JIIMS.cdr


ABSTRACT
Objective: To identify the different clinical and biochemical presentations of patients having polycystic ovarian
syndrome.
Study Design: A descriptive observational study.
Place and Duration of Study: This study was carried out at Obstetrics and Gynaecology department of CMH
Rawalpindi, from October 2010 to Sept 2011.
Materials and Methods: This observational study was conducted to identify the different presentation of
patients suffering from polycystic ovarian syndrome. Seventy five cases of polycystic ovarian syndrome who
reported in OPD were selected for the study.
Results:The patients mostly presented between 20-30 years of age with symptoms of oligomenorrhea, infertility
and hirsutism. Ultrasonography showed the morphology of polycystic ovary and deranged FSH, LH and
testosterone levels.

Keywords: Polycystic ovarian syndrome, Oligomenorrhea, Infertility, Hirsutism.

60

ORIGINAL ARTICLE

highlight the different symptoms and signs
with which the patients reported in the
gynaecology and obstetrics department of
Combined Military Hospital, Rawalpindi
over a period of one year.

This descriptive study was carried out at
Obstetrics and Gynecology department
CMH Rawalpindi. Seventy five cases of
polycystic ovarian syndrome were selected
for the study. Detailed menstrual history of
the patient was taken. Pelvic examination of
all the married patients was carried out in all
the patients. Ultrasonography pelvis was
carried out in all the patients. Hormonal
levels (FSH, LH, Prolactin, Testosterone,
Estradiol) were also carried out. Baseline
blood chemistry was done in all cases.
Patients who presented with complaints of
m e n s t r u a l i r re g u l a r i t i e s , i n f e r t i l i t y,
hirsutism and obesity were included in the
s t u d y. P a t i e n t s h a v i n g m e n s t r u a l
irregularities due to other causes, like
menorrhagia, and other causes of infertility,
like male causes, tubal occlusion, were
excluded from the study.

Out of the 75 women selected for the study

Materials and Methods

Results

Introduction

Polycystic ovarian syndrome (PCOS) is
associated with reproductive, metabolic and
psychological dysfunction and affects 4-18%

1
of women in reproductive age group. It is
the most common endocrinopathy affecting

2
women of reproductive age. There is an
increased risk of diabetes, hypertension,
metabolic syndrome, and endometrial

3
carcinoma. PCOS adversely affects the
female reproductive health leading to
infertility and miscarriages.
Diagnosis of PCOS is a challenge for the
clinicians and with availability of more
advanced diagnostic tools the prevalence
has seen to be increased because most of the

4
cases remain undiagnosed clinically. PCOS
is a frequent condition in women of
reproductive ageand has associated

5
metabolic dysfunction. This condition also
has serious psychological implication as

6
well. The usual manifestations include
irregular menses, androgen excess and

7
obesity. The aim of the present study is to

-------------------------------------------------
Correspondence:
Dr Nabila Amin
Consultant gynecologist & Obstetrician
Department of Gynae/Obs
Combined Military Hospital Rawalpindi

Presentations of Polycystic Ovarian Disease- Study at
Tertiary Care Hospital
Nabila Amin, Shazia Chohan, Farhat Kareem



Table I: Presenting features of patients with

PCOS

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51 (68%) had raised LH and FSH ratio while
testosterone was mildly raised in 20 patients
(Table II). On ultrasonography polycystic
ovaries were found in 49 (65%) patients
(Table II). Most common presenting
symptom wasoligomenorrhoea which was
present in 75% cases (56 patients) (Table I).
Fifty six perecent (42 patients) patients had
infertility while hirsutism was present in
53% (39 patients) cases (Table I). Most of the
patients presented in 20-30 years age group.
30 patients (40%) were found to be obese
(Table I).

Discussion

It was in 1935 that Stein and Leventhal
originally described the polycystic ovarian
syndrome. PCOS is diagnosed using the

8
Rotterdam criteria, which declares that
when at least two of the following three
features are present the patient can be
labeled as having PCOS:
� oligomenorrhea/ anovulation
� hyperandrogenism
� Polycystic ovaries
In the study Rotterdam criteria was used for
diagnosing the patients of PCOS. The
studyshows that the most common
presenting symptom was oligomenorrhoea,
this finding is similar to other studies carried
out and was of almost similar level to the one

9,10
reported in US study. Similarly infertility
was a very common symptom being present
in 65% of our patients. This shows that
married women tend to report for their
concern for infertility and are subsequently
diagnosed as having PCOS. The worldwide
incidence of patients with infertility having

11
PCOS is about 75%. Hirsutism is again a
very common symptom in patients of PCOS,
it being present in 35% patients in Chinese

12
population. Obesity is more commonly
present in women with PCOS of Hispanic,
black and white origin while its incidence is
l o w e r i n w o m e n o f M e d i t e r r a n e a n
d e s c e n t . 1 3 H y p e r a n d r o g e n i s m w a s
exhibited by the deranged levels of FSH, LH
and testosterone as in other studies these
levels play an important role in diagnosis of

Table II: Investigations of patients with PCOS

Figure 1:



62

1 4
PCOS. Transvaginal ultrasonography
carried out showed the presence of 12 or
more follicles measuring 2-9 mm in
diameter and increased ovarian volume
(more than 10cm3) in 65% patients, which is
one of the features of PCOS according to
Rotterdam criteria. The patients typically
presented in 3rd decade of life.

It can be concluded from this study that
patients present with menstrual cyclical
disturbances, infertility with and without
m e n s t r u a l d i s t u r b a n c e s , a s s o c i a t e d
h i r s u t i s m a n d o b e s i t y ,
ultrasonographicfeaturesandhormone level
estimation play pivotal role in diagnosis of
PCOS.

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Conclusion

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