Thursday, October 30, 2014


Hydrosalpinx

From Wikipedia, the free encyclopedia

A hydrosalpinx is a distally blocked fallopian tube filled with serous or clear fluid. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in diameter. The blocked tubes cause infertility.
A fallopian tube filled with blood is a hematosalpinx, and with pus a pyosalpinx.
Hydrosalpinx is a composite of the Greek words ὕδωρ (hydro - "water") and σαλπιγξ (salpinx - ' "trumpet"); its plural is hydrosalpinges.

Contents


·         1 Etiology
·         2 Symptoms
·         3 Diagnosis
·         4 Prevention
·         5 Management
·         6 History
·         7 See also
·         8 References
·         9 External links

Etiology[edit]

The major cause for distal tubal occlusion is pelvic inflammatory disease (PID), usually as a consequence of an ascending infection by chlamydia or gonorrhea. However, not all pelvic infections will cause distal tubal occlusion. Tubal tuberculosis is an uncommon cause of hydrosalpinx formation.
While the ciliae of the inner lining (endosalpinx) of the fallopian tube beat towards the uterus, tubal fluid is normally discharged via the fimbriated end into the peritoneal cavity from where it is cleared. If the fimbriated end of the tube becomes agglutinated, the resulting obstruction does not allow the tubal fluid to pass; it accumulates and reverts its flow downstream, into the uterus, or production is curtailed by damage to the endosalpinx. This tube then is unable to participate in the reproductive process: sperm cannot pass, the egg is not picked up, and fertilization does not take place.
Other causes of distal tubal occlusion include adhesion formation from surgery, endometriosis, and cancer of the tube, ovary or other surrounding organs.
A hematosalpinx is most commonly associated with an ectopic pregnancy. A pyosalpinx is typically seen in a more acute stage of PID and may be part of a tuboovarianabscess (TOA).
Tubal phimosis refers to a situation where the tubal end is partially occluded, in this case fertility is impeded, and the risk of an ectopic pregnancy is increased.

Symptoms

Symptoms can vary. Some patients have lower often recurring abdominal pain or pelvic pain, while others may be asymptomatic. As tubal function is impeded, infertility is a common symptom. Patients who are not trying to get pregnant and have no pain, may go undetected.
IUDs, endometriosis, and abdominal surgery sometimes are associated with the problem. As a reaction to injury, the body rushes inflammatory cells into the area, and inflammation and later healing result in loss of the fimbria and closure of the tube. These infections usually affect both fallopian tubes, and although a hydrosalpinx can be one-sided, the other tube on the opposite side is often abnormal. By the time it is detected, the tubal fluid usually is sterile, and does not contain an active infection.

Diagnosis

Hydrosalpinx may be diagnosed using ultrasonography as the fluid filled elongated and distended tubes display their typical echolucent pattern. However, a small hydrosalpinx may be missed by sonography. During an infertility work-up a hysterosalpingogram (HSG), an X-ray procedure that uses a contrast agent to image the fallopian tubes, shows the retort-like shape of the distended tubes and the absence of spillage of the dye into the peritoneum. If, however, there is a tubal occlusion at the utero-tubal junction, a hydrosalpinx may go undetected. When a hydrosalpinx is detected by an HSG it is prudent to administer antibiotics to reduce the risk of reactivation of an inflammatory process.
When a laparoscopy is performed, the surgeon will note the distended tubes, identify the occlusion, and may also find associated adhesions affecting the pelvic organs. A laparoscopy not only allows for the diagnosis of hydrosalpinx, but also presents a platform for intervention (see management).

Prevention

As pelvic inflammatory disease is the major cause of hydrosalpinx formation, steps to reduce sexually transmitted disease will reduce incidence of hydrosalpinx. Also, as hydrosalpinx is a sequel to a pelvic infection, adequate and early antibiotic treatment of a pelvic infection is called for.

Management

For most of the past century patients with tubal infertility due to hydrosalpinx underwent tubal corrective surgery to open up the distally occluded end of the tubes (salpingostomy) and remove adhesions (adhesiolysis). Unfortunately, pregnancy rates tended to be low as the infection process often had permanently damaged the tubes, and in many cases hydrosalpinges and adhesions formed again. Further, ectopic pregnancy is a typical complication.[1] Surgical interventions can be done by laparotomy or laparoscopy.
Non-infertile patients who suffer from severe chronic pain due to hydrosalpinx formation that is not relieved by pain management may consider surgical removal of the affected tube(s) (salpingectomy) or even a hysterectomy with removal of the tubes, possibly ovaries.

