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 !.