Questions about polycystic ovaries
Dear Dr Mitchell,
I am a 24-year-old woman who was diagnosed with ovarian cysts in 2011. I was feeling pain due to the rupture of the cysts; however, the pain ended after taking some medication and didn’t return until last year. I did an ultrasound and the doctor informed me that I have multiple cysts (poly ovarian cysts) and I was placed on medication — a contraceptive. The thing I am concerned about is that I was told that I would have to continuously take the pill until I am ready to have a child, which means that it’s not something that can be cured. Also, I’ve not done an ultrasound since last year. Is it important that I do another to see my progress? Also, what is the likelihood of me being infertile?
Polycystic ovaries is a common condition seen in women. It is associated with enlarged ovaries on ultrasound with the presence of multiple small cysts. There is associated excessive production of male hormones (testosterone) which causes excessive hair growth on the face, chin, chest, and abdomen in a male pattern type of distribution. This excessive production of testosterone may cause the voice to become hoarse and the clitoris to become enlarged in some women.
In some instances polycystic ovaries is associated with excessive weight gain and a greater tendency to develop diabetes mellitus because of an underlying tendency to develop resistance to insulin which controls the blood sugar.
Ovulation is also suppressed, so the menstrual cycle becomes increasingly irregular with some women having the menstrual period sometimes once to twice for the year. In severe cases there is complete absence of the menstrual period.
The women with polycystic ovaries usually have difficulty becoming pregnant, but do conceive in some instances without any intervention. The mainstay of management is to try to achieve your ideal weight for height by getting into a regular exercise regimen at least three times per week to burn off the extra calories. A diet that is low in fatty foods and sugar will also help you to lose some of the weight. Drug therapy in the form of Metformin is usually helpful to reverse some of the changes and restore regular cycles.
The combined oral contraceptive pill, especially one that has an anti-androgen (Cyproterone Acetate), is extremely helpful in suppressing cysts in the ovaries, reducing testosterone levels, and helps to reverse some of the excessive hair growth. The menstrual cycle is usually restored to regular monthly periods. The long-term benefit of using the oral contraceptive pill is that it reduces the risk of cancer of the uterus and ovaries in later years in women with polycystic ovaries. When pregnancy is desired, the oral contraceptive pill can be discontinued and Clomiphene Citrate (Clomid) commenced to help to induce ovulation. This, when taken with the Metformin, improves fertility significantly.
You should be able to have as many children as you desire when you are ready. Maintain your ideal weight for height and a healthy lifestyle with diet and exercise as part of your daily routine.
Consult your doctor who will advise you about repeating the pelvic ultrasound and further routine screening, including your Pap smear and vaccinations to prevent cervical cancer.
Best regards.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
