An open discussion of:
Polycystic Ovarian Syndrome treatments
in Oriental and Western Medicine

Hosted by Dr. Daoshing Ni
Chair of Doctoral program in Women’s Health and Reproductive Medicine
Yo San University of Chinese Medicine.

Part 1:
PCOS a clinical case study, definition, and epidemiology.

PCOS Case History
Dr. Xiao, Cheng Cong

28 yo female, 5-11-2009 first visit

Delayed menstruation 4 years

Due to moving 4 years ago, periods became delayed afterwards, 3-5/30-60, scanty dark flow with no clots, no dysmenorrhea LMP 3-9-2009.
Used TCM patent formulas no help,
Currently delayed menstruation, lower back soreness, weakness, poor appetite, sleep well, bm good,
Obese, 155 cm, weight 67.5kg, tongue pink coating white greasy, pulse deep slippery.

Menarche age 12, had regular menstrual cycle before the move at 30-day.

Exam: external genitalia hair seems to be quite thick, pelvic exam (-)

Blood Tests: LH 11.07 mIU/ml, FSH 3.78 mIU/ml, E2 60pg/ml, P 0.34 ng/ml, T 4.7 ng/ml, PRL 13.26 ng/ml.

TVS: Uterus 4×2.9×3.5cm, Endo 6mm, LOV 4.1×2.5cm, ROV3.9×2.4cm, 10+ polycystic none echoed areas.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women and yet remains enigmatic.

Despite its high prevalence in the population, much controversy remains regarding its diagnosis, its etiology and the most appropriate treatment strategy.

Polycystic Ovaries:
Women with PCOS may have enlarged ovaries that contain small collections of fluid — called follicles — located in each ovary as seen during an ultrasound exam.

Hirsutism, Acne:
Infrequent or prolonged menstrual periods, excess hair growth, acne, and obesity can all occur in women with polycystic ovary syndrome. In adolescents, infrequent or absent menstruation may raise suspicion for the condition.

Obesity, Delayed Menstruation:
The exact cause of polycystic ovary syndrome is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications, such as type 2 diabetes and heart disease.

In the United States, polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders of reproductive-age women, with a prevalence of 4-12%.
Up to 10% of women are diagnosed with PCOS during gynecologic visits.
In some European studies, the prevalence of PCOS has been reported to be 6.5-8%.

Ethnic Variability:
A great deal of ethnic variability in hirsutism is observed.
For example, Asian (East and Southeast Asia) women have less hirsutism than white women given the same serum androgen values.
In a study that assessed hirsutism in southern Chinese women, investigators found a prevalence of 10.5%.
In hirsute women, there was a significant increase in the incidence of acne, menstrual irregularities, polycystic ovaries, and acanthosis nigricans.

About Acanthosis nigricans:
Acanthosis nigricans is a skin condition characterized by areas of dark, velvety discoloration in body folds and creases. The affected skin can become thickened. Most often, acanthosis nigricans affects your armpits, groin and neck.

The skin changes of acanthosis nigricans typically occur in people who are obese or have diabetes. Children who develop the condition are at higher risk of developing type 2 diabetes. Rarely, acanthosis nigricans can be a warning sign of a cancerous tumor in an internal organ, such as the stomach or liver.

Affected Ages:
PCOS affects premenopausal women, and the age of onset is most often perimenarchal (before bone age reaches 16 y).

However, clinical recognition of the syndrome may be delayed by failure of the patient to become concerned by irregular menses, hirsutism, or other symptoms or by the overlap of PCOS findings with normal physiologic maturation during the 2 years after menarche.
In lean women with a genetic predisposition to PCOS, the syndrome may be unmasked when they subsequently gain weight.