from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm, mm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.platypus import PageBreak
from reportlab.lib.colors import HexColor

OUTPUT = "/home/daytona/workspace/pcos-pdf/PCOS_Diagnostic_Workup_Quick_Reference.pdf"

# ── Color palette ──────────────────────────────────────────────
C_TEAL      = HexColor("#1A6B72")   # header bar
C_TEAL_LT   = HexColor("#D6EEF0")   # section header bg
C_PURPLE    = HexColor("#5B2C8D")   # accent headings
C_PURPLE_LT = HexColor("#EDE7F6")   # alternating row
C_GOLD      = HexColor("#C8860A")   # warning / note highlight
C_GOLD_LT   = HexColor("#FFF8E1")   # note box bg
C_RED       = HexColor("#C0392B")   # critical flags
C_GREEN     = HexColor("#1E7D45")   # normal range
C_GREY_BG   = HexColor("#F4F6F8")   # table alt row
C_GREY_LINE = HexColor("#B0BEC5")   # grid lines
C_WHITE     = colors.white
C_BLACK     = HexColor("#1A1A2E")

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    topMargin=1.5*cm, bottomMargin=1.5*cm,
    leftMargin=1.8*cm, rightMargin=1.8*cm
)

W = A4[0] - 3.6*cm   # usable width

styles = getSampleStyleSheet()

# Custom styles
def ps(name, **kw):
    base = kw.pop("parent", "Normal")
    s = ParagraphStyle(name, parent=styles[base], **kw)
    return s

TITLE   = ps("TITLE",   fontSize=22, textColor=C_WHITE,    alignment=TA_CENTER, fontName="Helvetica-Bold", leading=28)
SUBTITLE= ps("SUBTITLE",fontSize=11, textColor=HexColor("#B2EBF2"), alignment=TA_CENTER, fontName="Helvetica", leading=16)
SEC_HDR = ps("SEC_HDR", fontSize=11, textColor=C_WHITE,    alignment=TA_LEFT,   fontName="Helvetica-Bold", leading=15, spaceBefore=6, spaceAfter=4)
BODY    = ps("BODY",    fontSize=9,  textColor=C_BLACK,    alignment=TA_JUSTIFY,fontName="Helvetica",      leading=13, spaceBefore=2)
BOLD9   = ps("BOLD9",   fontSize=9,  textColor=C_BLACK,    fontName="Helvetica-Bold", leading=13)
SMALL   = ps("SMALL",   fontSize=8,  textColor=HexColor("#555555"), fontName="Helvetica", leading=12)
NOTE    = ps("NOTE",    fontSize=8.5,textColor=HexColor("#5D4037"),fontName="Helvetica-Oblique", leading=12)
CELL_H  = ps("CELL_H",  fontSize=8.5,textColor=C_WHITE,   fontName="Helvetica-Bold", alignment=TA_CENTER, leading=12)
CELL    = ps("CELL",    fontSize=8.5,textColor=C_BLACK,    fontName="Helvetica",      alignment=TA_LEFT,   leading=12)
CELL_C  = ps("CELL_C",  fontSize=8.5,textColor=C_BLACK,    fontName="Helvetica",      alignment=TA_CENTER, leading=12)
CELL_B  = ps("CELL_B",  fontSize=8.5,textColor=C_BLACK,    fontName="Helvetica-Bold", alignment=TA_LEFT,   leading=12)
FOOT    = ps("FOOT",    fontSize=7.5,textColor=HexColor("#757575"), alignment=TA_CENTER, fontName="Helvetica-Oblique", leading=10)

story = []

# ── Helper: section header banner ─────────────────────────────
def sec(title, color=C_TEAL):
    tbl = Table([[Paragraph(f"  {title}", SEC_HDR)]], colWidths=[W])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("ROWBACKGROUNDS",(0,0),(-1,-1),[color]),
        ("TOPPADDING",(0,0),(-1,-1),5),
        ("BOTTOMPADDING",(0,0),(-1,-1),5),
        ("LEFTPADDING",(0,0),(-1,-1),8),
        ("RIGHTPADDING",(0,0),(-1,-1),8),
    ]))
    return tbl

def note_box(text, bg=C_GOLD_LT, border=C_GOLD):
    tbl = Table([[Paragraph(text, NOTE)]], colWidths=[W])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1), bg),
        ("BOX",(0,0),(-1,-1),1, border),
        ("TOPPADDING",(0,0),(-1,-1),5),
        ("BOTTOMPADDING",(0,0),(-1,-1),5),
        ("LEFTPADDING",(0,0),(-1,-1),8),
        ("RIGHTPADDING",(0,0),(-1,-1),8),
    ]))
    return tbl

def std_table(headers, rows, col_widths, alt=True):
    data = [[Paragraph(h, CELL_H) for h in headers]]
    for i, row in enumerate(rows):
        bg = C_GREY_BG if (alt and i % 2 == 1) else C_WHITE
        data.append([Paragraph(str(c), CELL) for c in row])
    tbl = Table(data, colWidths=col_widths, repeatRows=1)
    style = [
        ("BACKGROUND",(0,0),(-1,0), C_TEAL),
        ("GRID",(0,0),(-1,-1),0.4, C_GREY_LINE),
        ("ROWBACKGROUNDS",(0,1),(-1,-1),[C_WHITE, C_GREY_BG]),
        ("TOPPADDING",(0,0),(-1,-1),4),
        ("BOTTOMPADDING",(0,0),(-1,-1),4),
        ("LEFTPADDING",(0,0),(-1,-1),5),
        ("RIGHTPADDING",(0,0),(-1,-1),5),
        ("VALIGN",(0,0),(-1,-1),"MIDDLE"),
    ]
    tbl.setStyle(TableStyle(style))
    return tbl

# ═══════════════════════════════════════════════════════════════
# TITLE BLOCK
# ═══════════════════════════════════════════════════════════════
title_data = [[Paragraph("PCOS Diagnostic Workup", TITLE)],
              [Paragraph("Hormone Tests · Quick Reference Guide", SUBTITLE)],
              [Paragraph("Based on Rotterdam 2003 / Updated 2023 International Guidelines  |  Harrison's 22E · Berek & Novak · Henry's Clinical Lab Methods", SUBTITLE)]]
title_tbl = Table(title_data, colWidths=[W])
title_tbl.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,-1), C_TEAL),
    ("TOPPADDING",(0,0),(-1,0),14),
    ("BOTTOMPADDING",(0,-1),(-1,-1),12),
    ("TOPPADDING",(0,1),(-1,1),4),
    ("BOTTOMPADDING",(0,0),(-1,1),2),
    ("TOPPADDING",(0,2),(-1,2),2),
    ("LINEBELOW",(0,1),(-1,1),0.5, HexColor("#80CBC4")),
]))
story.append(title_tbl)
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════
# SECTION 1 – DIAGNOSTIC CRITERIA (Rotterdam 2023)
# ═══════════════════════════════════════════════════════════════
story.append(sec("1.  DIAGNOSTIC CRITERIA  —  Rotterdam 2023  (2 of 3 required, after exclusion of other causes)"))
story.append(Spacer(1, 4))

crit_data = [
    [Paragraph("Criterion", CELL_H), Paragraph("Details", CELL_H), Paragraph("Notes", CELL_H)],
    [Paragraph("<b>1. Menstrual Irregularity</b>", CELL),
     Paragraph("Oligomenorrhea (&lt;8 cycles/yr) or amenorrhea", CELL),
     Paragraph("In adolescents: wait ≥3 yrs post-menarche before diagnosing", CELL)],
    [Paragraph("<b>2. Hyperandrogenism</b>", CELL),
     Paragraph("Clinical (hirsutism, acne, alopecia) OR biochemical (↑ total/free testosterone)", CELL),
     Paragraph("mFG score ≥4–6 depending on ethnicity", CELL)],
    [Paragraph("<b>3. Polycystic Ovarian Morphology</b>", CELL),
     Paragraph("≥20 antral follicles or ovarian volume ≥10 cm³ on USS  OR  elevated AMH", CELL),
     Paragraph("Ultrasound criteria NOT used in adolescents", CELL)],
]
crit_tbl = Table(crit_data, colWidths=[3.8*cm, 8.2*cm, W-12*cm])
crit_tbl.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0), C_TEAL),
    ("GRID",(0,0),(-1,-1),0.4, C_GREY_LINE),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[C_WHITE, C_GREY_BG]),
    ("TOPPADDING",(0,0),(-1,-1),5),
    ("BOTTOMPADDING",(0,0),(-1,-1),5),
    ("LEFTPADDING",(0,0),(-1,-1),5),
    ("RIGHTPADDING",(0,0),(-1,-1),5),
    ("VALIGN",(0,0),(-1,-1),"TOP"),
]))
story.append(crit_tbl)
story.append(Spacer(1, 4))
story.append(note_box("⚠  PCOS is a DIAGNOSIS OF EXCLUSION. Always rule out: hypothyroidism, hyperprolactinemia, congenital adrenal hyperplasia (CAH), Cushing syndrome, androgen-secreting tumors, and primary ovarian insufficiency (POI) before confirming PCOS."))
story.append(Spacer(1, 8))

