24 year old married obese girl with this classical finding on USG. patient is planning a child. lets discuss management and diagnosis

POLYCYSTIC OVARIAN SYNDROME /PCOD is a chronic anovulatory endocrine disorder. * it is the commonest cause of anovulatory infertility. ROTHERDAM CRITERIA : for diagnosing pcod. requires two out of three criteria for diagnosing pcod. -oligo/anovulation = oligomenorrhoea /amenorrhoea. -clinical (acne, hirsutism, alopecia ) or biochemical signs of hyperandrogenism. -Polycystic ovaries. classic triad of pcod are -oligomenorrhoea. -hirsutism. -obesity. INVESTIGATIONS : * fsh, lh, prl, testosterone, tft, fbs, ppbs. * for hyperandrogenism dheas, androstenedione ,SHBG. * ultrasound. CLINICAL EXAMINATION : * BMI. see for acne, hirsutism, alopecia, acanthosis nigricans. MNEMONIC FOR PCOD. CHICAGO C Cystic ovaries. H Hirsutism , Hyperandrogenism. I Infertility, Insulin resistance. C Cortical stromal fibrosis. A Amenorrhoea, Acne. G Genetic predisposition, Gestational diabetes. O Obesity, oligomenorrhoea. ROLE OF METFORMIN IN PCOD. Metformin is a insulin sensitising drug. -improves insulin resistance. -restores normal cycle and ovulation. -promotes ovulation. -protects against first trimester miscarriage. -reduces GDM and fetal macrosomia. ROLE OF MYO INOSITOL IN PCOD. -insulin sensitiser. -improves the binding of insulin to the receptors on the cell wall. -improves the ovarian response to gonadotrophins. MANAGEMENT : *life style modifications. *diet and exercise effective in restoring ovulatory cycles and achieving pregnancy. * COCP ,METFORMIN. * myo inositol. *ovulation induction. * laparoscopic ovarian diathermy. * IVF if all measures fail.

29 year female....married with h/o irregular menses....diagonesed with p.c.o.d since 4 year difficulty in conceive ..kindly suggest best treatment.

### 26 years old girl, overweight, found to have grade 1 fatty liver and bilateral PCOD. Questions: (1) Treatment ??? (2) Dietary advice ??? (3) Is there any relationship of intake of cold beverages and PCOD ???

