LO Obgyn 1.

2 Dapots
1. USG pada PCOS

PCOS biasanya exhibit 3 characteristics on USG : Bilateral enlarged ovaries, multiple small follicles, and
increased stromal echogenicity

 Symmetrically enlarged ovaries. The shape change from ovoid to spherical. Ovarian volume can increase as
much as 6 ml, tapi gk semua ada increased ovarian volume
 Contain numerous follicles, follicles are small (0.5 – 0.8 cm), no dominant follicle is present. Paling sering
follicle nya ada di cortex tapi bisa juga di parenchyma. 5 atau lebih follicles bisa jadi diagnosis PCOS
 Org PCOS ovariumnya ada increased echogenicity (normalnya ovaries are hypoechoic dibandingkan
dengan surrounding pelvic fat and myometrium). Tapi biasanya di PCOS sepertiga dari ovarium masih
isoechoic atau hypoechoic relative to the myometrium
2. PCOS  A condition affecting ovaries

Three main features (syndrome) :

 Irregular periods  Ovaries irregularly release eggs (ovulation)

 Excess androgen  Hirsutism
 Polycystic ovaries  Pembesaran ovarium dan terdapat banyak follicles (fluid-filled sacs)

Diagnosis

At least meet 2 of these criterias :

 Chronic anovulation
 Hyperandrogenism
 Polycystic ovaries

Lab diagnosis :

 LH level  2-3 kali FSH (walaupun masih dalam normal range)  Elevated LH to FSH ration of 3 : 1
The change in the ration disrupts ovulation
 Increased free and total testosterone
 Increased greater than 200 ug/dl
 Bisa normal bisa elevated 25-40 ng/ml
 Estrogen within normal range because high insulin and testosterone is sometimes converted into
estrogen
 High level of PCOS (based on research) can cause insulin resistance and cause PCOS
 Based on research PCOS can cause high cholesterol, high LDL, high triglyceride, low HDL  Can cause
heart disease
 Fasting blood glucose tend to be high (> 126 mg/dl)

3. Nilai normal hormone perempuan pada hari ke 23

 LH & FSH
 At the beginning of the cycle  5-20 mlU/ml
 24 jam sebelum ovulation LH melonjak menjadi 25-40 mlU/ml. Setelah ovulasi, LH levels goes back
down
 Progesterone
 Produced by corpus luteum after ovulation helps to prepare the uterine lining for pregnancies
LO Obgyn 1.2 Dapots
 Orang yg PCOS dan mau hamil harus check progesterone levels 7 days after ovulation. Kalau nilainya
tinggi (biasanya lebih dari 14 ng/ml) itu berarti ovulasi benar-benar terjadi (egg eas released from the
ovary). Orang dengan PCOS biasanya merasa bahwa ovulation terjadi, tetapi kalau test nya
menyatakan hasil yg lebih rendah maka ovulation dikatakan tidak terjadi. Jika itu terjadi,
kemungkinan tubuh tetap memproduksi follicle dan prepare untuk ovulation, but for some reason the
egg is actually not released form the ovary.
 Total serum testosterone
 6 – 8.6 ng/dl
 Free testosterone  amount of testosterone that is unbound and actually active in your body
 0.7 – 3.6 pg/ml
 Dehydroepiandrosterone (DHEA-S)
 Secreted by the adrenal gland
 35-430 ug/dl
 Fasting blood glucose
 N < 126 mg/dl
 Prolactin
 Less than 25 ng/ml
 Thyroid Stimulating Hormone
 Produced by thyroid
 N = 0.4 – 3.8 ulU/ml
 Underactive or overactive thyroid can often cause irregular or lack of period and anovulation
 Adrostenedione (ANDRO)
 Produced by ovaries and adrenal glands
 0.7 – 3.1 ng/ml
 Elevated levels can affect estrogen and testosterone levels
 Estrogen
 Secreted by ovaries and small quantities by adrenal glands
 Bentuk aktifnya adalah estradiol
 N = 25 – 75 pg/ml