Polycystic Ovarian Syndrome:

Typical Presentation or Complaint of A Polycystic Ovarian Syndrome would be from, Hirsutism , Infertility , or Irregular vaginal bleeding, usually an Obese female with also signs of increased insulin resistance (hyperglycemia , Acanthosis Nigricans).

Pathogenesis:

 The Key to help me understand the pathogenesis of polycystic ovarian syndrome is to understand that it’s due to ANOVULATORY cycle, the cause of an-ovulation is unknown!, however by understanding the normal hormonal and physiological stages that occur in the normal female ovulatory cycle , ovulation occurs normally at mid-cycle , in PCOS there’s no ovulation, so you would expect the Persistence of the hormonal levels that are found in the normal female during the middle of her menstrual cycle prior to ovulation , so you would expect the Estrogen induced LH surge to be persistent ! Which will result in :

Increased Estrogen Levels,  which would result in endometrial hyperproliferation leading to Irregular vaginal bleeding and Increased risk of endometrial cancers

Markedly elevated LH levels which would stimulate theca cells resulting in increased androgen production and Hirsutism (Increased male pattern hair growth), and demonstratred by LH: FSH ratio more than 3:1.

Increased Insulin resistance

The gold standard to diagnose PCOS is Vaginal US which would show multiple (usually greater than 20) subcapsular cystic ovarian changes with increased stromal echogenecity (hyperproliferating theca cells), also increased endometrial stromal thickness