Selected aspects of polycystic ovarian disease
Goldzieher, J.W.; Young, R.L.
Endocrinology and Metabolism Clinics of North America 21(1): 141-171
1992
ISSN/ISBN: 0889-8529 PMID: 1533584 Document Number: 320913
Ultrasonography provides physicians much information for the epidemiology and diagnosis of polycystic ovarian disease (PCOD)--a yet to be defined associated syndrome. For example, some physicians used it to reveal that 92% of women with hirsutism and regular menstrual cycles had PCOD. Considerable research exists on the link between insulin resistance. PCOD, and hyperandrogenism. Some results confirm the link while others do not. Abnormal gonadotropin dynamics are 1 of the most consistent characteristics of PCOD. Researchers have conceived various hypotheses for PCOD. A long-lived hypothesis is that elevated estrone levels which occur regularly in PCOD increase the sensitization of pituitary luteinizing hormone (LH) secretion and reduces secretion of follicle stimulating hormone to the gonadotropin releasing hormone stimulus. Another hypothesis is that progesterone deficiency facilitates PCOD. Various PCOD treatments exist. Physicians have treated PCOD with clomiphene citrate or nighttime small doses of corticosteroids for 20-30 years. Recent observations indicate the dexamethasone has a longer half life than prednisone or prednisolone. Since almost 50% of women with PCOD are obese, weight reduction has beneficial effects. Administration of progesterone is a possible treatment that is often ignored. Several clinical studies have included administration of bromocriptine to women with PCOD since a sizable number of such women have high levels of prolactin indicating a possible dopamine deficiency. The studies with bromocriptine have not showed much promise. Evidence suggests that administering oral contraceptives to premenopausal women with PCOD may reduce their risk of later developing ovarian cancer. Gonadotropin and gonadotropin releasing hormone therapies are possible means of inducing ovulation in PCOD women. Various physicians have used laparoscopy to apply different techniques to induce ovulation in women with PCOD. These techniques included sharp puncture, electric current, and laser vaporization or endocoagulation of the cysts.