<prompt> Which of the following is true about Polycystic ovarian disease?Hirsutism hypertensionOligomenorrrhea hypertensionHirsutism oligomenorrhea hypertensionPolymenorrhea  <response>: Ans. c Hirsutism oligomenorrhea hypertension. Ref. Gynacology by Shaw, 12th ed., 75,311POLYCYSTIC 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, LHFSH 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. 