About ovarian dysfunction

ONE of the major gynaecological issues women face is infertility, and the majority of the focus has always been on expensive in-vitro fertilisation used to treat one cause of infertility.

However, obstetrician-gynaecologist Dr Ryan Halsall said about 25-30 per cent of infertile women have what is known as ovarian dysfunction.

“Simply put, it’s when the ovaries aren’t doing what they were meant to do — produce eggs,” he said.

Dr Halsall explained that colloquially, ovarian dysfunction is referred to as “hormone imbalance”, which is accurate, but doesn’t even begin to tell the tale of all the possible causes.

“The ovary is controlled by hormones produced in the brain, so ovarian dysfunction can occur not only with disorders of the ovary, but also anything that affects the communication between the brain and the ovary,” he said.

With regards to symptoms, Dr Halsall said the hallmark symptom of ovarian dysfunction is irregular menses, or no menses.

“Now if you normally see your period regularly and then you miss one or two months, please don’t assume hormonal imbalance; get a pregnancy test done,” he said.

“The normal cycle length is around 24 to 35 days, and this is measured from the first day of your period to the day before your next cycle starts. If your cycle length is irregular, or longer than 35 days, chances are you have some form of ovarian dysfunction. Other symptoms will point to the underlying cause of the dysfunction and vary widely.”

The most common cause of ovarian dysfunction is polycystic ovarian syndrome (PCOS), which he said is a relatively poorly understood condition with many theories as to its origin.

“Whatever the case may be, there ends up being abnormal hormonal production by the ovaries which leads to excess male hormones being produced, irregular periods, and multiple tiny cysts on both ovaries. The cysts themselves are not cause for concern and require no treatment themselves. Other symptoms associated with this condition included excess facial hair and belly hair and acne,” Dr Halsall said.

He explained that PCOS as well as other things can affect the communication between the brain and ovary. These other things include things like being underweight, obese, anaemic, mental stress and excessive strenuous exercise, which can all negatively affect egg production. Medical conditions include overactive or underactive thyroid gland, brain tumours, and even chronic kidney disease.

Treatment of this condition is usually aimed at the underlying cause.

“Correcting weight issues and low blood count, normalising thyroid and kidney function, and reducing emotional stress can help. If controlling the underlying conditions do not help, then further interventions are usually employed,” he said.

Dr Halsall explained that the rest of the management is dependent on whether you want kids right now.

“If no kids are on the agenda then simply regularising your period with the contraceptive pill is all that’s required. If kids are on the agenda then you will require stimulation of your ovaries with medication in order to produce eggs.”