To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Ovarian endometriomas are a common and specific manifestation of the disease endometriosis. In vitro fertilization (IVF) treatment in the words of the European Society of Human Reproduction and Embryology (ESHRE) Special Interest Group (SIG) on Endometriosis appears to be appropriate in patients with advanced endometriosis, which is frequently associated with adhesions, ovarian endometriomas, and tubal obstruction. Ovarian responsiveness to hyperstimulation plays a crucial role in determining the success rate of IVF. There are currently insufficient data to clarify whether the endometrioma-related damage to ovarian responsiveness precedes or follows surgery. Elucidation of this point is of utmost interest since it would strongly impact on the decision of whether to operate on women with endometriomas and who are selected for IVF. At present, there appears to be evidence supporting both an endometrioma-related injury and a surgery-mediated damage. The physiological mechanisms leading to ovulation are abnormal in ovaries with endometriomas.
Polycystic ovary syndrome (PCOS) is the most common endocrine disturbance, affecting 10-15% of women in the UK. The definition of PCOS has been much debated, while its pathophysiology appears to be multifactorial and is still being actively researched. There is no doubt that PCOS has a significant effect on quality of life and psychological morbidity and, as many specialists are involved in its management, a multidisciplinary approach is required. The 59th RCOG Study Group brought together a range of experts who treat women with PCOS. This book presents the findings of the Study Group, including:A definition of PCOSThe accuracy of diagnostic interventionsThe particular challenges of adolescent diagnosis and managementThe correlation to ethnicityCurrent approaches to therapyThe potential individualisation of therapy The role of the alternative therapies used to manage some aspects of PCOS.
This chapter describes the diagnosis, pathophysiology, treatments, and current management of polycystic ovary syndrome (PCOS). A definitive diagnosis of PCOS can be difficult to achieve in adolescence and an early diagnosis should be re-evaluated in adulthood. The management of PCOS (including its long-term health risks) is best delivered by a multidisciplinary approach, including dietary and educational counselling, exercise training, stress management and psychosocial support. All women with PCOS should be assessed for the risk of developing impaired glucose tolerance and type 2 diabetes. Metformin is overused in the treatment of PCOS and is ineffective as a solo agent or in combination to treat infertility and to achieve live births. Large cross-sectional studies are required of different ethnic communities to assess the prevalence of PCOS and longitudinal studies are required of its evolution over time, from puberty and throughout life.
The majority of women with anovulation or oligo-ovulation due to polycystic ovary syndrome (PCOS) have clinical and/or biochemical evidence of hyperandrogenism. This chapter describes treatment with clomifene, aromatase inhibitors, gonadotrophins, and metformin. Weight loss has the undoubted advantages of being effective and cheap with no adverse effects and should be the first line of treatment in obese women with anovulatory infertility associated with PCOS. The aromatase inhibitors letrozole (Femara, Novartis) and anastrozole (Arimidex, AstraZeneca) have mainly been employed for the treatment of postmenopausal women with advanced breast cancer. In women with PCOS, metformin is said to lower fasting insulin concentrations but also probably acts directly on theca cells and attenuates androgen production. There is now sufficient evidence that low-dose step-up gonadotrophin therapy should be preferred to the now outdated conventional therapy for anovulatory patients and particularly for those with PCOS.
Polycystic ovary syndrome (PCOS) is a heterogeneous collection of signs and symptoms that, gathered together, form a spectrum of a disorder with a mild presentation in some, whereas in others there may be a severe disturbance of reproductive, endocrine and metabolic function. The definition of the syndrome has been much debated, with key features including menstrual cycle disturbance, hyperandrogenism and obesity. The pathophysiology of PCOS appears to be multifactorial and polygenic and is still being actively researched. PCOS is the most common endocrine disturbance and affects 10-15% of women in the UK. The clinical findings of hirsutism, acne, alopecia and obesity do not always correlate with the serum biochemistry, which itself may be difficult to assess. There is no doubt that PCOS has a significant effect on quality of life and psychological morbidity and, as many specialists may be involved in its management, a multidisciplinary approach is required.
The 59th RCOG Study Group brought together a wide range of experts who treat women with PCOS and the clinical conditions related to the syndrome. The actual definition, the accuracy of diagnostic investigations, the particular challenges in adolescent diagnosis and management, the relationship with ethnicity and issues relating to the clinical care of women with PCOS are all covered in this comprehensive book.
Polycystic ovary syndrome (PCOS) is associated with approximately 75% of the women who suffer from infertility due to anovulation (Adams et al. 1986, Hull 1987) and is frequently diagnosed for the first time in the infertility clinic. The majority of women with anovulation or oligo-ovulation due to PCOS often have clinical and/or biochemical evidence of hyperandrogenism. Almost all these women will have a typical ultrasonic appearance of the ovaries (Adams et al. 1985).
Making the diagnosis of PCOS is important as this will dictate the treatment plan and the prognosis, and will serve in the avoidance of possible complications of treatment. Before embarking on ovulation induction therapy, although not theoretically essential for initial therapeutic decisions, for screening I usually take a blood sample for luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone, and fasting glucose and insulin concentrations. The ratio of fasting glucose to insulin levels gives a good indication of insulin sensitivity (Legro et al. 1998) and as hyperinsulinemia is present in about 80% of obese women and 30–40% of women of normal weight with PCOS (Dunaif et al. 1989) and is strongly associated with anovulation then it is certainly useful to know for possible therapeutic intervention. The LH value may be expected to be high in 40% of women with PCOS and is thought to be detrimental to successful ovulation induction and to the incidence of miscarriage (Balen et al. 1995).
Email your librarian or administrator to recommend adding this to your organisation's collection.