Which of the following is true about Polycystic ovarian disease?

Ans. c (Hirsutism + oligomenorrhea + hypertension). (Ref. Gynacology by Shaw, 12th ed., 75,311)POLYCYSTIC OVARIAN DISEASE (PCOD)# The classical Stein Leventhal triad of- anovulation,- hyperandrogenism and- obesity (need not be necessarily be present)# It is characterized by amenorrhoea or oligomenorrhoea, obesity, hirsutism and often infertility.# Both the ovaries are enlarged and covered with a thick, smooth fibrotic pearly white capsule.# Long term complications are- hyperplasia of endometrium,- cardiovascular disease and- NIDDM.# LH levels are raised, LH/FSH ratio is high, estrogen may be high or normal, and androgens are increased; however progesterone is absent.# Radiological criteria for dianosis:- Polycystic ovaries are best demonstrated on TVS.- In 50% of cases TVS shows:* Bilateral enlarged ovaries of 2-5 times normal volume* Multiple cysts in a subcortical position ("necklace" sign)* Each cyst measuring < 1 cm.- A third of patients have normal ovarian volumes- A quarter will show no evidence of cyst formation.- Normal ovaries may contain cysts that are unilateral and which vary in size, but the ovaries are not enlarged.- Clomiphene is drug of choice- Estrogen break through bleeding occurs when estrogen stimulation of the endometrium is continuous and is not interrupted by cyclic progesterone withdrawal, as can occur in PCOS.