PCOs (polycystic ovarian syndrome): is a hormonal disorder

discovered by 2 scientist(stein and leventhal) for pathology in 1932-1933,in 1934 7 cases

discovered ,in 1935 they suggest a treatment. It’s also known as syndrome. they knew it’s
etiology(modified now) ,pathology and symptoms(same).
•no cure for this disease, it’s incidence show increase in the last century
•The WHO each month spread awarness about breast cancer, pelvic endometreosis (march),PCOs
(september) because it’s incidence is increasing in an epidemic way, it affect about 10% of
women in the world, it’s about 6-10% in America and about 4 millions are diagnosed with pco
yearly and this costs USA about 4.3 billion dollar to treat PCOS and it’s complication.
•This disease is widely spread in high % in India is about 20%, girl (15-23 year ) is about 30%
which affect fertility in abad way ,the second country is Middle East (Egypt it’s about 30%)
•Symptoms (disturbed menstrual cycle, oily skin, hair fall , hair all over body, fatigue, hirstisum,
high level of testesterone, late pregenancy: pcos is considered one of the main reason for
infertility in the world nowadays, 80% of female with ovulatory problem are bec of pcos )
•100% of people with Pcos will have Diabetes, 25% may have atherosclerosis ( lifelong disease)
•Reasons for Pcos is unknown but runs in families (genetic tendency, gene not exactly known,it’s
present in 30% in female but not all have they are just susceptible to pcos (epigenetic), it’s
affected by other 2 factors that may lead to increase incidence and activate gene.
•Pcos is related to family tendancy of diabetes (insulin resistance), abnormal level of insulin, the
main job for insulin is to open the gate for glucose enterance so decrese level ,what happen in
insulin resistance (genetic) ;when increase in weight ( change in feeding habit) the fat cell expand
receptor shape change insulin can’t fit ,glucose don’t enter so pancrease produce more insulin
gates open glucose enter in extensive way; glucose drop so feel headache, hungry to eat carb so
cycle continue insulin is always high so by time end expose to diabetes. High insulin get with it
LH hormone.
•Ovary work by 2 hormones FSH ,LH . At the start of period FSH have to be double LH; people
with insulin resistance have hyperinsulinema increase LH in constant way cause arrest to follicle
in ovary so thickening in ovarian capsule , androgen levels increase, LH normally only increase
in middle of month to rupture matured follicle.
•Ovary contain enzyme (aromatase) when there is androgen change to insulin, When LH increase
androgen inc and decrease aromatase action
•insulin resistance = high insulin = high LH= thickening in ovarian capsule = arrest of follicular
growth = increase in ovarian androgen affect aromatase activity= more and more androgen by
ovary instead of estrogen by time get out in blood cause symptoms.
SYMPTOMS
•Hirsutism, acne, oily skin, high androgen in blood, hair loss, no ovulation, late pregenancy,
disturbed menstrual cycle (not necessary) , oligomenorrhea, hypomenorrhea, irregular period and
some cases have regular one ,increase in weight in certain area with difficulty to lose which lead
to more insulin resistance so more and more LH ( weight gain lead to pcos and vice versa),
hypertension , high cholesterol, atherosclerosis, female with pcos and pregnant higher abortion
rate about 48%, higher rate for cesarean section, higher chance for DM and HTN during
pregnancy.
Clinical picture
•high androgen in female blood change in fat in to a type of estrogen known as esterone (bad,
carcinogenic)
•no ovulation , no menstruation which lead to estrogen increase from follicle without
progesterone lead to thickening of endometrium continous exposure to this end with endometrial
hyperplasia that end with endometrial carcinoma
•recently 20% of PCOs patient are lean (thin), lean PCOs is most difficult and persistance cases
and fail to respond treatment bec first line of treatment is weight loss and they are already thin.
•obesity mean high fat cell so high bad estrogen and also decrease globulin protein produced
from liver (6 hormone binding globulin) which is normally hold androgen and estrogen so
bounded form not free to work so obesity when decrease protein cause the free form of androgen
and estrogen to inc so affect the body.
PCOD (polycystic ovarian disease): disease affect one system
PCOS(polycystic ovarian syndrome): affect more than system

Diagnosis
•in past test for FSH,LH hormone
•nowadays autogram standard (2 out of 3 criteria: 1- irregular period (women get period 9 or less
times in year through tracking ovulation), 2- symptoms of androgen excess either clinically or
hormonal in lab , 3- Ultrasound vaginal : ovary size 10cm , multiple cyst in ovary (12-25)of size
9 ml , US alone don’t diagnose and don’t deny that someone have PCOs. (abdominal US not very
accurate), Us very good in water area magnify it
Treatment and controlling:
1- Diagnosed with PCOs
2- change lifestyle( weight loss , diet ,exercise, sleep)
3- take contraceptive pills (some used with high androgen effect) if stop suddenly and PCOs not
treated well may return back
4- use insulin sensitizer (metformin ,sedovag): increase sensitivity of cells to insulin so decrease
insulin resistance
5- laser and before it hormonal treatment
6- if want to get pregnant take drugs to improve ovulation bec pcos may cause infertility but not
permenant
7- severe cases do for them labroscopic ovarian drain bec of idea of thick ovarian capsule