# ═══════════════════════════════════════════════════════════════
# SECTION 2 – COMPLETE HORMONE TEST PANEL
# ═══════════════════════════════════════════════════════════════
story.append(sec("2.  COMPLETE HORMONE TEST PANEL"))
story.append(Spacer(1, 4))

panel_headers = ["Test", "Purpose in PCOS", "Timing", "Reference / Interpretation"]
panel_rows = [
    # ── FSH/LH block ──
    ["FSH (Follicle-Stimulating Hormone)",
     "Assess gonadotropin axis; rule out ovarian failure or hypothalamic-pituitary dysfunction",
     "Day 2–3 of cycle (early follicular phase)",
     "Normal: 3–10 mIU/mL. Low/normal in PCOS. FSH >10 mIU/mL → diminished ovarian reserve"],
    ["LH (Luteinizing Hormone)",
     "Elevated LH drives ovarian androgen excess via thecal cell stimulation; key neuroendocrine marker",
     "Day 2–3 of cycle (fasting preferred)",
     "Lean PCOS: LH elevated (often 10–20 mIU/mL). Random value unreliable due to pulsatility"],
    ["LH : FSH Ratio",
     "Classic PCOS pattern: GnRH pulse frequency skew toward LH",
     "Same sample as above",
     "Ratio >2:1 or >3:1 supportive of PCOS. Minor criterion only — not in Rotterdam 2023 criteria. Normal in obese PCOS."],
    # ── Androgens ──
    ["Total Testosterone",
     "Primary biochemical hyperandrogenism marker; required for Rotterdam criterion 2",
     "8–10 AM fasting (diurnal variation); Day 2–5 preferred",
     "PCOS: typically 100–200 ng/dL. >200 ng/dL raises suspicion of androgen-secreting tumor"],
    ["Free Testosterone",
     "More sensitive than total T; useful when total T borderline normal",
     "Same as total testosterone",
     "Elevated free T with normal total T still confirms biochemical HA (Rotterdam criterion)"],
    ["DHEA-S (Dehydroepiandrosterone Sulfate)",
     "Adrenal androgen marker; distinguishes adrenal vs ovarian source of androgens",
     "Any time (relatively stable level)",
     ">700 µg/dL → adrenal tumor. Mildly elevated in PCOS (~50%). Very high → adrenal source"],
    ["17-OH Progesterone",
     "Rule out non-classical congenital adrenal hyperplasia (21-hydroxylase deficiency)",
     "Day 2–5, early AM",
     "<2 ng/mL: normal. >2 ng/mL: proceed to ACTH stimulation test. Key exclusion test"],
    # ── Prolactin/Thyroid ──
    ["Prolactin (PRL)",
     "Rule out hyperprolactinemia as cause of anovulation and irregular menses",
     "Fasting morning, no sexual activity prior",
     ">25–30 ng/mL → hyperprolactinemia. Mild elevation can be stress-related; recheck"],
    ["TSH (Thyroid Stimulating Hormone)",
     "Rule out hypothyroidism mimicking PCOS (weight gain, irregular cycles, anovulation)",
     "Any time (stable)",
     "Normal: 0.4–4.0 mIU/L. TSH >4 → hypothyroidism. Address before confirming PCOS"],
    # ── Insulin / Metabolic ──
    ["Fasting Insulin",
     "Assess insulin resistance (IR); IR amplifies ovarian androgen production",
     "8–12 hr fast",
     "No universal cutoff. HOMA-IR = [fasting glucose (mmol/L) × fasting insulin (µU/mL)] / 22.5. HOMA-IR >2.5 suggests IR"],
    ["Fasting Blood Glucose / HbA1c",
     "Screen for type 2 diabetes and prediabetes; PCOS carries significant metabolic risk",
     "Fasting (8–12 hrs)",
     "FBG ≥126 mg/dL or HbA1c ≥6.5% = diabetes. Impaired FBG: 100–125 mg/dL"],
    ["2-hr OGTT (Oral Glucose Tolerance Test)",
     "Preferred over FBG in PCOS for detecting glucose intolerance; AES-PCOS Society recommended",
     "Fasting; 75 g glucose load",
     "2-hr glucose ≥200 mg/dL = diabetes; 140–199 mg/dL = impaired glucose tolerance"],
    # ── AMH ──
    ["AMH (Anti-Mullerian Hormone)",
     "Reflects antral follicle pool; now included in 2023 PCOS criteria as alternative to USS",
     "Any day of cycle (stable across cycle)",
     "Elevated in PCOS (reflects large small-antral follicle pool). Lab/assay-specific cutoffs — consult local lab"],
    # ── Estradiol / Progesterone ──
    ["Estradiol (E2)",
     "Assess follicular activity; Day 3 E2 with FSH helps interpret ovarian reserve",
     "Day 2–3 of cycle",
     "Day 3 E2 >80 pg/mL + elevated FSH = ovarian stimulation/failure. Low in hypothalamic amenorrhea"],
    ["Progesterone (midluteal)",
     "Confirm ovulation occurred; useful in assessing anovulation",
     "Day 21 (28-day cycle) or 7 days before expected next period",
     ">3 ng/mL = ovulation confirmed. <3 ng/mL = anovulatory cycle"],
    # ── Cortisol ──
    ["24-hr Urinary Free Cortisol / 1 mg Overnight Dexamethasone Suppression Test",
     "Rule out Cushing syndrome — can mimic PCOS with central obesity, hirsutism, irregular cycles",
     "As directed",
     "Post-dexamethasone cortisol <1.8 µg/dL = Cushing excluded (screening)"],
    # ── Lipid profile ──
    ["Fasting Lipid Profile",
     "Screen for dyslipidemia; part of metabolic risk assessment mandatory in PCOS",
     "12-hr fast",
     "Look for: ↑ LDL, ↑ triglycerides, ↓ HDL — metabolic syndrome pattern common in PCOS"],
]

col_w = [3.5*cm, 5.0*cm, 3.2*cm, W - 11.7*cm]
panel_data = [[Paragraph(h, CELL_H) for h in panel_headers]]
row_colors = [
    C_TEAL_LT, C_TEAL_LT, C_PURPLE_LT,   # FSH, LH, ratio
    C_GREY_BG, C_WHITE, C_GREY_BG, C_WHITE,  # androgens
    C_GOLD_LT, C_GOLD_LT,                 # PRL, TSH
    C_WHITE, C_GREY_BG, C_WHITE,          # metabolic
    C_TEAL_LT,                            # AMH
    C_GREY_BG, C_WHITE,                   # E2, Prog
    C_GOLD_LT,                            # Cortisol
    C_WHITE,                              # Lipids
]
for i, row in enumerate(panel_rows):
    panel_data.append([Paragraph(str(c), CELL) for c in row])

panel_tbl = Table(panel_data, colWidths=col_w, repeatRows=1)
row_style = [
    ("BACKGROUND",(0,0),(-1,0), C_TEAL),
    ("GRID",(0,0),(-1,-1),0.35, C_GREY_LINE),
    ("TOPPADDING",(0,0),(-1,-1),4),
    ("BOTTOMPADDING",(0,0),(-1,-1),4),
    ("LEFTPADDING",(0,0),(-1,-1),5),
    ("RIGHTPADDING",(0,0),(-1,-1),5),
    ("VALIGN",(0,0),(-1,-1),"TOP"),
]
for i, bg in enumerate(row_colors):
    row_style.append(("BACKGROUND",(0,i+1),(-1,i+1), bg))

panel_tbl.setStyle(TableStyle(row_style))
story.append(panel_tbl)
story.append(Spacer(1, 8))

