Tag Archives: medical education

Polycystic Ovary Syndrome (PCOS) – Causes, Risks and Treatments

Hey everyone! In this lesson, I’m going tobe talking to you guys about polycystic ovary ailment, what it is, what are someof the causes of the disorder, what are some diseases that are highly associatedwith polycystic ovary ailment, and then finally, I’m going to talk to you guysabout some care methods to help alleviate some indications of polycysticovary illnes. So to begin, what is polycystic ovary condition? Well as thename shows, it involves a polycystic ovaries.So ovaries with multiple cysts, and you can actually see this on an ultrasound of a patient’s ovaries. Youcan actually visualize these like black little flaws, that look like black hole – they’re actually cysts within the ovary. So what are some of the specific features, or what are some of the symptoms of the disorder? Well one of the main ones ismenstrual breach, and this irregularity can happen as soon as the patient actually registers pubescence. So a lot of epoches, these patientswill have a delayed onset of menarche, or a delayed onset of their first period.So they have their first period a little bit later or a little bit older thanaverage. They likewise can have oligomenorrhea, which is having lessthan nine menstrual dates per year. So they have less menstrual ages, andduring their adulthood, sometimes we are to be able to even have amenorrhea, which isno menstrual stages at all – so they just go through theirlife without having any periods whatsoever.But interestingly enough, we are to be able to have a regularization after the age of 40 andwhat I imply by that is they often have a lot of these indications such as oligomenorrhea and/ or amenorrhea, but these can actually kind of normalize after the ageof 40. So after 40 years of age they can havemore regular spans. And another prime the special characteristics of polycystic ovarysyndrome is hyperandrogenism, and this is kind of one of the big ones( kind of oneof the big characteristics) that make a lot of the perceptible evidences that you seewith these patients.The first one is acne – acne is verycommon in cases with polycystic ovary disorder because of the high levels ofandrogens. Another one is hirsutism – now hirsutism is actually precisely a expansion ofhair, so these patients oftentimes will grow or have more terminal hair growthso you get this kind of darker hair developing particularly on their face or onother parts of their body. And another one is actually hair loss – soit’s almost a kind of a male pattern hair loss due to high levels ofandrogens. Now what is the incidence of this syndrome.Well the frequency isquite alarming. It’s actually one of the most common endocrine operatives inwomen and frequently about 6.5 to 8% of women are affectedwith this syndrome. So what are some of the medical conditions that arehighly associated with the polycystic ovary condition? Well first off approximately 40 to 85% of women withpolycystic ovary condition are overweight or obeseso there’s oftentimes a connection between BMI and polycystic ovarysyndrome so this leads us to a inventory of conditions that are associated withoverweight and obesity itself, such as type 2 diabetes. So women with PCOS normally have an increased risk of nature 2 diabetes againthis follows in line with glucose xenophobium and insulin resist. Theyare also at risk for dyslipidemia — which again follows insulin resistance and becausethey are at a higher risk of being overweight or obese, they have a higherrisk of having obstructive sleep apnea( OSA ). Another condition that’s associatedwith insulin resistance in obesity is non-alcoholic fatty liver disease andwomen with polycystic ovary disorder have a higher incidence of non-alcoholicfatty liver disease, and you can see here that on the left that’s a regular liveron the left, but the one on the right is a fatty liver, and you can see there’s alot of lipid droplets within the liver. Again, a lot of these women too suffer from depression and suspicion. And because, as I mentionedbefore, they have menstrual inconsistency they can often have anovulatoryinfertility, so if they have amenorrhea, typically they have something known asanovulatory infertility, so they actually don’t ovulate properly and they becomeinfertile as a result.Another one is endometrial hyperplasia -now endometrial hyperplasia is just an overgrowth or undue swelling of theendometrium within the uterus and now this also leads to an increased risk ofendometrial cancer because of the hyperplasia. Now moving on to some of theetiology and pathogenesis of polycystic ovary ailment – to begin the etiology isunclear, it’s hasn’t really been explained at present; however, althoughthe etiology is unclear it is known that sure-fire types are at a higher riskof polycystic ovary condition. Souls again who are obese are typically athigher risk of having polycystic ovary ailment( association , not definitely causation ). As I mentioned beforethose that are insulin resistant are at a higher probability of polycystic ovarysyndrome.Type 1 and kind 2 gestational diabetic mummies are also at a higher riskfor polycystic ovary condition. Another one is premature adrenarche.Now adrenarche is the start or the onset of the adrenal glands toproduce androgens. So during childhoodpeople often display some quantities of androgens very low quantities, but souls that have a premature adrenarche seem to be at a higher risk of polycystic ovary syndrome. Likewise peoplewith first-degree relatives that have polycystic ovary ailment are at ahigher risk of going it themselves and now this gives credence to possiblegenetic affects. So a lot of these may be the cause of polycystic ovarysyndrome or perhaps the result – it’s still not known for sure, but again thefirst-degree relatives appear to show that there are some geneticinfluences in matters relating to polycystic ovary syndrome.And that kind of leadsinto the pathogenesis, and really there have been multiple studies showing thatthere is some genetic attribute involved and there does appear to be environmentalfactors that influence the onset or the phenotype of the polycystic ovarysyndrome. Some studies have shown that perhaps