Comparative study of the clinico-trichoscopic response to treatment of hirsutism with long pulsed (1064 nm) Nd:YAG laser in idiopathic hirsutism and polycystic ovarian syndrome patients

Polycystic ovarian syndrome (PCOS) is the commonest cause of anovulatory infertility. Depending on the population studied between 5 and 18% of women of reproductive age suffer from PCOS, however not all of them are anovulatory or experience subfertility. PCOS has been associated with numerous reproductive and metabolic abnormalities. Despite enormous advances in the management of reproductive dysfunction, insight into the metabolic implications of PCOS is limited by the lack of uniform diagnostic criteria, the heterogeneity of the condition and the presence of confounders including obesity. Obesity clearly has a role in long term health and may best predict both reproductive and metabolic dysfunction as well as negatively affect the response to treatment in women with PCOS. Diabetes, cardiovascular disease and cancer are also at the forefront of any risk assessment or comprehensive treatment strategy for these women. Lifestyle modifications including dietary changes, increased exercise and weight loss are appropriate first line interventions for many women with PCOS. Pharmaceuticals including metformin, lipid lowering agents and oral contraceptives should be tailored to the individual’s risk profile and treatment goals. The fertility treatment in women with subfertility and PCOS aimed to safely induce monofollicular ovulation resulting in the birth of a singleton child. Women with PCOS undergoing fertility treatment are at risk of multi-follicular development as well as ovarian hyper-stimulation syndrome (OHSS), so they must be carefully counselled and monitored during fertility treatment. It is imperative that prior to embarking on fertility treatment, a patient’s health and weight is optimised. This chapter will explore the latest evidence for fertility treatments for women with PCOS.

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HIRSUTISM

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.06.1629 ◽

2016 ◽

Vol 23 (06) ◽

pp. 741-745

Author(s):

Muhammad Usman Anjum ◽

Surriya Yasmin ◽

Hashim Riaz ◽

Syed Humayun Shah

Keyword(s):

Large Scale ◽

Polycystic Ovarian Syndrome ◽

Free Testosterone ◽

Descriptive Study ◽

Drug Induced ◽

True Prevalence ◽

Idiopathic Hirsutism ◽

The Common ◽

Ovarian Syndrome ◽

Follicular Stimulating Hormone

elf-esteem, psychological distress and cosmetic embarrassment. Objective: Tostudy the clinical, biochemical and etiological profile of patients with hirsutism in Abbottabad,Pakistan. Duration and place: This descriptive study was performed in Frontier Medical & DentalCollege, Abbottabad from January, 2015 to December, 2015. Methods: Fifty patients wereincluded in the study. Complete clinical assessment and abdominal and pelvic ultrasonographywas carried out. Ferriman and Gallwey score was used to assess the extent and pattern ofhirsutism. Endocrinological investigations performed in these patients included prolactin,testosterone, luteinizing and follicular stimulating hormone (LH, FSH), thyroid function testsand cortisol. Results: Fifty patients were included in the study. Their mean age was 28.30±5.83years. About 88% of the women were married and 70% were obese. The polycystic ovariansyndrome (58%) was diagnosed as the main cause of hirsutism followed by idiopathic hirsutism(38%) and drug-induced hirsutism (4%). Majority of patients, 50%, had hirsutism for 1-5 yearswhile 22% and 20% had hirsutism for 6-10 years and > 10 years respectively. The rate of infertilityamong hirsute women was 70% (35 cases), out of which, 24 (48%) cases had primary infertilitywhile 11 (22%) had secondary infertility. Most of the hirsuite patients, 26 (52%), presented withthe complaints of infertility and menstrual disturbances followed by infertility alone in 9 (18%)cases, hirsutism in 6 (12%) cases and menstrual irregularities in 5 (10%). The 60% of patientsbelonged to moderate category according to FG score, (FG score 17-24). The 26% belonged tomild category (FG score 8-16) and 14% belonged to severe category (FG score 25-30). About72% of our patients used treatment of any kind for their disease. The common hair removingpractices used by these patients included bleaching (22%), waxing (20%), epilation (20%),electrolysis (6%) and shaving (4%). Serum free testosterone levels were elevated in 44% of ourpatients, LH/FSH ratio was more than 2 in 42.1% patients and prolactin levels were raised in10% of the patients. Conclusion: Hirsutism is not uncommon in Pakistan. The most commoncause of hirsutism was polycystic ovarian syndrome and idiopathic hirsutism. There is a need toconduct large scale studies to determine the true prevalence and etiological profile of patientswith hirsutism.

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