# ═══════════════════════════════════════════════════════════════
# SECTION 3 – FSH / LH INTERPRETATION TABLE
# ═══════════════════════════════════════════════════════════════
story.append(sec("3.  FSH / LH PATTERN INTERPRETATION  —  Differential Diagnosis"))
story.append(Spacer(1, 4))

interp_headers = ["Condition", "FSH", "LH", "LH:FSH Ratio", "Key Distinguishing Features"]
interp_rows = [
    ["<b>PCOS (lean/typical)</b>", "Normal / Low-normal", "<b>↑ Elevated</b>", ">2:1 to 3:1",
     "Testosterone ↑, irregular cycles, polycystic ovaries on USS, anovulation"],
    ["<b>PCOS (obese)</b>", "Normal", "Normal or mildly ↑", "Often normal",
     "Obesity blunts LH; diagnosis relies more on testosterone + USS + AMH"],
    ["<b>Primary Ovarian Insufficiency (POI)</b>", "<b>↑↑ Very High</b>", "↑ Elevated", "<1:1 or near 1:1",
     "FSH >25 mIU/mL (x2), estradiol low, age <40; anti-thyroid Ab, karyotype"],
    ["<b>Hypothalamic Amenorrhea</b>", "Low / Normal", "Low / Normal", "~1:1",
     "Stress, weight loss, exercise; estradiol low; GnRH pulse frequency reduced"],
    ["<b>Hyperprolactinemia</b>", "Low-normal", "Low-normal", "Variable",
     "Prolactin ↑; galactorrhea; MRI pituitary; LH/FSH suppressed by prolactin"],
    ["<b>Non-classical CAH</b>", "Normal", "Normal", "Normal",
     "17-OH progesterone ↑ (>2 ng/mL Day 3); ACTH stim test positive"],
    ["<b>Hypothyroidism</b>", "Normal", "Normal", "Normal",
     "TSH ↑, free T4 ↓; may cause hyperprolactinemia secondarily"],
    ["<b>Androgen-Secreting Tumor</b>", "Normal/Low", "Normal/Low", "Normal",
     "Testosterone >200 ng/dL; rapid virilization; pelvic/adrenal imaging"],
]
col_w2 = [3.5*cm, 2.0*cm, 2.0*cm, 2.5*cm, W - 10*cm]
interp_data = [[Paragraph(h, CELL_H) for h in interp_headers]]
alt_colors2 = [C_WHITE, C_GREY_BG] * 10
for i, row in enumerate(interp_rows):
    interp_data.append([Paragraph(str(c), CELL) for c in row])

interp_tbl = Table(interp_data, colWidths=col_w2, repeatRows=1)
interp_tbl.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0), C_PURPLE),
    ("GRID",(0,0),(-1,-1),0.35, C_GREY_LINE),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[C_WHITE, C_PURPLE_LT]),
    ("TOPPADDING",(0,0),(-1,-1),4),
    ("BOTTOMPADDING",(0,0),(-1,-1),4),
    ("LEFTPADDING",(0,0),(-1,-1),5),
    ("RIGHTPADDING",(0,0),(-1,-1),5),
    ("VALIGN",(0,0),(-1,-1),"TOP"),
]))
story.append(interp_tbl)
story.append(Spacer(1, 8))

# ═══════════════════════════════════════════════════════════════
# SECTION 4 – FSH/LH TESTING PITFALLS
# ═══════════════════════════════════════════════════════════════
story.append(sec("4.  KEY PITFALLS IN FSH / LH TESTING IN PCOS", color=C_GOLD))
story.append(Spacer(1, 4))

pitfall_data = [
    [Paragraph("Pitfall", CELL_H), Paragraph("Explanation", CELL_H), Paragraph("Action", CELL_H)],
    [Paragraph("LH pulsatility", CELL_B),
     Paragraph("LH secreted in pulses — a single random draw may miss elevation. LH can vary 2-3x within hours.", CELL),
     Paragraph("Measure Day 2-3 fasting. Interpret ratio cautiously; single value unreliable.", CELL)],
    [Paragraph("Obesity blunts LH", CELL_B),
     Paragraph("Obese PCOS women often have normal LH:FSH due to adipose-mediated LH suppression.", CELL),
     Paragraph("Do not rule out PCOS based on normal LH alone. Rely on testosterone + USS + AMH.", CELL)],
    [Paragraph("Urinary LH kits (OPKs) unreliable", CELL_B),
     Paragraph("Chronically elevated baseline LH in PCOS gives false-positive ovulation predictor kit results throughout the cycle.", CELL),
     Paragraph("Use midluteal serum progesterone (Day 21) to confirm ovulation instead.", CELL)],
    [Paragraph("LH:FSH ratio is minor criterion only", CELL_B),
     Paragraph("Rotterdam 2023 guidelines do NOT include LH:FSH ratio as a primary diagnostic criterion.", CELL),
     Paragraph("Treat ratio as supportive evidence. Diagnosis requires 2 of 3 Rotterdam criteria.", CELL)],
    [Paragraph("Day of cycle matters", CELL_B),
     Paragraph("FSH measured in mid/late follicular phase may appear falsely elevated. LH peaks at ovulation.", CELL),
     Paragraph("Always measure FSH and LH on Day 2–3 of cycle for standardized interpretation.", CELL)],
    [Paragraph("Oral contraceptives suppress FSH/LH", CELL_B),
     Paragraph("OCP use suppresses gonadotropins — LH:FSH ratio will be falsely normal on OCP.", CELL),
     Paragraph("Ideally discontinue OCP ≥3 months before testing. Note OCP use in lab request.", CELL)],
]
p_col_w = [3.5*cm, 7.0*cm, W - 10.5*cm]
pitfall_tbl = Table(pitfall_data, colWidths=p_col_w, repeatRows=1)
pitfall_tbl.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0), C_GOLD),
    ("GRID",(0,0),(-1,-1),0.35, C_GREY_LINE),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[C_WHITE, C_GOLD_LT]),
    ("TOPPADDING",(0,0),(-1,-1),4),
    ("BOTTOMPADDING",(0,0),(-1,-1),4),
    ("LEFTPADDING",(0,0),(-1,-1),5),
    ("RIGHTPADDING",(0,0),(-1,-1),5),
    ("VALIGN",(0,0),(-1,-1),"TOP"),
]))
story.append(pitfall_tbl)
story.append(Spacer(1, 8))

# ═══════════════════════════════════════════════════════════════
# SECTION 5 – STEP-BY-STEP DIAGNOSTIC ALGORITHM
# ═══════════════════════════════════════════════════════════════
story.append(sec("5.  STEP-BY-STEP DIAGNOSTIC ALGORITHM"))
story.append(Spacer(1, 4))

steps = [
    ("Step 1 — History & Menstrual Pattern",
     "Document cycle frequency, duration, last menstrual period. ≥1 year of irregular cycles required. In adolescents: irregular menses ≥2 years post-menarche."),
    ("Step 2 — Clinical Hyperandrogenism Assessment",
     "Hirsutism: modified Ferriman-Gallwey (mFG) score ≥4–6. Also assess: acne, androgenic alopecia. Clinical HA alone can satisfy criterion 2."),
    ("Step 3 — Initial Hormone Screen (Exclusion Panel)",
     "Order: TSH, Prolactin, 17-OH Progesterone (Day 2–5 AM). These exclude hypothyroidism, hyperprolactinemia, and non-classical CAH — three key PCOS mimics."),
    ("Step 4 — Androgen Testing",
     "Total testosterone (AM fasting, Day 2–5). Free testosterone if total borderline. DHEA-S if adrenal source suspected (total T >200 ng/dL, rapid onset, virilization)."),
    ("Step 5 — FSH, LH & Estradiol",
     "Day 2–3 of cycle. FSH & LH to assess gonadotropin axis. Elevated FSH + LH → POI (not PCOS). Low FSH + LH → hypothalamic amenorrhea. Elevated LH with normal-low FSH → supports PCOS. Estradiol Day 3 to assess follicular reserve."),
    ("Step 6 — Metabolic Screening",
     "Fasting glucose, fasting insulin (HOMA-IR), HbA1c, fasting lipid profile. OGTT (75 g) preferred over FBG alone. Weight, BMI, waist circumference, blood pressure."),
    ("Step 7 — AMH",
     "Elevated AMH now accepted as an alternative to ultrasound in the 2023 guidelines. Use assay with validated PCOS cutoffs. Stable across cycle days."),
    ("Step 8 — Pelvic Ultrasound",
     "Transvaginal USS preferred. ≥20 antral follicles OR ovarian volume ≥10 cm³ in at least one ovary = polycystic morphology. Note: ultrasound NOT used to diagnose PCOS in adolescents."),
    ("Step 9 — Confirm Diagnosis",
     "Apply Rotterdam 2023 criteria: 2 of 3 criteria met + all exclusions cleared = PCOS confirmed. Document PCOS phenotype (1–4) for management planning."),
]

