=====Ovarian Pathology =====

==== Ovarian cyst ====

  * Most are functional or follicular cysts and generally >1cm in size
  * Less common include PCOS, cystadenomas, and dermoid cysts
  * Usually symptom free unless complication 
      * risk of torsion when >4cm
      * <2cm are virtually risk free from torsion

=== Clinical Features ===

Most tend to be asymptomatic but can cause:
   * Dull pelvic pain or fullness; they can be significantly painful if ruptured
   * Dyspareunia
   * Pressure on the bladder
If there is bleeding into the cyst and it ruptures, it can be life threatening, with signs of peritonitis, shock

=== Management ===

  * simple analgesia eg NSAIDs
  * ensure exclusion of complications and other more sinister differential diagnoses of abdo pain.

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====Polycystic Ovary Syndrome====

Exact pathophysiology = unclear
  *often have raised testosterone
  *inappropriate gonadotrophin secretion - probably as a result of ovarian dysfunction rather than cause
  *most common hormonal abnormalities: excess Luteinising hormone (LH) and Insulin resistance

Diagnostic criteria have varied over the years and vary according to authority group! Include the following:
  *evidence of ovarian dysfunction
  *exclusion of other disorders - eg other hormonal causes (Hypothyroidism, Hyperprolactinaemia, Cushing’s disease)
  *biochemical evidence of hyperandrogenism
  *?USS evidence

Major features
  *menstrual dysfunction - usually a chronic pattern
  *anovulation
  *signs of hyperandrogenism - male hair distribution, acne
  *~50% are obese
  *Acanthosis nigricans - possibly due to insulin resistance
  *Hypertension
  *chronic pelvic pain

treatments aimed at so-called metabolic derangements, such as anovulation, hirsutism, and menstrual irregularities.

====Ovarian Hyperstimulation Syndrome (OHSS)====
  *a rare, complication of IVF
  *characterized by ovarian enlargement due to multiple ovarian cysts and an acute fluid shift into the extravascular space.
  *Complications of OHSS include ascites, hemoconcentration, hypovolemia, and electrolyte imbalances
  *Enlargement of the ovaries causes abdominal pain, nausea, and vomiting
  *3rd space losses due to hyperpermeability and ovarian cyst rupture
  *peritonitis when blood in fluid of ruptured follicles
  *ovarian torsion
  *symptoms:
    *SOB in most
    *abdo pain in most, nausea, vomiting and diarrhoea in around 50%
  *beware: hypercoagulability, electrolyte and fluid disturbances

==References include:==
https://emedicine.medscape.com/article/256806-overview\\ 
https://teachmeobgyn.com/gynaecology/ovarian/polycystic-ovary-syndrome/\\