there are certain genes onchromosome 2 or chromosome 9 – here’s a handful of different genes or proteinsthat may be involved in polycystic ovary illnes. One is luteinizinghormone receptor. Another one is human chorionic gonadotropin receptor. Theother one is called FATA. Another one is androgen receptor, another one is sexhormone binding globulin.Another one is DENN/ MADD domain-containing protein 1a andthe last one again is insulin. So there still could be some issue with insulinor insulin signaling that’s predisposing someones for polycystic ovarysyndrome. And in fact as most of the affiliated jeopardies involved withpolycystic ovary syndrome show is that a lot of them seem have insulin being involved such as insulin resistance and obesity anddifferent types of diabetes. And another important thing is that insulin isactually an activator of thecal cell production processes androgens, sothecal cadres are the cadres that actually surround a developing follicle withinthe ovary and insulin actually arouses the thecal cadres to releaseandrogens. So again, that’s another possible mechanism by which polycysticovary ailment makes hyperandrogenism. So now that we know some of the symptomsand some of the risks and some of the diseases associated with polycysticovary syndrome, what are some of the managements we can give to these patients? Well one of the first things we like to focus on are some lifestylechanges, because as I mentioned before a large amount of cases with PCOS are overweight or obese, so we like to try to change some of thoseparameters.So we like to get them on a food or rehearsal really to try to reduce their BMI try to reduce their heavines and to try tonormalize their insulin, insulin forbearance, and glucose tolerance. There’salso some pharmacologic medications as well and this is particularly importantfor stabilizing the menstrual irregularity. So some of these include the following: combinedestrogen progestin contraceptives are very effective, oral contraceptives can analyse not only the menstrual irregularity but alsohyperandrogenism something else that’s important is medroxyprogesteroneacetate and you can give this to patients and this is veryimportant for giving and for protecting these patients against anyendometrial cancer as I mentioned before.This may nottreat the hyperandrogenism instantly but it considers or protects theendometrium from any hyperplasia or cancer. Metformin again is a regulatorof insulin signaling and this has been been shown to help a little bit withwith the polycystic ovary syndrome evidences. Now for cases that arejust not getting the effect that they crave, they’re not assure, you know, the changes that they demand perhaps they still have hirsutism or bad acneyou can give these patients antiandrogens, such asspironolactone and finasteride. These two medications can act to impede androgeninfluence and treat some of those hyperandrogenism indications such as acne, hirsutism. And another set of pharmacologic treatment is the gonadotropinreleasing hormone agonists that can help stabilize the mental cycle as well.Anyways guys, that was a brief lesson on polycystic ovary syndrome.I hope you foundit helpful and thank you so much for watching and have a great day !.

THE TWO WEEK WAIT: Week 3 Pregnancy Vlog

welcome back everyone last week wetalked all about optimizing natural fertility so if you missedany of those great tips-off about going pregnant fast go back and check outepisode two which implies this week we are on weekthree of our 40 -week pregnancy journey and we’re going to be talking abouteverything that happens after ovulation fertilization the embryo’s journeyimplantation and the dreaded two-week weight make sure you stay tunedat the end of this episode we’re going to take a pregnancy test we’re bothreally excited about that area but in cases your first time meeting us we’reboth physicians documenting our own trying to conceiveand hopefully our own pregnancy travel sharing some professional medical informationalong the way i’m sarah i’m an ob gyn i’m kurt apediatrician and we are the doctors the part so today is week three in our week byweek leader to everything that’s happening in pregnancyfrom the doctor’s side of things this 40 week series is going to covereverything in terms of children growth and pregnancylabor and delivery in addition to all that we’re also going to be sharingwhat’s going on in real life the books we’re reading things we’redoing to prepare and other things we’re learning as hopefulsoon to be mothers we’re going to find out if all that advice we’ve been givingpatients over the years is going to stack upand stay sung at the end of this episode we are going to takea pregnancy test after our very own two week wait yeahlast week we talked all about ovulation tips-off to get pregnant fastbut what about after all that effort what happens nextso in other words this week we’re going to be talking about during that two-weekwaiting period after ovulation before you can take apregnancy test so the two-week wait is brutal uh thedays kind of time creep by and you’re waiting and waiting andwaiting and i’m feeling my tits to see if i’m feeling any changes and i’mlooking for body changes and googling all sorts of things i’m inob gyn and i’m googling these meetings on when people got their firstpregnancy positive pregnancy research and i’m googling what people’s earlypregnancy indications were and looking at things about implantationbleeding and it only constructs you crazy and then you have another two week waitbecause you weren’t pregnant the first time and then you have another one andi’d say by the third one i was convinced i would probably never get pregnantum and i know that these things are all normalso it’s a crazy process and that’s where we’re at which means thatwe’re going to talk about the very first meeting of sperm and egg and thatjourney and developed at a baby fetu so around daytime 14 of the menstrual cyclethe ovary secretes an egg and that is called ovulation that isthat big occurrence that you are trying to time sex with to optimize your chancesof getting pregnant after that egg is released the fallopiantube cleans around the ovary and picks up that egg in about two