for step_title, step_body in steps:
    row = [[
        Paragraph(f"<b>{step_title}</b>", CELL_B),
        Paragraph(step_body, CELL)
    ]]
    t = Table(row, colWidths=[4.5*cm, W - 4.5*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(0,-1), C_TEAL_LT),
        ("BACKGROUND",(1,0),(1,-1), C_WHITE),
        ("BOX",(0,0),(-1,-1),0.5, C_GREY_LINE),
        ("LINEAFTER",(0,0),(0,-1),0.5, C_GREY_LINE),
        ("TOPPADDING",(0,0),(-1,-1),5),
        ("BOTTOMPADDING",(0,0),(-1,-1),5),
        ("LEFTPADDING",(0,0),(-1,-1),6),
        ("RIGHTPADDING",(0,0),(-1,-1),6),
        ("VALIGN",(0,0),(-1,-1),"TOP"),
    ]))
    story.append(t)
    story.append(Spacer(1, 2))

story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════
# SECTION 6 – ADDITIONAL TESTS BY INDICATION
# ═══════════════════════════════════════════════════════════════
story.append(sec("6.  ADDITIONAL TESTS BY INDICATION", color=C_PURPLE))
story.append(Spacer(1, 4))

add_headers = ["Indication", "Test(s) to Order", "What to Look For"]
add_rows = [
    ["Suspected Cushing syndrome\n(central obesity, striae, hypertension)",
     "24-hr urinary free cortisol\n1 mg overnight dexamethasone suppression test\nLate-night salivary cortisol",
     "Post-dex cortisol >1.8 µg/dL → Cushing not excluded → refer endocrinology"],
    ["Suspected androgen-secreting tumor\n(Testosterone >200 ng/dL, rapid virilization)",
     "Total and free testosterone\nDHEA-S\nPelvic/adrenal MRI or CT",
     "Very high T or DHEA-S; adrenal/ovarian mass on imaging → urgent referral"],
    ["Fertility evaluation\n(infertility workup, IVF planning)",
     "AMH\nAntral Follicle Count (AFC) on USS\nFSH Day 3 + Estradiol Day 3",
     "AMH + AFC assess ovarian reserve. FSH >10 = diminished reserve. High AMH in PCOS → OHSS risk with IVF"],
    ["Adolescent PCOS (puberty period)",
     "Testosterone (total + free)\nLH, FSH\nDo NOT use USS or AMH for criteria",
     "Diagnosis requires: irregular menses + hyperandrogenism only. Both criteria must be met."],
    ["Pregnancy or fertility treatment",
     "Progesterone, hCG\nThyroid function (TSH + free T4)\nFasting glucose",
     "Progesterone monitoring post-ovulation induction. Thyroid optimization before conception."],
    ["Monitoring on treatment (OCP/metformin)",
     "Annual: fasting glucose, HbA1c, lipid profile, BP\nTestosterone if symptomatic",
     "OCP suppresses FSH/LH — do not use to monitor gonadotropins on treatment"],
]
add_col_w = [4.5*cm, 5.0*cm, W - 9.5*cm]
story.append(std_table(add_headers, add_rows, add_col_w))
story.append(Spacer(1, 8))

# ═══════════════════════════════════════════════════════════════
# SECTION 7 – QUICK REFERENCE: PCOS PHENOTYPES
# ═══════════════════════════════════════════════════════════════
story.append(sec("7.  PCOS PHENOTYPES  (Rotterdam Classification)"))
story.append(Spacer(1, 4))

phen_headers = ["Phenotype", "HA (Clinical/Biochem)", "Ovulatory Dysfunction", "Polycystic Ovaries on USS", "Notes"]
phen_rows = [
    ["1 — Full PCOS", "✓", "✓", "✓", "Most common; classic presentation; highest metabolic risk"],
    ["2 — Classic without PCO", "✓", "✓", "✗", "Classic NIH 1990 phenotype; significant metabolic risk"],
    ["3 — Ovulatory PCOS", "✓", "✗", "✓", "Regular cycles but biochemical HA + polycystic USS; milder metabolic risk"],
    ["4 — Non-androgenic PCOS", "✗", "✓", "✓", "No hyperandrogenism; irregular cycles + polycystic USS; mildest phenotype; exclude other causes carefully"],
]
phen_col_w = [3.5*cm, 2.8*cm, 3.0*cm, 3.2*cm, W - 12.5*cm]
phen_data = [[Paragraph(h, CELL_H) for h in phen_headers]]
phen_alt = [C_WHITE, C_GREY_BG, C_TEAL_LT, C_PURPLE_LT]
for i, row in enumerate(phen_rows):
    phen_data.append([Paragraph(str(c), CELL) for c in row])

phen_tbl = Table(phen_data, colWidths=phen_col_w, repeatRows=1)
phen_style = [
    ("BACKGROUND",(0,0),(-1,0), C_TEAL),
    ("GRID",(0,0),(-1,-1),0.35, C_GREY_LINE),
    ("TOPPADDING",(0,0),(-1,-1),4),
    ("BOTTOMPADDING",(0,0),(-1,-1),4),
    ("LEFTPADDING",(0,0),(-1,-1),5),
    ("RIGHTPADDING",(0,0),(-1,-1),5),
    ("VALIGN",(0,0),(-1,-1),"TOP"),
]
for i, bg in enumerate(phen_alt):
    phen_style.append(("BACKGROUND",(0,i+1),(-1,i+1), bg))
phen_tbl.setStyle(TableStyle(phen_style))
story.append(phen_tbl)
story.append(Spacer(1, 8))

# ═══════════════════════════════════════════════════════════════
# FOOTER NOTE
# ═══════════════════════════════════════════════════════════════
story.append(HRFlowable(width=W, thickness=0.5, color=C_GREY_LINE))
story.append(Spacer(1, 4))
story.append(Paragraph(
    "Sources: Harrison's Principles of Internal Medicine 22E (2025) · Berek &amp; Novak's Gynecology · "
    "Henry's Clinical Diagnosis &amp; Management by Laboratory Methods (Tietz) · Dermatology 2-Volume Set 5e · "
    "Textbook of Family Medicine 9e  |  Rotterdam Criteria (2003, updated 2023 International PCOS Guidelines)  |  "
    "For educational / clinical reference use. Verify all reference ranges with your local laboratory.",
    FOOT
))

# ── Build ──────────────────────────────────────────────────────
doc.build(story)
print(f"PDF saved: {OUTPUT}")

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm, mm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.colors import HexColor
from reportlab.graphics.shapes import Drawing, Rect, Circle, String, Line
from reportlab.graphics import renderPDF

OUTPUT = "/home/daytona/workspace/pcos-pdf/PCOS_Patient_Handout.pdf"

# ── Palette (soft, warm, approachable) ─────────────────────────
C_ROSE       = HexColor("#C2185B")   # header / accent
C_ROSE_LT    = HexColor("#FCE4EC")   # soft pink bg
C_TEAL       = HexColor("#00796B")   # section headers
C_TEAL_LT    = HexColor("#E0F2F1")   # teal light bg
C_PURPLE     = HexColor("#6A1B9A")   # accent 2
C_PURPLE_LT  = HexColor("#F3E5F5")
C_AMBER      = HexColor("#F57F17")   # tips/notes
C_AMBER_LT   = HexColor("#FFFDE7")
C_GREEN      = HexColor("#2E7D32")
C_GREEN_LT   = HexColor("#E8F5E9")
C_BLUE       = HexColor("#1565C0")
C_BLUE_LT    = HexColor("#E3F2FD")
C_GREY_LT    = HexColor("#F5F5F5")
C_GREY_LINE  = HexColor("#CFD8DC")
C_BLACK      = HexColor("#212121")
C_DARK_GREY  = HexColor("#424242")
C_WHITE      = colors.white

