闭经和pcos-吴瑞瑾.ppt.pptVIP

Rotterdam consensus on PCOS 2003 ESHRE/ASRM meeting 20 people with expertise on PCOS Discussed diagnostic criteria for PCOS Consensus reached – published 2004 oligoanovulation/anovulation hyperandrogenism (clinical and/or biochemical) polycystic ovaries exclusion other aetiologies 2 out of 3 criteria wider criteria for family studies Fauser 2004 Rotterdam consensus criteria for PCOS Ultrasound consensus definitions Balen et al Hum Reprod 9:505, 2003 Technical issues: transvaginal, state of art equipment, well trained staff, D3-5 or following progestin bleed, repeat scan if dominant follicle, calculate ovarian volume, count antral follicles, diameter 3 dimensions Either 12 or more follicles 2-9mm or ovarian volume over 10ml Subjective assessment follicle distribution should be ignored as well as stroma Only one ovary is adequate for diagnosis Does not apply to OCP users: PCO does not mean PCOS What is the relationship between PCO and PCOS? Since 20-25% of women have PCO, we should not equate PCO with PCOS clinically as yet BUT PCO women get hyperstimulation like PCOS women Evidence of similar degree of metabolic problems in women with PCO (no hyperandrogenaemia) (Norman et al 1995) Siblings of PCOS more hyperinsulinaemic (Norman et al 1995) Siblings of PCOS more insulin resistant, hyperandrogenaemic and more likely to get diabetes mellitus (Legro et al 2002, Yildiz et al 2003) More likely PCO is part of a spectrum WHO II WHO II Anovulatory Infertility:Paradigm Shift Irregular Cycles LH Androgens Insulin Obesity PCO PCOS Laven, Ob Gyn Surv 2002 Fauser 2004 PCOS的合并症 肥胖 代谢综合征 胰岛素抵抗 肥胖的诊断标准 采用亚洲成人根据BMI对体重的分类 分类 BMI(kg/m2) 相关疾病的危险性 体重过低 18.5 低（但其他疾病风险性增加） 正常范围 18.5~22.9 平均水平 超重 ≥23 肥胖前期 23~24.9 增加 I度肥胖 25~29.9 中度增加 II度肥胖