pcos

Ovulation

Release of ovum from ovary

Rupture of graffian follicle

Stages of ovum maturation

1. Primordial

2. Secondary ( pre antral )

3. Teritary ( antral )

4. Graffian

Mrkh syndrome name

Mullerian agenesis

Mullerian agenesis means ?

Agenesis is a complete failure of an organ or body parts development during embryonic development

Mullerian refers to mullerian ducts

The ducts that are formed in female reproductive tract

What is mrkh syndrome ?

Functional ovaries

But no uterus or cervix or upper vagina

Mrkh has secondary amenorrhea

Wrong primary amenorrhea

What is CAH

Congenital adrenal hyperplasia

Cushing syndrome is caused because of

High cortisol

If total testosterone is very high this would indicate

Tumor on ovary or CAH

Why free testosterone is elevated

Because of low shbg

Why shbg is low

Hyper insulin

Dhea is mainly produced by

Zona retucularis in adrenal cortex

Androstendion is mainly in

Ovary

Why prolactin cause pco like symptoms

Prolactin causes negative feedback on lh

Decreases gnrh activity

So lh is low no rupture of graffian follicles

T3 is low then shbg is low why ?

Because t3 stimulate production of shbg in liver

Tsh has to be low especially if trying to conceive . Tsh should be ?

Below 2.5

Mechanism of action of metformin

Decrease

1. Hepatic glucneogenesis

2. Intestinal glucose absorption

3. Peripheral glucose uptake

Myoinositol

Is a part of secondary messenger system

Granulose cells are high in vitamin b 8

True

2ry messenger system

Moves signal forward

Examples of 2ry messenger

Camp

Ip3 ( inositols triphosohate )

Dag

Calcium

Secondary messnger is generated after ?

Receptor is stimulated

Co factor types

Essential

Accessory

Menarch

First menstrual period in a woman’s life

Amh is used as a potential alternative to ultrasound why ?

Amh is produced by small antral follicles

What is secondary amenorrhea

If no period for 3 months ( if cycles were regular before )

Or

If no period for 6 months ( cycles werent regular )

MRKH SYNDROME ?

Mullerian agenesis

Estrogen levels through menustral cycle

In Follicular phase ( low then gradually increases then rises pre ovulation to trigger ovulation to exert postive feedback on lh for ovulation

And then gradually decreases and drops if no pregnancy

Estrogen effect on lh during menustral cycle

Negative feedback on lh

Then postive feedback

Why negative feedback from estrogen on lh

To prevent early lh surge

To prevent early ovulation

To prevent multiple dominant follicles formation

Lh surge stays for ?

24 to 48 hours

Progesterone levels on pcos

Low

What is oocyte

Immature egg

Ovum

Mature egg

Ovum contains

Theca cells and granulosa cells

Theca cells have what receptors

Lh receptors and insulin receptors

Is lh elevated in pcos

Yes chronically elevated

Effect of elevated lh on theca cells

Stimulate production of androgens

Why aromatase enzyme is low in pcos

Primary factor is the low fsh

Indirect effect high lh

How high lh affect aromatase enzyme

High lh activate theca cells

Produce more androgens

And excess androgens damage granulosa cells function

Where is the aromatase enzyme

In granulosa cells

When fsh is low : aromatase is low

Hyperinsulinemia effect

Amplify or enhances lh activity on theca cells

Estrogen dominance?!

Estrogen is high relative to progesterone

What is the effect of unopposed estrogen

Irregular periods and endometrium thicknening ( hyperplasia risk )

Estrogen effect on hpo axis

Estrogen is dominant so it favors lh over fsh

Androgens are produced from

Adrenal cortex ( zona reticularis ) and ovary - but with small amounts

Theca cells produce androgens and theca make aromatase convert androgens to estrogen

No granulosa make aromatase which converts androgens to estrogen

Hyper insulinemia effect on liver

Inhibit shbg

Low shbg means

Excess androgens

In pcos

Ultrasound shows

Enlargement of ovary

Volume more than 10 cm

Cysts more than or equals to 12

Diameter of each 2-9 mm

Irregular period means

Less than 9 cycle per year

More than 35 days between cycles

Less than 20 days between cycles

Cysts seen in ultrasound

Arrested antral follicles

Acne is caused because of

Androgens effect on sebaceous glands

Increase sebum production

Promote bacterial growth

Cause inflammation

clinical symptoms

Of pcos

Acne - androgenic alopecia - hirtuism