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    topMargin=1.4*cm, bottomMargin=1.4*cm,
    leftMargin=1.8*cm, rightMargin=1.8*cm
)
W = A4[0] - 3.6*cm

def ps(name, **kw):
    base = kw.pop("parent", "Normal")
    return ParagraphStyle(name, parent=getSampleStyleSheet()[base], **kw)

# Styles
TITLE    = ps("TITLE",   fontSize=26, textColor=C_WHITE,  alignment=TA_CENTER, fontName="Helvetica-Bold", leading=32)
TAGLINE  = ps("TAGLINE", fontSize=12, textColor=HexColor("#F8BBD0"), alignment=TA_CENTER, fontName="Helvetica-Oblique", leading=17)
SEC_H    = ps("SEC_H",   fontSize=12, textColor=C_WHITE,  alignment=TA_LEFT,   fontName="Helvetica-Bold", leading=16, spaceBefore=4, spaceAfter=2)
BODY     = ps("BODY",    fontSize=10, textColor=C_BLACK,  alignment=TA_JUSTIFY,fontName="Helvetica",      leading=15, spaceBefore=2)
BODY_L   = ps("BODY_L",  fontSize=10, textColor=C_BLACK,  alignment=TA_LEFT,   fontName="Helvetica",      leading=15, spaceBefore=2)
BOLD10   = ps("BOLD10",  fontSize=10, textColor=C_BLACK,  fontName="Helvetica-Bold", leading=15)
CELL     = ps("CELL",    fontSize=9.5,textColor=C_BLACK,  fontName="Helvetica",      leading=14, alignment=TA_LEFT)
CELL_H   = ps("CELL_H",  fontSize=9.5,textColor=C_WHITE,  fontName="Helvetica-Bold", leading=14, alignment=TA_LEFT)
CELL_C   = ps("CELL_C",  fontSize=9.5,textColor=C_BLACK,  fontName="Helvetica",      leading=14, alignment=TA_CENTER)
NOTE     = ps("NOTE",    fontSize=9,  textColor=HexColor("#4E342E"), fontName="Helvetica-Oblique", leading=13)
TIP_H    = ps("TIP_H",   fontSize=10, textColor=C_AMBER,  fontName="Helvetica-Bold", leading=14)
SMALL    = ps("SMALL",   fontSize=8,  textColor=HexColor("#757575"), fontName="Helvetica", leading=11, alignment=TA_CENTER)
Q        = ps("Q",       fontSize=10, textColor=C_TEAL,   fontName="Helvetica-Bold", leading=14)
ANS      = ps("ANS",     fontSize=10, textColor=C_BLACK,  fontName="Helvetica",      leading=15, alignment=TA_JUSTIFY)
BULLET   = ps("BULLET",  fontSize=10, textColor=C_BLACK,  fontName="Helvetica", leading=15, leftIndent=12, firstLineIndent=-12)
EMPH     = ps("EMPH",    fontSize=10, textColor=C_PURPLE, fontName="Helvetica-Bold", leading=15, alignment=TA_CENTER)

story = []

# ══════════════════════════════════════════════════════════════
# TITLE BANNER
# ══════════════════════════════════════════════════════════════
def title_banner():
    rows = [
        [Paragraph("Understanding PCOS", TITLE)],
        [Paragraph("Polycystic Ovary Syndrome", TAGLINE)],
        [Paragraph("A guide for patients & families", TAGLINE)],
    ]
    t = Table(rows, colWidths=[W])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), C_ROSE),
        ("TOPPADDING",  (0,0), (-1,0), 16),
        ("BOTTOMPADDING",(0,-1),(-1,-1), 14),
        ("TOPPADDING",  (0,1), (-1,1), 3),
        ("BOTTOMPADDING",(0,0),(-1,1), 3),
        ("TOPPADDING",  (0,2), (-1,2), 2),
    ]))
    return t

story.append(title_banner())
story.append(Spacer(1, 8))

# ══════════════════════════════════════════════════════════════
# Helper: section header
# ══════════════════════════════════════════════════════════════
def sec(icon, title, color=C_TEAL):
    t = Table([[Paragraph(f"  {icon}  {title}", SEC_H)]], colWidths=[W])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1), color),
        ("TOPPADDING",(0,0),(-1,-1),6),
        ("BOTTOMPADDING",(0,0),(-1,-1),6),
        ("LEFTPADDING",(0,0),(-1,-1),6),
    ]))
    return t

def info_box(text, bg=C_AMBER_LT, border=C_AMBER, style=NOTE):
    t = Table([[Paragraph(text, style)]], colWidths=[W])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1), bg),
        ("BOX",(0,0),(-1,-1),1.2, border),
        ("TOPPADDING",(0,0),(-1,-1),7),
        ("BOTTOMPADDING",(0,0),(-1,-1),7),
        ("LEFTPADDING",(0,0),(-1,-1),10),
        ("RIGHTPADDING",(0,0),(-1,-1),10),
    ]))
    return t

def two_col(left_content, right_content, lw=None, rw=None):
    lw = lw or W * 0.48
    rw = rw or W * 0.48
    t = Table([[left_content, right_content]], colWidths=[lw, W - lw - 0.2*cm])
    t.setStyle(TableStyle([
        ("VALIGN",(0,0),(-1,-1),"TOP"),
        ("LEFTPADDING",(0,0),(-1,-1),0),
        ("RIGHTPADDING",(0,0),(-1,-1),0),
        ("TOPPADDING",(0,0),(-1,-1),0),
        ("BOTTOMPADDING",(0,0),(-1,-1),0),
    ]))
    return t

def bullet_table(items, bullet="•", color=C_TEAL, bg=C_WHITE):
    rows = []
    for item in items:
        rows.append([
            Paragraph(f'<font color="#{color.hexval()[2:]}"><b>{bullet}</b></font>', CELL),
            Paragraph(item, CELL)
        ])
    t = Table(rows, colWidths=[0.4*cm, W - 0.4*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1), bg),
        ("TOPPADDING",(0,0),(-1,-1),2),
        ("BOTTOMPADDING",(0,0),(-1,-1),2),
        ("LEFTPADDING",(0,0),(-1,-1),4),
        ("RIGHTPADDING",(0,0),(-1,-1),4),
        ("VALIGN",(0,0),(-1,-1),"TOP"),
    ]))
    return t

# ══════════════════════════════════════════════════════════════
# SECTION 1 – WHAT IS PCOS?
# ══════════════════════════════════════════════════════════════
story.append(sec("❓", "What Is PCOS?", C_ROSE))
story.append(Spacer(1, 5))
story.append(Paragraph(
    "PCOS (Polycystic Ovary Syndrome) is one of the most common hormonal conditions in women of "
    "reproductive age, affecting about <b>1 in 10 women worldwide</b>. It affects how the ovaries work "
    "and causes an imbalance in hormones — particularly higher-than-normal levels of male hormones "
    "(androgens). Despite its name, you do not need to have cysts on your ovaries to have PCOS.",
    BODY))
story.append(Spacer(1, 5))
story.append(info_box(
    "💡  PCOS is NOT your fault. It is caused by a combination of genetic and hormonal factors. "
    "It cannot be 'caught' and is not caused by anything you did or didn't do.",
    bg=C_TEAL_LT, border=C_TEAL, style=NOTE))
story.append(Spacer(1, 8))