to threeminutes and then pushes it into the upper end ofthe fallopian tube and there is where that egg and seman converge frequently within2 4 hours of the egg being liberated that that fertilized egg hangs out inthe upper culminate of the fallopian tube for about three daysbefore making an epic three-day journey down the tubeto the uterus this first six days howeverisn’t just about making a journey from the ambulance to the uterusduring this time the fertilized egg is actually ripen ripening and dividinggrowing and subdividing going from two cadres to four cells to eight cadres untilit’s a 64 cadre blastocyst which at that time is already startingto differentiate in between the component that is the placentaand the part of that is baby over the week after that there’s a complex seriesof happens that are available as this does ready for implantationimplantation occurs often around daylight 9 but could be anywhere from era 6to daylight 12. It is also around this time of implantation that that outer seam ofcells of the blastocyst start secreting human chorionic gonadotropin or hcgand that is the hormone that you’ve been waiting for because hcg is what isdetected by a pregnancy test hcg can be detected in the blood asearly as eight days after fertilization and that level only preserves originating andgrowing until it’s able to be detected in a urinearound 10 to 14 epoches after fertilization and that’s what you’re picking up onyour home pregnancy test okay let’s talk about pregnancytests some people say wait till you’re missedperiod some people start testing on post ovulation day eight that with mei just couldn’t wait and started pee-pee on a stickas soon as i thought there was a chance that there was hcg inthe urine um so there’s a variety of tests if you’re going to experiment earlythis is a the one i use because it sees an hcglevel of like six to ten um there are the digital ones that have a digitalreadout that say pregnant or not there’s the triple jam-pack where one is anearly test one is done in 60 seconds and then one’sdigital um they’re all super expensive and soby my second or third two week wait i said we just can’tpay for that and so i discovered these wandfo six dates sooner on the lovely amazon iwill introduced a relation for them below um and then there little divests it comesin a jam-pack of 25 testing and they spy an hcg of ten. so this is how to pregnancy test early on a budgethaving done all this testing in early testing i will say the one downside tostarting to test early is that you get that negative onpost ovulation daytime eight and then you get a negative on berth ovulation daytime 12 and then you get another negative and then you get your period and it was justso many epoches of kind of being let down thatit can be really hard and so you are going to have todecide what is best for you and what your heart can handlein this process so we want you to know that even though the buildinganticipation you may be feeling during this two-week wait can border on torturethere’s a couple of things you can keep in mind that might make it a little biteasier the maternity hasn’t really deposited untilsix to eight epoches after the seman encounters the eggand then after that there’s still a few more eras until the maternity hormonegets to a tier that’s detectable on your home maternity exam rightknowing all this for us having established it a bit more exciting as we are rooting theprocess on uh every two week journey we wentthrough and also made it a bit more exciting knowing whentest day was coming so keep sung we are going to take apregnancy test here at the end of our two-week wait right after thisand satisfy keep in mind you may have to endure a few of these two-week weightsbefore you get your positive pregnancy evaluation and that is verynormal so we’re back we’re on month three of trying one threepost ovulation day number eleven eleven eleven um and we’re gonna see if uh thismonth was the month paws spanned more calamity ormaybe some excitement um i think neither of us are thatoptimistic this month for whatever reasonum partly because sarah was negative yesterday when she experimented without meum but we’ll see what happens today yeah is it time can you walk now we canlook now okay he’s like you can glance sure how am i gonna looklook is that a sham one this is no longer a drillthis one’s real this one’s real you’re kidding noyou’re not kidding no there’s two cables this month no way do you have to keep recording i entail ithought it would be really funny to get this livebecause i knew he would cry anyway well that’s excitingthat’s exciting i didn’t think that was gonna happen how does it realize you feelreally scared um and stimulated and nervous andum we’ll find out now we get to see what happenswe’re hoping it lodges yeah things can happen a lot of things canhappen one in four clinically recognized pregnancies ends with miscarriage andthis is not clinically recognized hitherto wewould be three weeks and four epoches along at this phase socool nature to genuinely making the commotion statu up for this momentso uh obgyn brain exactly doesn’t shut off anyway there’s two boundaries that’s fun ohyeah yeah yeah there’s also this one you what did youdo these did you know this did you know this yeah you knew todayyeah you’re such a beard i may or may nothave experimented this morning while kurt was at work heis on call this weekend and um i thought it was too early i didn’tthink it’d be positive but i make those stupid little experiments every dayand actually yesterday i thought it was starting to turnpositive on that little deprive but i thought i was imagining iti was like no that’s just an evaporation text i’m making this upi always reposted it it was very much what they call a squinterum well yeah because i sent scenes to mel and she was liketake another one so anyway well uh the tests say pregnanti probably can’t read that out of focus but anyway umi guess we’ve got um 38 weeks to go so uh we’ll told you next week surprise we’re doctors but not your doctorsanything we’ve said in this video is for education orentertainment roles merely “its not” medical adviceany specific medical questions you have should be directed to your provider