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Printable Handouts
Navigable Slide Index
- Introduction
- Talk outline
- Subgroups of Polycystic Ovary Syndrome (PCOS)
- Historical aspects of PCOS
- Diagnostic criteria of PCOS
- What is polycystic ovary syndrome?
- PCOS versus PCO
- Diagnostic features of PCOS versus associations
- Metabolic dysfunction; ‘Syndrome XX’
- Steroid metabolism
- PCOS pathogenesis
- Genetic predisposition and weight gain
- Effects of secondary hyperinsulinaemia
- Insulin post-receptor pathways
- Metabolic heterogeneity in phenotypic subgroups
- PCOS phenotypic subgroups
- Insulin-resistance in PCOS phenotypic subgroups
- Role of visceral fat
- T1-weighted axial MRI scans & body fat measures
- Fat depot measurements
- Global adiposity in PCOS
- Genetic corroboration with obesity
- FTO gene region: obesity and PCOS
- A allele of FTO rs9939609
- Association of FTO variants with PCOS
- FTO rs9939609 and PCOS in UK samples
- Association of FTO variants with PCOS
- PCOS: Obstructive Sleep Apnoea
- Prevalence of OSA in obese patients with T2D
- Epidemiology and link with insulin resistance
- Does PCOS make it harder to lose weight?
- Possible mechanisms for weight loss difficulty
- Insulin resistance & weight loss
- Postprandial thermogenesis & weight loss
- PCOS: use of metformin
- Metformin: clinical evidence
- Summary
- Thank you
Topics Covered
- What is PCOS?
- Pathogenesis: obesity, insulin resistance and visceral fat
- Genetic corroboration with obesity
- Obstructive sleep apnoea
- Does PCOS make it harder to lose weight?
- Use of metformin
Links
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Therapeutic Areas:
Talk Citation
Barber, T. (2016, January 31). Obesity and women’s health 2: polycystic ovary syndrome [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved October 14, 2024, from https://doi.org/10.69645/MMMS3069.Export Citation (RIS)
Publication History
Financial Disclosures
- Dr. Thomas Barber has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
Obesity and women’s health 2: polycystic ovary syndrome
Published on January 31, 2016
45 min
Other Talks in the Series: Obesity: Science, Medicine and Society
Transcript
Please wait while the transcript is being prepared...
0:00
My name is Dr. Thom Barber.
I'm an Associate Professor
and Honorary Consultant
Endocrinologist
based at the University
of Warwick in UK
and UHCW NHS Trust.
So in the second part
of this talk,
I'm going to
specifically talk about
Polycystic Ovary Syndrome,
which is a very common condition
affecting pre-menopausal women
and a condition which is very
closely associated with obesity.
0:24
In this part of the talk,
I will firstly consider
what is PCOS.
I'll talk about
its pathogenesis,
genetic corroboration
with obesity,
links with obstructive
sleep apnea
and then consider specifically
whether having PCOS may
make it harder to lose weight
and also use of
metformin therapy
in women with PCOS.
0:44
So what is
Polycystic Ovary Syndrome?
0:48
Some historical aspects.
In 1921, Archard and Thiers
first made a link between
hirsutism and metabolic
derangements
in their description
of a bearded lady with diabetes.
But it wasn't until 1935
when Stein and Leventhal
first described
the syndrome of PCOS.
But it really wasn't until much
more recently in 1980
when we realized
that Polycystic Ovary Syndrome
is actually
an insulin resistant condition
and a condition
which is associated
with multiple
dysmetabolic features.
And since then, of course,
there has been much research
into the cardiometabolic
associations of PCOS.
1:26
What is
Polycystic Ovary Syndrome?
A couple of diagnostic criteria
which I used,
and on the right is shown
the NIH criteria from 1990.
And the NIH criteria
defined PCOS
as presence of both
hyperandrogenic features
in addition
to chronic anovulation.
Hyperandrogenic features are
defined by either chemically,
mainly through increased levels
of testosterone
or free androgen index,
for example.
Clinically, and the main
clinical manifestations include,
for example, hirsutism,
androgenetic alopecia and acne.
In 2003, the NIH criteria was
superseded by Rotterdam criteria
which used two of three ruled
and the three criteria
are defined as, number one,
Polycystic ovarian morphology,
which is defined
presence of at least 12 follicles
of between 2 and 9 millimeters
in diameter
in either ovary
or an ovarian volume
of at least 10 milliliters
in either ovary.
Oligo-amenorrhoea
is the second criteria
and this is
an inter-menstrual interval
of at least 42 days.
And finally,
as with the NIH criteria,
hyperandrogenism, which again
defined either biochemically,
and, or clinically
in terms of hirsutism definition
and this is defined
as the Ferriman-Gallwey score
of at least eight or the need
for at least weekly
cosmetic treatments
of hirsutism.
Now importantly,
Polycystic Ovary Syndrome
is a diagnosis of exclusion.
There are many conditions
which can masquerade as PCOS
and many conditions
are associated with hirsutism,
for example, under
oligo-amenorrhoea in women.
And some of these are
shown here, for example,
Cushing's syndrome, acromegaly,
congenital adrenal hyperplasia,
hyperprolactinemia,
adrenal and ovarian tumors
which cause hyperandrogenaemia.
And of course, it's important
to exclude
these other conditions
before we diagnose
a woman with PCOS.
In terms of Cushing's
and acromegaly,
we only tend to screen
for these biochemically
if there clinical features
of these syndromes, but looking
for a 17-hydroxyprogesterone
can be quite useful
to exclude CAH, for example.
And prolactin level should be
a part of the biochemical workup
as well.
As a general rule of thumb,
if testosterone levels are above
5 nanomoles per liter,
then we would then need to look
for an adrenal and ovarian origin
with scanning
to exclude any tumor of
the adrenal gland or ovaries.