# ══════════════════════════════════════════════════════════════
# SECTION 2 – SYMPTOMS
# ══════════════════════════════════════════════════════════════
story.append(sec("🩺", "Common Symptoms", C_ROSE))
story.append(Spacer(1, 5))
story.append(Paragraph(
    "PCOS affects every woman differently. You may have a few symptoms or many. "
    "Symptoms often start in your teens or early 20s.", BODY))
story.append(Spacer(1, 5))

sym_left = [
    ["<b>Symptom</b>", "<b>What It Means</b>"],
    ["Irregular or missed periods", "Ovulation does not happen regularly, causing unpredictable cycles"],
    ["Excess hair on face, chest, or back (hirsutism)", "Higher androgen (male hormone) levels stimulate hair follicles"],
    ["Acne or oily skin", "Androgens increase oil production in skin glands"],
    ["Thinning hair or hair loss on scalp", "Again related to elevated androgens acting on hair follicles"],
    ["Weight gain (especially around the belly)", "Insulin resistance makes it easier to gain and harder to lose weight"],
    ["Difficulty getting pregnant", "Irregular ovulation means fewer chances of conception each month"],
    ["Mood changes, anxiety, or low mood", "Hormonal imbalance and living with a chronic condition can affect mental health"],
    ["Fatigue", "Often linked to poor sleep, blood sugar swings, or low mood"],
]
sym_col_w = [4.5*cm, W - 4.5*cm]
sym_data = [[Paragraph(r[0], CELL_H if i==0 else CELL_C),
             Paragraph(r[1], CELL_H if i==0 else CELL)]
            for i, r in enumerate(sym_left)]
sym_tbl = Table(sym_data, colWidths=sym_col_w, repeatRows=1)
sym_tbl.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0), C_ROSE),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[C_WHITE, C_ROSE_LT]),
    ("GRID",(0,0),(-1,-1),0.35, C_GREY_LINE),
    ("TOPPADDING",(0,0),(-1,-1),5),
    ("BOTTOMPADDING",(0,0),(-1,-1),5),
    ("LEFTPADDING",(0,0),(-1,-1),6),
    ("RIGHTPADDING",(0,0),(-1,-1),6),
    ("VALIGN",(0,0),(-1,-1),"TOP"),
]))
story.append(sym_tbl)
story.append(Spacer(1, 5))
story.append(info_box(
    "⚠️  Not all women with PCOS have all symptoms. Some women only discover they have PCOS "
    "when they have difficulty getting pregnant. See your doctor if you have irregular periods or "
    "any of the symptoms above.",
    bg=C_AMBER_LT, border=C_AMBER))
story.append(Spacer(1, 8))

# ══════════════════════════════════════════════════════════════
# SECTION 3 – HOW IS PCOS DIAGNOSED?
# ══════════════════════════════════════════════════════════════
story.append(sec("🔬", "How Is PCOS Diagnosed?", C_TEAL))
story.append(Spacer(1, 5))
story.append(Paragraph(
    "There is no single test for PCOS. Your doctor will use a combination of your symptoms, "
    "blood tests, and an ultrasound scan. According to international guidelines (<b>Rotterdam Criteria 2023</b>), "
    "you need to have <b>2 out of the following 3 features</b>, after other conditions have been ruled out:", BODY))
story.append(Spacer(1, 5))

diag_rows = [
    ["Feature 1", "Irregular or absent periods\n(fewer than 8 menstrual cycles per year, or no periods)"],
    ["Feature 2", "Signs of high male hormones (androgens)\nEither on examination (e.g. excess facial hair, acne) OR in your blood tests"],
    ["Feature 3", "Polycystic-looking ovaries on ultrasound scan\nOR an elevated AMH blood test result"],
]
diag_col_w = [2.8*cm, W - 2.8*cm]
diag_data = [[Paragraph(f"<b>{r[0]}</b>", CELL), Paragraph(r[1], CELL)] for r in diag_rows]
diag_colors = [C_TEAL_LT, C_GREEN_LT, C_PURPLE_LT]
diag_tbl = Table(diag_data, colWidths=diag_col_w)
diag_tbl.setStyle(TableStyle([
    ("BOX",(0,0),(-1,-1),1, C_GREY_LINE),
    ("LINEBELOW",(0,0),(-1,-2),0.5, C_GREY_LINE),
    ("TOPPADDING",(0,0),(-1,-1),7),
    ("BOTTOMPADDING",(0,0),(-1,-1),7),
    ("LEFTPADDING",(0,0),(-1,-1),8),
    ("RIGHTPADDING",(0,0),(-1,-1),8),
    ("VALIGN",(0,0),(-1,-1),"MIDDLE"),
    *[("BACKGROUND",(0,i),(-1,i), diag_colors[i]) for i in range(3)],
]))
story.append(diag_tbl)
story.append(Spacer(1, 5))
story.append(info_box(
    "📋  PCOS is a diagnosis of exclusion — your doctor must first rule out other conditions "
    "that can look similar, such as thyroid problems, raised prolactin hormone, or adrenal gland conditions.",
    bg=C_BLUE_LT, border=C_BLUE))
story.append(Spacer(1, 8))

# ══════════════════════════════════════════════════════════════
# SECTION 4 – BLOOD TESTS EXPLAINED
# ══════════════════════════════════════════════════════════════
story.append(sec("🩸", "Blood Tests Your Doctor May Order", C_TEAL))
story.append(Spacer(1, 5))
story.append(Paragraph(
    "Blood tests help confirm the diagnosis and check for related health conditions. "
    "Here is a plain-language guide to each test:", BODY))
story.append(Spacer(1, 5))

tests = [
    ("Testosterone (Total & Free)",
     "Checks the level of the main 'male hormone' in your blood. Women normally have small "
     "amounts, but in PCOS it is often higher than normal. This can cause excess hair and acne.",
     C_ROSE_LT, C_ROSE),
    ("LH & FSH\n(Luteinising Hormone & Follicle-Stimulating Hormone)",
     "These are 'messenger hormones' from your brain that tell your ovaries to release an egg. "
     "In PCOS, LH is often higher than FSH, which disrupts ovulation. <i>Note: these are measured "
     "on Day 2–3 of your period for best results.</i>",
     C_TEAL_LT, C_TEAL),
    ("AMH\n(Anti-Müllerian Hormone)",
     "Reflects the number of small egg follicles in your ovaries. Women with PCOS often have a "
     "higher AMH level because they have more follicles than usual. AMH can be measured any day "
     "of your cycle.",
     C_PURPLE_LT, C_PURPLE),
    ("17-OH Progesterone",
     "Rules out a condition called Congenital Adrenal Hyperplasia (CAH), which can look very "
     "similar to PCOS. This is measured on Days 2–5 of your cycle, in the morning.",
     C_GREEN_LT, C_GREEN),
    ("Prolactin",
     "A hormone produced by the pituitary gland (in the brain). High prolactin can stop ovulation "
     "and cause irregular periods — so it needs to be ruled out before confirming PCOS.",
     C_BLUE_LT, C_BLUE),
    ("TSH (Thyroid Stimulating Hormone)",
     "Checks your thyroid gland. An underactive thyroid can cause weight gain, irregular periods, "
     "and tiredness — symptoms that overlap with PCOS. Can be tested any time of day.",
     C_AMBER_LT, C_AMBER),
    ("Fasting Blood Glucose & HbA1c",
     "Checks your blood sugar level and your average blood sugar over 3 months. Women with PCOS "
     "are more likely to develop prediabetes or type 2 diabetes, especially with weight gain.",
     C_ROSE_LT, C_ROSE),
    ("Fasting Insulin / HOMA-IR",
     "Checks whether your body is responding properly to insulin (the hormone that controls blood "
     "sugar). Many women with PCOS have 'insulin resistance' — their body makes extra insulin to "
     "keep blood sugar normal, which worsens hormone imbalance.",
     C_TEAL_LT, C_TEAL),
    ("DHEA-S",
     "Another male hormone, but made by the adrenal glands (above the kidneys) rather than the "
     "ovaries. Helps distinguish whether excess androgens come from the ovaries (PCOS) or adrenal "
     "glands (adrenal condition).",
     C_PURPLE_LT, C_PURPLE),
    ("Fasting Lipid Profile\n(Cholesterol & Triglycerides)",
     "PCOS increases the risk of unhealthy cholesterol levels. This test checks LDL ('bad') "
     "cholesterol, HDL ('good') cholesterol, and triglycerides (blood fats).",
     C_GREEN_LT, C_GREEN),
]

for test_name, test_desc, bg, border in tests:
    row = [[
        Paragraph(f"<b>{test_name}</b>", BOLD10),
        Paragraph(test_desc, CELL)
    ]]
    t = Table(row, colWidths=[4.2*cm, W - 4.2*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(0,-1), bg),
        ("BACKGROUND",(1,0),(1,-1), C_WHITE),
        ("BOX",(0,0),(-1,-1),0.8, border),
        ("LINEAFTER",(0,0),(0,-1),0.8, border),
        ("TOPPADDING",(0,0),(-1,-1),6),
        ("BOTTOMPADDING",(0,0),(-1,-1),6),
        ("LEFTPADDING",(0,0),(-1,-1),7),
        ("RIGHTPADDING",(0,0),(-1,-1),7),
        ("VALIGN",(0,0),(-1,-1),"TOP"),
    ]))
    story.append(t)
    story.append(Spacer(1, 3))

story.append(Spacer(1, 5))
story.append(info_box(
    "📌  For hormone tests like LH, FSH, testosterone and 17-OH progesterone, timing matters. "
    "Your doctor will usually ask you to come in on Day 2–5 of your menstrual cycle, fasting "
    "(nothing to eat for 8–10 hours). If you are on the contraceptive pill, these tests may need "
    "to wait until 3 months after stopping, as the pill suppresses hormone levels.",
    bg=C_AMBER_LT, border=C_AMBER))
story.append(Spacer(1, 8))