IVF and hydrosalpinx

With the advent of IVF which bypasses the need for tubal function a more successful treatment approach has become available for women who want to conceive. IVF has now become the major treatment for women with hydrosalpinx to achieve a pregnancy.
Several studies have shown that IVF patients with untreated hydrosalpinx have lower conception rates than controls and it has been speculated that the tubal fluid that enters the endometrial cavity alters the local environment or affects the embryo in a detrimental way. Thus, many specialists advocate that prior to an IVF attempt, the hydrosalpinx should be removed.

History

Regnier de Graaf may have been the first to understand basic tubal function, describe hydrosalpinx, and link the development of hydrosalpinx with female infertility. The usually infectious cause of the process was well known to physicians by the end of the nineteenth century. With the introduction of hysterosalpingography (1914) and tubal insufflation(1920) its non-surgical diagnosis became possible. Surgery was gradually displaced by IVF as the main treatment for tubal infertility after the birth of Louise Brown in 1978.


What is Adenomyosis & What are Adhesions


What is Adenomyosis?  
Adenomyosis is where endometriosis is found within the muscle wall of the uterus.  A gynaecologist may be suspicious adenomyosis is present because of symptoms and the uterus can look and feel 'bulky'.  Some women can have both adenomyosis and endometriosis.   The symptoms of adenomyosis often respond well to medical treatment and an IUS (Intrauterine System) is often offered. A hysterectomy is sometimes recommended to remove the uterus but this will depend on many factors including your choice.

What are Adhesions? 

