What may be earliest symptom of PCO ?? Phase I: symptoms (age 16-21 yrs-College going girls-admittedly such symp may not be present in all cases  ): . One shouldn’t ignore Symp of A) oligomenorrhea persisting beyond 2 yrs after the onset of menarche, similarly B) progressive gain in wt particularly at belly (middle part of body, not at hip) , acne, C)  ab hair growth are the other symp .D) occasionally there can be premature thelarche due to  hyper-oestrogenaemia induced by PCO but admittedly this symp is very uncommonly seen.  But by and large it is common to see cases where an  adolescent girl express by saying to her mother that she is having (oligomeno, abnormal hair growth, acne  ). Even if there is  no other symptom  the fact someone is having oligo 2 yrs past of menarche alone is a sufficient  evidence of PCO, My dear members please do  remember absence of evidence is not the absence of diseases or syndrome  and the more we go on chatting more we acquire knowledge & wisdom and learn our mistakes of omission in early diagnosis of PCO .

   

Expansion of Knowledge::

PCO Chronological  Phase II(age group-21-30 yrs  ) : a) anovulatory subfertility, b) more acne, c) fall of hair, d) frontal baldness e) raised W/H ratio and BMI continues  to jump up (in some cases 32 by 24 yrs of age- arbitrarily admitted for teaching P G students --) if dragon is very furious. F) Above all still persisting menst abnormality with progressive gain wt.

PCO Chronological  Phase III(age 31 yrs -40 yrs arbitrarily admitted for teaching P G students )

) .

  After yawing in adolescent  years:-When dragon satnds up in 4^th decade the concerned woman sales her ornaments for purchase of drugs to pay fees for Gym, more maid servants  as she goes on mooring & evening walk and go to parlor to remove ab hairs  .

PCO Chronological  Phase IV : Dragon now chases /  starts running after the concerned woman \ and the unfortunate woman who was not diagnosed for the fault of primary physicians at her father’s home (when she was adolescent )  she is distressed  with HTN, more distressing AUB, HTN .

PCO Chronological Phase V: In the decade of 6^th the dragon eats completely by causing endometrial ca or promoting coagulatory diosrder, Fatty liver, NAFL. NASH *& finally hepatocellar Cancer to excess fat deposition in hepatic cells with portal HTN due to gross echogenecity of liver bed preventing venous return from portal vein directly easily(now the dia of Portal vein exceeds 12 mm  and there will be visible pulsations in Portal vein Doppler study) .

PCO Chronological  Phase VI: I the 5^th to 6^th decade she will dies of MI, DVT, Pulm Embolism DM induced CKD an most commonly Arrhythmia due to atheroma  progressing up to SA node, The dragon then after satisfied that PCOO has been able to kill the woman by 50-60 yrs of age goes back to Hell.

: Militants are here in my family, may be in your family too : The dragons or militants are just dormant / sleepy : Identify PCO early & adopt appropriate measures to make the Tiger to go  sleep by spl bullet as is used by Forest  Officers. Kill this disorder  by catching/identifying tadpoles age.

Etilogy: Possibly genetic :-In fact the diseases was dormant in her foetal stage if not while it was embryo( fertilization to 10 weeks of gestation) and the abnormal metabolic pattern  got imprinted when the concerned “ female  foetus”- was in her mother’s womb (Foetal origin of adult diseases-genetic cause of PCO -Barkers hypothesis ) .

In tie prescription paper : please avoid the terminology of androgen excess or cyst in  ovary  :A note of caution from a senior practioner:- Never, I repeat never, write in the prescription Polycystic ovary syn --> that will hurt the adoles girl and she may consider that she is not going to have normal womb or egg producing organ., We  as we have no right to declare a pt as U have cancer similar we must not tell / communicate / write on her prescription however florid the PCO / abnormal hair growth . Please be sympathetic and offer empathy which   must be on her head as we are basically care givers. We should not hurt anyway to a young mind though the current   terminology is “Androgen Excess Diosrder”. But as a physician Dr Pal have some objection to this  VERY WORD androgen to young educated net minded girl.  The suitable word un Indian context will be possibly Hyperinsulianemic oligomenorrhoic, overweight, no hirsute normal volume ovaries with slight echogenic cortex with W/Hip  ratio of ---.This terminology will bring more peace and restful mind . In fact such a eight adjectives are more gentle and acceptable to her and excess androgen or Cystic ovary will have detrimental effects to her mind, mind.  Under no circumstances she will accept the diag of CYST neither the ANDROGEN Excess .  At least I feel in that  way

Avoid the terminology of androgen excess or cyst in your ovary: A note of caution from a senior practioner:- Never, I repeat never, write in the prescription Polycystic ovary syn --?> that will hurt the adobes girl nd she may consider that she is not going to have normal womb or egg producing organ, We  as we have no right to declare a pt as U have cancer similar we must not tell / communicate / write on her prescription however florid the PCO / abnormal hair growth sympathy  must on her head as we are basically care givers. We should not hurt anyway to a young mind though the current   terminology is “Androgen Excess Diosrder”. But as a physician Dr pal have some objection to this androgen words to young educated net minded girl.  The suitable word un Indian context will be possibly Hyperinsulianemic oligomenorrhoic, overweight , no hirsute normal volume ovaries with slight echogenic cortex with W/Hip  ratio of ---.This terminology more long but to my minds will be more acceptable to the young mind.  Under no  circumstances she will accept the diag of CYST neither the ANDROGEN> At least I feel in that  way

  .Yes, PCO  is written  on her face!!! I can read  her face as she enters at OPD with her anxious mother with delayed period of 4 months. Many bad ideas /  things lurks in the minds of mother as her daughter now 21 yrs has go to tutorials by auto /Bus and returns home after 2-3 tutorials after finishing College classes. She comes back home at 10 p.m. It’s another type of anxiety in mothers mind which doc wont realize. After all we doctors  have  to read the face of the oligomenorrhoic adolescents 2 yrs past of menarche & still suffering from delayed periods . A great anxiety of that adoles girl.