# ══════════════════════════════════════════════════════════════
# SECTION 5 – LONG-TERM HEALTH RISKS
# ══════════════════════════════════════════════════════════════
story.append(sec("❤️", "Long-Term Health Conditions to Be Aware Of", C_PURPLE))
story.append(Spacer(1, 5))
story.append(Paragraph(
    "PCOS can increase the risk of certain health conditions over time. "
    "The good news is that many of these risks can be <b>significantly reduced</b> with the "
    "right lifestyle changes and medical treatment.", BODY))
story.append(Spacer(1, 5))

risk_rows = [
    ["Health Condition", "What Increases the Risk?", "How to Reduce Your Risk"],
    ["Type 2 Diabetes\n& Prediabetes",
     "Insulin resistance, weight gain",
     "Healthy diet, regular exercise, regular blood sugar checks"],
    ["Cardiovascular Disease\n(Heart & Blood Vessels)",
     "Unhealthy cholesterol, high blood pressure, obesity",
     "Exercise, healthy eating, weight management, stop smoking"],
    ["Endometrial Cancer\n(Womb Cancer)",
     "Infrequent periods mean the womb lining builds up",
     "Induce regular periods (with medication if needed); lose weight if overweight"],
    ["Obstructive Sleep Apnoea",
     "Obesity and hormonal factors",
     "Weight loss, sleep study if snoring or poor sleep"],
    ["Mental Health Problems\n(Anxiety, Depression)",
     "Hormonal imbalance, body image concerns, fertility worries",
     "Seek support early; therapy, peer support groups, medication if needed"],
    ["Difficulty Conceiving",
     "Irregular ovulation reduces monthly chance of pregnancy",
     "Fertility treatments available; lifestyle changes improve ovulation"],
]
risk_col_w = [3.8*cm, 4.5*cm, W - 8.3*cm]
risk_data = [[Paragraph(str(c), CELL_H if i==0 else CELL) for c in r] for i, r in enumerate(risk_rows)]
risk_tbl = Table(risk_data, colWidths=risk_col_w, repeatRows=1)
risk_tbl.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0), C_PURPLE),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[C_WHITE, C_PURPLE_LT]),
    ("GRID",(0,0),(-1,-1),0.35, C_GREY_LINE),
    ("TOPPADDING",(0,0),(-1,-1),5),
    ("BOTTOMPADDING",(0,0),(-1,-1),5),
    ("LEFTPADDING",(0,0),(-1,-1),6),
    ("RIGHTPADDING",(0,0),(-1,-1),6),
    ("VALIGN",(0,0),(-1,-1),"TOP"),
]))
story.append(risk_tbl)
story.append(Spacer(1, 8))

# ══════════════════════════════════════════════════════════════
# SECTION 6 – TREATMENT OPTIONS
# ══════════════════════════════════════════════════════════════
story.append(sec("💊", "Treatment Options", C_GREEN))
story.append(Spacer(1, 5))
story.append(Paragraph(
    "There is no cure for PCOS, but the symptoms can be very well managed. "
    "Treatment is tailored to your specific symptoms and goals "
    "(e.g. managing periods, reducing hair growth, getting pregnant, or improving metabolic health).",
    BODY))
story.append(Spacer(1, 6))

# Lifestyle block
lifestyle_items = [
    "<b>Healthy diet:</b> Low glycaemic index (GI) foods — wholegrains, legumes, vegetables, lean protein. Reduce processed foods and sugary drinks.",
    "<b>Regular exercise:</b> Aim for at least 150 minutes of moderate activity per week. Both cardio and strength training are beneficial.",
    "<b>Weight management:</b> Losing even 5–10% of body weight can restore ovulation, improve periods, and reduce androgen levels in overweight women.",
    "<b>Stress reduction:</b> Chronic stress worsens insulin resistance. Sleep well (7–9 hours), try yoga, mindfulness, or relaxation techniques.",
]

lifestyle_tbl = Table([
    [Paragraph("🥗  Lifestyle Changes (First-Line Treatment for ALL Women with PCOS)", TIP_H)],
    [bullet_table(lifestyle_items, color=C_GREEN)],
], colWidths=[W])
lifestyle_tbl.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0), C_GREEN_LT),
    ("BACKGROUND",(0,1),(-1,1), C_WHITE),
    ("BOX",(0,0),(-1,-1),1, C_GREEN),
    ("TOPPADDING",(0,0),(-1,0),7),
    ("BOTTOMPADDING",(0,0),(-1,0),5),
    ("TOPPADDING",(0,1),(-1,1),4),
    ("BOTTOMPADDING",(0,1),(-1,1),6),
    ("LEFTPADDING",(0,0),(-1,-1),10),
    ("RIGHTPADDING",(0,0),(-1,-1),10),
]))
story.append(lifestyle_tbl)
story.append(Spacer(1, 6))

# Medications
med_rows = [
    ["Treatment", "What It Does", "Used For"],
    ["Combined Oral Contraceptive Pill (OCP)",
     "Regulates periods, lowers androgen levels, improves acne and excess hair",
     "Irregular periods, acne, hirsutism"],
    ["Metformin",
     "Improves insulin resistance, helps regulate periods, may aid weight management",
     "Insulin resistance, prediabetes, irregular cycles, fertility support"],
    ["Anti-androgens\n(e.g. spironolactone, cyproterone acetate)",
     "Block the effect of male hormones on the skin and hair follicles",
     "Hirsutism (excess hair), acne, hair loss"],
    ["Clomifene / Letrozole",
     "Stimulates ovulation to help you get pregnant",
     "Fertility treatment for women trying to conceive"],
    ["Gonadotrophins\n(FSH / LH injections)",
     "Directly stimulate the ovaries to produce eggs",
     "Fertility treatment when tablets have not worked"],
    ["Inositol\n(Myo-inositol / D-chiro-inositol)",
     "Supplement that may improve insulin sensitivity and ovulation regularity",
     "Insulin resistance, ovulation support — ask your doctor"],
    ["Eflornithine cream",
     "Slows the growth of facial hair",
     "Facial hirsutism"],
]
med_col_w = [3.8*cm, 5.5*cm, W - 9.3*cm]
med_data = [[Paragraph(str(c), CELL_H if i==0 else CELL) for c in r] for i, r in enumerate(med_rows)]
med_tbl = Table(med_data, colWidths=med_col_w, repeatRows=1)
med_tbl.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0), C_GREEN),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[C_WHITE, C_GREEN_LT]),
    ("GRID",(0,0),(-1,-1),0.35, C_GREY_LINE),
    ("TOPPADDING",(0,0),(-1,-1),5),
    ("BOTTOMPADDING",(0,0),(-1,-1),5),
    ("LEFTPADDING",(0,0),(-1,-1),6),
    ("RIGHTPADDING",(0,0),(-1,-1),6),
    ("VALIGN",(0,0),(-1,-1),"TOP"),
]))
story.append(med_tbl)
story.append(Spacer(1, 5))
story.append(info_box(
    "💊  Always take medications only as prescribed by your doctor. Do NOT start or stop any "
    "treatment without medical advice. Some medications interact with each other or are not safe "
    "in pregnancy.",
    bg=C_AMBER_LT, border=C_AMBER))
story.append(Spacer(1, 8))

