcrdamediacrrdacarrierCurrent management of polycystic ovary syndrome /edited by Adam H. Balen ...[et. al.]1st ed.London RCOG20101 online resource (ix, 227 pages) digital, PDF file(s)Title from publisher's bibliographic system (viewed on 05 Oct 2015).1-906985-41-3 Includes bibliographical references and index.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.Polycystic ovary syndrome (PCOS) is the most common endocrine disturbance, affecting 10-15% of women in the UK. The definition of PCOS has been much debated, while its pathophysiology appears to be multifactorial and is still being actively researched. There is no doubt that 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. The 59th RCOG Study Group brought together a range of experts who treat women with PCOS. This book presents the findings of the Study Group, including: • a definition of PCOS • the accuracy of diagnostic interventions • the particular challenges of adolescent diagnosis and management • the correlation to ethnicity • current approaches to therapy • the potential individualisation of therapy • the role of the alternative therapies used to manage some aspects of PCOS.Polycystic ovary syndromeOvariesCystsPolycystic ovary syndrome.OvariesCysts.618.1/1Balen Adam1760988MiAaPQMiAaPQMiAaPQBOOK9910819029003321Current management of polycystic ovary syndrome4200156UNINA