Adhesions are bands of fibrous scar tissue which cause organs or tissue to stick together in an abnormal way eg, the ovary to the pelvic side wall. They may be congenital, or caused by endometriosis or indeed by surgery.  Adhesions can cause pain and disrupt normal function. Adhesions should be removed during surgery and every precaution taken to prevent their recurrence. They often look like rubber bands and or cobwebs!
Paracetamol is not helping my pain. What else can I take to help give me some relief?
Paracetamol alleviates pain by reducing the body’s sensitivity to pain.  It belongs to a group of medicines called simple analgesics and is used for mild-moderate pain.  Since this medicine doesn’t stop the body producing prostaglandins (chemicals that cause the cramping type of pain) taking an anti inflammatory e.g. ibuprofen, Diclofenac, either in combination or instead of, is often a good option.  Codeine is a stronger pain reliever and reduces your perception of pain by blocking pain signals from nerves in your body.  It can be used alone or in combination with Paracetamol and anti-inflammatories.
Can I take Ibuprofen and Naproxen together to give me better relief from period pain?
Ibuprofen (Nurofen®) and Naproxen (Naprogesic®, Synflex®) are both anti-inflammatory medicines that work by preventing the body producing prostaglandins. These chemicals cause the cramping type of pain that occurs on the days at the beginning of your period. Taking anti inflammatories results is less pain, swelling, and inflammation. However, since they work by stopping the production of prostaglandins, they must be taken before any of these chemicals are produced. Therefore, you need to start taking anti inflammatories at least 24 hours before you expect to pain to occur. Not taking these medicines until after you feel pain, means the medication cannot block the pain-producing chemicals as they have already been released, so they cannot stop the pain.
Since these medicines are in the same group/family it is not recommended that you take both together.  A side effect of taking anti inflammatory medicines is stomach/gastric irritation.  Taking each dose with food can help reduce any of these effects.  If you are already taking an anti inflammatory (ibuprofen, naproxen, Diclofenac (Voltaren®), mefenemic acid (Ponstan®) medicine you can still take Paracetamol and or codeine containing medicines as these work quite differently and block pain.
I have been told that if I go on to the 'pill' it can help relieve some of my endometriosis symptoms.  How can a pill used as a contraceptive do this?
The ‘pill’ or combined oral contraceptive pill is not just one drug. There are many different types, with each product containing a specific low-dose combination of synthetic oestrogen and progestagen (progesterone). The medication alleviates the pain of endometriosis by suppressing menstruation while still controlling normal hormone patterns, and inhibiting the growth of the endometrial implants.  Ovulation is also prevented so ovulation pain can be treated by taking the pill.  Taking the pill continuously allows you to decrease the number of periods per year, therefore usually results in less period pain. The pill is often used as a first line treatment, but isn’t suitable for everyone and it doesn’t work for some girls and women.
What is the difference between an IUD and GnRH products?
An IUD (intrauterine device) e.g. Mirena® is a tiny plastic t-shaped device that releases progesterone (levonogestrel) directly to the uterus. The progesterone acts locally in the uterus and only a small amount is transferred to the bloodstream.  The Mirena® IUD reduces bleeding and dysmenorrhoea and provides superior effectiveness compared to traditional copper IUDs.  The device can provide contraception for up to 5 years while making periods lighter and usually less painful.  New endometriosis lesions may be discouraged from forming once a Mirena® IUD has been fitted.
GnRH(Gonadotrophin Releasing Hormone) analogue products are a range of medicines that, when used continuously for longer than 2 weeks, they stop oestrogen production in several different ways. These medicines seems like natural GnRH to the body but they work by preventing an egg being released and cause very little oestrogen to be produced. This deprives the endometrional implants of oestrogen causing them to become inactive and degenerate.  These are usually given as a long-acting injection once a month for up to 6 months. While on GnRH analogues your periods usually stop, therefore are an option for treating painful periods. Some women experience unpleasant side effects. Symptoms can often return following a course of GnRH.
I had sex for the first time last year when I was 16 and it really hurt. I know it can hurt the first time but I’ve had sex a few times since then and it still hurts. My periods are really bad as well and sometimes I stay home from school. We had the ‘me’ programme come to my school and we were told that painful sex is never normal. Now I don’t want to do it. What do you think I should do?    - Polly
Hi Polly - I was really sad to hear that your first sexual experiences have hurt.  I’d like you to think about the words you used. Sometimes things can hurt or sometimes things can be painful.   What do you think you experienced?  There are a number of reasons sex can hurt like if there is not enough lubrication, if your hymen is still intact, if you are uptight and not relaxed or have an infection (like thrush).  If you are at all concerned and it’s still happening, you should talk to a doctor or nurse. It might be quite simple and easily fixed and you normally feel better when you’ve shared something which is concerning you.   Pain with sex is never normal. Sometimes the pain can be felt deep inside and some women use words like throbbing, stabbing or sharp to describe what they feel. It can be painful at the time and even ache afterwards for a short time or sometimes for several hours.  Sex wasn’t designed to cause this sort of pain!  Painful sex is a symptom of endometriosis and if your periods are also causing you enough grief that you have to stay at home, this is definitely time to talk to a doctor. Make sure you tell the doctor all the symptoms and the things that you are worried about. What you describe isn’t life threatening Polly, but it can make you feel miserable and bad about yourself and your relationship.  Remember, when you feel bad, others around you can feel bad too.  Symptoms tell us there’s something not quite right and the sooner we check things out, the better off we are.  A doctor might suspect endometriosis and talk about a plan to help your pain and improve your quality of life.  It’s also a good idea to monitor your progress so that everything’s fine in the future if you want to have a family
I’ve had bad endometriosis since my periods started and while I like my job, my boss doesn’t have much sympathy for me.  I’ve used up all my sick leave (mainly on doctor’s visits and surgery). I feel isolated and don’t know what to do.
You have raised an issue which is the reality for many women in the workforce and it’s tricky to sometimes find the best path through.  Through no fault of their own, many women are in an unenviable position in that they need and want to work and yet their health lets them down. What’s more, having endometriosis is costly in lost productivity, relationships, physically, emotionally and financially.  It’s not only the pain, you can also feel isolated, exhausted and suffer other symptoms too.  It’s usually sensitive discussing these matters with employers, particularly when you don’t seem to be any better despite having treatment.  Your boss may very well have other reasons for having a short fuse and your health concerns have just become another gripe.  It’s time for you to take stock of where you’re at.  It doesn’t sound to me like carrying on like this is an option!
Well, there is a way through! 