# ══════════════════════════════════════════════════════════════
# SECTION 7 – PCOS & FERTILITY
# ══════════════════════════════════════════════════════════════
story.append(sec("👶", "PCOS & Fertility — What You Need to Know", C_ROSE))
story.append(Spacer(1, 5))
story.append(Paragraph(
    "One of the most common concerns for women with PCOS is fertility. "
    "PCOS is a leading cause of irregular ovulation, which makes it harder — but <b>not impossible</b> — "
    "to get pregnant.", BODY))
story.append(Spacer(1, 5))

fert_items = [
    "Most women with PCOS <b>can and do</b> get pregnant, either naturally or with medical help.",
    "Losing weight (if you are overweight) is one of the most effective ways to restore ovulation.",
    "Letrozole is the first-line fertility medication for PCOS (recommended over clomifene in current guidelines).",
    "If tablets do not work, FSH injections or IVF may be offered.",
    "Women with PCOS undergoing IVF have a higher risk of Ovarian Hyperstimulation Syndrome (OHSS) — your fertility team will monitor this closely.",
    "During pregnancy, PCOS is associated with a slightly higher risk of gestational diabetes and high blood pressure — regular antenatal checks are important.",
]
story.append(bullet_table(fert_items, color=C_ROSE, bg=C_ROSE_LT))
story.append(Spacer(1, 8))

# ══════════════════════════════════════════════════════════════
# SECTION 8 – LOOKING AFTER YOUR MENTAL HEALTH
# ══════════════════════════════════════════════════════════════
story.append(sec("🧠", "Looking After Your Mental Health", C_PURPLE))
story.append(Spacer(1, 5))
story.append(Paragraph(
    "Living with PCOS can be emotionally challenging. Body image concerns, fertility worries, "
    "and the ongoing nature of the condition mean that many women with PCOS experience anxiety, "
    "depression, or low self-esteem. <b>You are not alone, and support is available.</b>", BODY))
story.append(Spacer(1, 5))

mh_items = [
    "<b>Talk to your doctor:</b> If you feel low, anxious, or overwhelmed, tell your GP or specialist. Mental health support is part of PCOS care.",
    "<b>Connect with others:</b> PCOS support groups (online and in person) can be enormously helpful.",
    "<b>Cognitive Behavioural Therapy (CBT):</b> Evidence-based talking therapy that helps with anxiety and depression.",
    "<b>Body-positive thinking:</b> Focus on health and how you feel, not just appearance.",
    "<b>Regular exercise:</b> One of the best evidence-based treatments for mild to moderate depression and anxiety.",
]
story.append(bullet_table(mh_items, color=C_PURPLE, bg=C_PURPLE_LT))
story.append(Spacer(1, 8))

# ══════════════════════════════════════════════════════════════
# SECTION 9 – QUESTIONS TO ASK YOUR DOCTOR
# ══════════════════════════════════════════════════════════════
story.append(sec("💬", "Questions to Ask Your Doctor", C_TEAL))
story.append(Spacer(1, 5))

qa_pairs = [
    ("Which PCOS features do I have? What is my phenotype?",
     "Understanding your phenotype helps personalise your treatment."),
    ("Do I have insulin resistance? Should I take metformin?",
     "Metformin is very helpful for some women but not all — depends on your results."),
    ("What blood tests do I need and when should I repeat them?",
     "Ongoing monitoring is important for metabolic health."),
    ("What are my fertility options?",
     "Even if you're not trying to get pregnant now, it's good to plan ahead."),
    ("Should I be referred to a specialist (endocrinologist, gynaecologist, dietitian)?",
     "PCOS is best managed by a team when possible."),
    ("Are there any clinical trials I could join?",
     "New treatments for PCOS are being studied — ask if any are available near you."),
]

for q, a in qa_pairs:
    row = [[Paragraph(f"Q: {q}", Q), Paragraph(f"A: {a}", ANS)]]
    t = Table(row, colWidths=[W*0.46, W*0.54])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(0,-1), C_TEAL_LT),
        ("BACKGROUND",(1,0),(1,-1), C_WHITE),
        ("BOX",(0,0),(-1,-1),0.6, C_GREY_LINE),
        ("LINEAFTER",(0,0),(0,-1),0.6, C_TEAL),
        ("TOPPADDING",(0,0),(-1,-1),6),
        ("BOTTOMPADDING",(0,0),(-1,-1),6),
        ("LEFTPADDING",(0,0),(-1,-1),7),
        ("RIGHTPADDING",(0,0),(-1,-1),7),
        ("VALIGN",(0,0),(-1,-1),"TOP"),
    ]))
    story.append(t)
    story.append(Spacer(1, 3))

story.append(Spacer(1, 8))

# ══════════════════════════════════════════════════════════════
# SECTION 10 – KEY FACTS AT A GLANCE
# ══════════════════════════════════════════════════════════════
story.append(sec("⭐", "Key Facts at a Glance", C_ROSE))
story.append(Spacer(1, 5))

facts = [
    ("1 in 10", "women of reproductive age have PCOS worldwide"),
    ("2 of 3", "Rotterdam criteria needed to diagnose PCOS"),
    ("50–70%", "of women with PCOS have insulin resistance"),
    ("5–10%", "weight loss can restore periods and ovulation"),
    ("70%", "of PCOS women in the US have hirsutism"),
    ("2–6×", "increased risk of endometrial cancer if periods are very infrequent"),
]
fact_col = W / 3 - 0.2*cm
fact_rows_top = facts[:3]
fact_rows_bot = facts[3:]

def fact_cell(num, desc):
    t = Table([
        [Paragraph(f'<font color="#{C_ROSE.hexval()[2:]}"><b>{num}</b></font>', ps("FN", fontSize=20, fontName="Helvetica-Bold", alignment=TA_CENTER, leading=24))],
        [Paragraph(desc, ps("FD", fontSize=9, fontName="Helvetica", alignment=TA_CENTER, leading=13, textColor=C_DARK_GREY))],
    ], colWidths=[fact_col])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1), C_ROSE_LT),
        ("BOX",(0,0),(-1,-1),0.8, C_ROSE),
        ("TOPPADDING",(0,0),(-1,-1),6),
        ("BOTTOMPADDING",(0,0),(-1,-1),6),
    ]))
    return t

row1 = [[fact_cell(n, d) for n, d in fact_rows_top]]
row2 = [[fact_cell(n, d) for n, d in fact_rows_bot]]
gap = 0.3*cm
fact_tbl1 = Table(row1, colWidths=[fact_col, fact_col, fact_col],
                  rowHeights=None)
fact_tbl1.setStyle(TableStyle([
    ("LEFTPADDING",(0,0),(-1,-1),2),
    ("RIGHTPADDING",(0,0),(-1,-1),2),
    ("TOPPADDING",(0,0),(-1,-1),0),
    ("BOTTOMPADDING",(0,0),(-1,-1),0),
]))
fact_tbl2 = Table(row2, colWidths=[fact_col, fact_col, fact_col])
fact_tbl2.setStyle(TableStyle([
    ("LEFTPADDING",(0,0),(-1,-1),2),
    ("RIGHTPADDING",(0,0),(-1,-1),2),
    ("TOPPADDING",(0,0),(-1,-1),0),
    ("BOTTOMPADDING",(0,0),(-1,-1),0),
]))
story.append(fact_tbl1)
story.append(Spacer(1, 4))
story.append(fact_tbl2)
story.append(Spacer(1, 8))

# ══════════════════════════════════════════════════════════════
# FOOTER
# ══════════════════════════════════════════════════════════════
story.append(HRFlowable(width=W, thickness=0.6, color=C_GREY_LINE))
story.append(Spacer(1, 4))
story.append(Paragraph(
    "This handout is for educational purposes only and does not replace advice from your doctor or healthcare team. "
    "Information based on: Rotterdam Criteria 2023 · Harrison's Principles of Internal Medicine 22E · "
    "Berek &amp; Novak's Gynecology · Henry's Clinical Diagnosis and Management by Laboratory Methods.",
    SMALL))
story.append(Spacer(1, 3))
story.append(Paragraph(
    "If you have concerns about your health, please speak to your GP, gynaecologist, or endocrinologist.",
    SMALL))

doc.build(story)
print(f"PDF saved: {OUTPUT}")