Friends today I am discussion about Hormanal imbalance. Hormonal imbalances occur when there is too much or too little of a hormone in the bloodstream. Because of their essential role in the body, even small hormonal imbalances can cause side effects throughout the body. Hormones are chemicals that are produced by glands in the endocrine system. Hormones travel through the bloodstream to the tissues and organs, delivering messages that tell the organs what to do and when to do it. Hormones are important for regulating most major bodily processes, so a hormonal imbalance can affect a wide range of bodily functions. Hormones help to regulate: metabolism and appetite heart rate sleep cycles reproductive cycles and sexual function general growth and development mood and stress levels body temperature Men and women alike can be affected by imbalances in insulin, steroids, growth hormones, and adrenaline. Women may also experience imbalances in estrogen and progesterone levels, while men are more likely to experience imbalances in testosterone levels. Symptoms Hormonal imbalance in men and women Everyone experiences periods of hormonal imbalance at certain points in their life, but these can also occur when the endocrine glands are not functioning properly. The symptoms of a hormonal imbalance depend on which glands and hormones are affected. Symptoms associated with the more common causes of hormonal imbalances include: unexplained weight gain or weight loss unexplained or excessive sweating difficulty sleeping changes in sensitivity to cold and heat very dry skin or skin rashes changes in blood pressure changes in heart rate brittle or weak bones changes in blood sugar concentration irritability and anxiety unexplained and long-term fatigue increased thirst depression headaches needing to go to the bathroom more or less than usual bloating changes in appetite reduced sex drive thinning, brittle hair infertility puffy face blurred vision a bulge in the neck breast tenderness deepening of the voice in females Causes Everyone will experience natural periods of hormonal imbalance or fluctuations at particular points in their life. But hormonal imbalances can also occur when the endocrine glands are not functioning properly. Endocrine glands are specialized cells that produce, store, and release hormones into the blood. There are several endocrine glands located throughout the body that control different organs, including the: adrenal glands gonads (testis and ovaries) pineal gland pituitary gland hypothalamus gland thyroid and parathyroid glands pancreatic islets Several medical conditions are known to impact some, or several, of the endocrine glands. Certain lifestyle habits and environmental factors may also play a role in hormonal imbalances. Causes of hormonal imbalances include: chronic or extreme stress type 1 and type 2 diabetes hyperglycemia (overproduction of glucagon) hypoglycemia (more insulin produced than there is glucose in the blood) underactive thyroid (hypothyroidism) overactive thyroid (hyperthyroidism) over- or underproduction of the parathyroid hormone poor diet and nutrition being overweight hormonal replacement or birth control medications abuse of anabolic steroid medications solitary thyroid nodules pituitary tumors Cushing's syndrome (high levels of the hormone cortisol) Addison's disease (low levels of cortisol and aldosterone) benign tumors and cysts (fluid-filled sacks) that affect the endocrine glands congenital adrenal hyperplasia (low levels of cortisol) endocrine gland injury severe allergic reactions or infections cancers that involve endocrine glands chemotherapy and radiation therapy iodine deficiency (goiters) hereditary pancreatitis Turner syndrome (females with only one functioning X chromosome) Prader-Willi syndrome anorexia phytoestrogens, naturally-occurring plant estrogens found in soy products exposure to toxins, pollutants, and endocrine disrupting chemicals, including pesticides and herbicides Hormonal imbalances in women Hormonal imbalance occurs during pregnancy Women experience several periods of hormonal change in their lifetime, primarily during puberty, menstruation, pregnancy and menopause. Women naturally experience several periods of hormonal imbalance throughout their lifetime, including during: puberty menstruation pregnancy, childbirth, and breast-feeding perimenopause, menopause, and postmenopause Women are also at risk of developing different types of hormonal imbalance disorders than men because they have different endocrine organs and cycles. Medical conditions causing irregular hormonal imbalances in women include: polycystic ovary syndrome (PCOS) hormone replacement or birth control medications early menopause primary ovarian insufficiency (POI) ovarian cancer Symptoms of hormonal imbalances in women include: heavy, irregular, or painful periods osteoporosis (weak, brittle bones) hot flashes and night sweats vaginal dryness breast tenderness indigestion constipation and diarrhea acne during or just before menstruation uterine bleeding not associated with menstruation increased hair growth on the face, neck, chest, or back infertility weight gain thinning hair or hair loss skin tags or abnormal growths deepening of the voice clitoral enlargement Bioidentical hormones: How are they used? Bioidentical hormones: How are they used? Hormone therapy and birth control pills both use bioidentical hormones. Learn more about them here. Hormonal imbalances in men Men also experience natural periods of hormonal imbalance during their lifetime. Natural causes of hormonal imbalances in men include: puberty aging Men are also at risk of developing different hormonal imbalances than women because they have different endocrine organs and cycles. Medical conditions causing hormonal imbalances in men include: prostate cancer hypogonadism (low testosterone) Symptoms of hormonal imbalances in men include: reduced sex drive erectile dysfunction (ED) low sperm count reduced muscle mass reduced body hair growth overdevelopment of breast tissue breast tenderness osteoporosis Treatment Treatment for hormonal imbalances may vary depending on the cause. Every person may require different types of treatment for hormonal imbalances. Treatment options for women with hormone imbalances include: Hormone control or birth control. For those who are not trying to get pregnant, medications containing forms of estrogen and progesterone can help regulate irregular menstrual cycles and symptoms. People can take birth control medications as a pill, ring, patch, shot, or an intrauterine device (IUD). Vaginal estrogen. People experiencing vaginal dryness associated with changes in estrogen levels can apply creams containing estrogen directly to vaginal tissues to reduce symptoms. They can also use estrogen tablets and rings to reduce vaginal dryness. Hormone replacement medications. Medications are available to temporarily reduce severe symptoms associated with menopause, such as hot flashes or night sweats. Eflornithine (Vaniqa). This prescription cream may slow excessive facial hair growth in women. Anti-androgen medications. Medications that block the predominately male-sex hormone androgen can help limit severe acne and excessive hair growth or loss. Clomiphene (Clomid) and letrozole (Femara). These medications help stimulate ovulation in people with PCOS who are trying to become pregnant. Those with PCOS and infertility may also be given injections of gonadotropins to help increase the chances of pregnancy. Assisted reproductive technology. In vitro fertilization (IVF) may be used to help those with PCOS complications get pregnant. Treatment options for anyone with hormonal imbalances include: Metformin. A medication for type 2 diabetes, metformin can help manage or lower blood sugar levels. Levothyroxine. Medications containing levothyroxine, such as Synthroid and Levothroid, can help improve symptoms of hypothyroidism. Treatment options for men with hormonal imbalances include: Testosterone medications. Gels and patches containing testosterone can help reduce symptoms of hypogonadism and other conditions that cause low levels of testosterone, such as delayed or stunted puberty. Natural remedies Some natural supplements can help hormonal imbalance Some natural supplements can be used to reduce symptoms. People have used natural supplements to treat hormonal imbalances for thousands of years. However, there are no natural remedies that have been consistently proven in clinical studies to treat hormonal imbalances and their causes, aside from lifestyle changes. Natural supplements commonly used for the reduction of symptoms associated with hormonal imbalances include: black cohosh, dong quai, red clover, and evening primrose oil for hot flashes caused by menopause ginseng for irritability, anxiousness, and sleep disturbances caused by menopause ginseng, and maca for ED Lifestyle changes that may help reduce the likelihood and symptoms of hormonal imbalances include: maintaining a healthy body weight eating a nutritious and balanced diet exercising regularly practicing good personal hygiene, focusing on washing areas with a lot of natural oils, such as the face, neck, back, and chest using over-the-counter acne washes, rinses, and medicated creams or gels for minor to moderate acne avoiding triggers that cause hot flashes, such as warm weather and spicy, rich, or hot foods and drinks reducing and managing stress practicing yoga, meditation, or guided visualization limiting sugary foods and refined carbohydrates avoiding packaged foods replacing older non-stick pans with ceramic pans using glass containers to store and heat foods and drinks restricting the use of cleaning products that contain toxic chemicals, such as bleach buying fruits and vegetables that have not been sprayed with pesticides or ripening chemicals not microwaving foods and drinks in plastics Outlook Nearly everyone experiences at least one or two periods of hormonal imbalance during their lifetime. Hormonal imbalances are more common during puberty, menstruation, and pregnancy. But some people experience continual, irregular hormonal imbalances. Many hormonal imbalances are caused by external factors, such as stress or hormone medications. However, hormonal imbalances can also be caused by any medical condition that impacts or involves the endocrine system or glands. A person should speak to a doctor about long-term unexplained symptoms, especially those that cause pain, discomfort, or interfere with everyday activities.