1.    Take time to assess your health and your needs.  This may sound simple but once you get on life’s roller coaster, the important things often get put on the back burner.  Sometimes I use two words – ‘distress and discomfort’, to ask those questions.  If any symptoms are distressing, you need full gynaecological review as to why.
2.    Take time to talk to someone close to you and share your concerns.  Many women harbour their feelings and pain because they don’t want to appear like the complaining type and because it just gets so dull and boring feeling sick most of the time.  This is usually when you become sick and tired of being sick and tired. So, you probably isolate yourself and those close to you are often left in the dark.  It’s really true that ‘a problem shared is a problem halved’.   Hopefully, through sharing and discussion, you will be able to nut out a few key things you can do make change.  Make a list and tick the boxes as you action the things.
3.    Not all gynaecologists are endometriosis specialists.  You may have had surgery to treat the disease but was it resected or removed explains what kind of surgery is considered ‘best practice’ by those gynaecologists with a special interest and skill in treating the disease.  We’re really fortunate in NZ to have quite a few who do!  See if you can get a referral to one of these specialists or you may be in a position to access this through one of the private endometriosis clinics in the country and some hospitals have specialist gynaecologists.
4.    There is usually a medical plan which can offer you relief. You need something to get on top of the pain now, while you wait for gynaecological review and there are hormonal drugs which can effectively slow progression of disease and bring some pain relief.  The latest of these drugs have fewer side effects but you need advice from your doctor and specialist gynaecologist who understand. Sometimes an IUS (Intra-uterine-system), a contraceptive which is fitted at the time of surgery and can help to slow disease progression and give relief from heavy bleeding and pain.
5.    Once symptoms start to impact on your life, you also need to think about self management options. For instance, if you have bowel symptoms (like bloating, diarrhoea and fluctuating bowel habit, excess and painful wind and pain going to the toilet) you can modify your diet which can help such a lot.  There are specific foods which tend to trigger
6.    Pick a good time to talk to your boss about your health and work.  Often employers will consider anything which shows productivity and workplace happiness will be enhanced.  Maybe this could be raised by the staff and ideas could be brainstormed, BUT make sure the employer doesn’t think it’s a full on attack or revolt.  State the positive spin offs about introducing things which are going to make you an even better employee. This could be shorter but more frequent breaks through the day, glide time hours or improvements to your workspace. Depending on the job, some employers have agreed to a partial ‘work from home’ situation.  Corporate companies often have wellness programmes and the subject could arise out of that. You may even be surprised how many others at your work suffer similarly and your work may even consider special arrangements because of this.  Find out about the WISE programmeand see whether it would be possible to have this at your work.  WISE has covered all topics relating to gynaecology including menopause and fertility and it can be framed to suit your workplace.  Remember too, that while these are woman’s conditions, men suffer too! 
7.    Weigh everything up and think about ‘now’ and your future.  Can you actually afford to take a few months off and concentrate on your health so that you are able to work in the future?
What is endometrioma?
An endometrioma is the medical name for a cyst of endometriosis usually found growing in the ovary or sometimes both ovaries.  They are often referred to as chocolate cysts because they are filled with thick chocolaty type fluid.  Endometrioma’s can distort the ovary and impair ovarian function.  They can be fully excised leaving normal ovarian tissue but this requires advanced surgical skill. Depending on age or fertility, an ovary may need to be removed because of the severity of the endometrioma(s).  You should always be fully informed if this option is considered. 
Can endometriosis come back after surgery?
This is a commonly asked question and the answer can be complex.  Quite simply the answer is ‘yes’ but it does depend on quite a few factors.
·         We don’t yet know the exact cause of endometriosis so, while it can be removed or excised at surgery, this doesn’t guarantee a long term cure.   
·         The exact percentage of how often endometriosis can come back varies and depend on the type of surgery and other treatments you may have. However, it does seem that endometriosis recurs more often in girls and young women.
·         The best outcomes tend to be with: a) complete removal of endometriosis (excision or resection). It is therefore important to ask what technique your surgeon uses and whether they are skilled in advanced laparoscopic procedure, b) a multi-disciplinary approach to treatment and management.
Why am I still in pain when I have tried everything?
This can be so frustrating and exhausting.  Unfortunately it can be common to feel this way.  Read the pages on treatment and management.  Sometimes it feels as if you’ve tried everything and there’s no hope for having an improved quality of life.  But, there is hope!  Where endometriosis seems to take over and become all consuming, one treatment is often not enough.  When things reach this point surgery or medications on their own are unlikely to be the answer.  This is why we advocate a multi-disciplinary holistic approach to treatment which is considered best practice.  All symptoms should be investigated. Women can have nerve pain which is sometimes called neuropathic pain and nerve entrapment has also been identified as causing ongoing pain.  You can do a lot to help yourself by identifying the pain. Is it stabbing, burning or sharp?  Is the pain constant or aching and dull?  The different types of pain are explained fully in the book “Endometriosis and Pelvic Pain”.   Be clear about what symptoms have improved since surgery, what’s different and what’s remained the same or even worsened.  You can do a lot to help yourself with self management, some of which are explained in the management section.  Ultimately, if things persist, you will need help from a multi-disciplinary team of experts AND investigate the lifestyle changes which can relieve some of those painful and exhausting symptoms. who can consider all the facts and help you with a pathway to deliver the best possible outcomes.
Can I still get endometriosis after I have a hysterectomy?
YES.  Endometriosis needs oestrogen produced by the ovaries to be active, so removing the uterus at hysterectomy doesn’t mean curing the disease.  Many women have relief following hysterectomy but it’s important that the surgeon removes the endometriosis as well, not just the uterus. A hysterectomy will cure adenomyosis.  Sometimes, in very severe cases, a surgeon might recommend removing one or both ovaries as well. This is called an oopherectomy or bilateral oopherectomy (both ovaries).  This option requires a lot of discussion with specialists as well as taking into account your own feelings and your age, fertility and other needs.  Be well informed.
Can teenagers get endometriosis?
The answer is ABSOLUTELY.  It’s really common for symptoms to start in the teen years, sometimes from the very first period.  This is particularly so if there’s a family history of endometriosis or menstrual pain and troublesome symptoms.  It’s really important not to delay seeking help as early intervention is vital to improve quality of life, relieve suffering and avoid the possibility of fertility being compromised down the track.
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Thursday, May 29, 2014

