Polycystic Ovary Syndrome Evidence Based Practice

5380 words - 22 pages

Management of Symptoms in Polycystic PAGE 1
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of adolescent girls, and it has profound implications throughout women's reproductive years. Untreated, the syndrome places a person at a risk of developing metabolic syndrome, type II diabetes, hyperlipidemia, hypertension, cardiovascular disease, infertility, and endometrial hyperplasia and carcinoma, therefore strategies to address PCOS deserve particular attention (Hassan & Gordon, 2007). It has been found to affect between 5% and 8% of women, and may be increasing in prevalence due to increasing obesity among teenagers (Dronavalli & Ehrmann, 2007). The syndrome involves reproductive, metabolic, and cardiovascular components. It is strongly associated with overweight, as 55% to 73% of girls diagnosed with PCOS are overweight (Stanley & Misra, 2008). Excess adipose tissue leads to decreased insulin sensitivity and this in turn leads to hyperinsulinemia. High insulin levels stimulates ovarian androgens and luteinizing hormone secretion, and decrease liver production of sex hormone binding globulin (SHBG), resulting in increased level of circulating free testosterone, and signs of hyperandrogenism such as acne and hirsutism (Hassan & Gordon). The genetic component of PCOS is still being investigated (Stanley & Misra). Common complaints associated with the condition are irregular menses or amenorrhea, obesity, hirsutism, acne, and acanthosis nigricans (Hassan & Gordon). Unfortunately, the condition is often unrecognized and undiagnosed because many teenage girls without PCOS have acne and irregular menses. It is essential to evaluate and diagnose PCOS, so the therapeutic interventions begin as early as possible, to prevent the long term health risks of the disorder. In addition to the debilitating effects on health, the cosmetic concerns may affect body image and self-esteem, which are especially important for adolescents, when appearance and acceptance by peers are of greatest importance.Although three criteria were developed and approved for the diagnosis of PCOS, there still remains some controversy. Trivax and Azziz (2007) report that The National Institutes of Health (NIH) defined PCOS in 1990 as presence of hyperandrogenism, chronic anovulation, and exclusion of other related disorders. The authors also inform that Rotterdam 2003 set the second criteria, stating that diagnosis can be confirmed by the presence of two of the following after exclusion of other disorders: oligo-ovulation, hyperandrogenism, or polycystic ovaries. The most recent criteria proposed by the Androgen Excess Society (AES) in 2006 suggests hirsutism and/or hyperandrogenemia, oligo-ovulation and/or polycystic ovaries, and exclusion of other related disorders. The related disorders to be evaluated and excluded before the diagnosing PCOS is made are: thyroid disorders, hyperprolactinemia, congenital adrenal hyperplasia, Cushing...

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