Monday, November 18, 2013

What are ovaries & Polycystic ovaries

What are ovaries?

The ovaries  are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus. The uterus is the hollow, pear-shaped organ where a baby grows. Each ovary is about the size and shape of an almond. The ovaries produce eggs and female hormones. Hormones are chemicals that control the way certain cells or organs function.
Every month, during a woman's menstrual cycle, an egg grows inside an ovary. It grows in a tiny sac called a follicle . When an egg matures, the sac breaks open to release the egg. The egg travels through the fallopian  tube to the uterus for fertilization. Then the sac dissolves. The empty sac becomes corpus luteum . Corpus luteum makes hormones that help prepare for the next egg.
The ovaries are the main source of the female hormones estrogen  and progesterone .
These hormones affect:
  • The way breasts and body hair grow
  • Body shape
  • The menstrual cycle
  • Pregnancy


What are ovarian cysts?

A cyst is a fluid-filled sac. They can form anywhere in the body. Ovarian cysts  form in or on the ovaries. The most common type of ovarian cyst is a functional cyst.
Functional cysts often form during the menstrual cycle. The two types are:
  • Follicle cysts. These cysts form when the sac doesn't break open to release the egg. Then the sac keeps growing. This type of cyst most often goes away in 1 to 3 months.
  • Corpus luteum cysts. These cysts form if the sac doesn't dissolve. Instead, the sac seals off after the egg is released. Then fluid builds up inside. Most of these cysts go away after a few weeks. They can grow to almost 4 inches. They may bleed or twist the ovary and cause pain. They are rarely cancerous. Some drugs used to cause ovulation, such as Clomid® or Serophene®, can raise the risk of getting these cysts.
Other types of ovarian cysts are:
  • Endometriomas 
  • These cysts form in women who have endometriosis . This problem occurs when tissue that looks and acts like the lining of the uterus grows outside the uterus. The tissue may attach to the ovary and form a growth. These cysts can be painful during sex and during your period.
  • Cystadenomas 
  • These cysts form from cells on the outer surface of the ovary. They are often filled with a watery fluid or thick, sticky gel. They can become large and cause pain.
  • Dermoid cysts
  • These cysts contain many types of cells. They may be filled with hair, teeth, and other tissues that become part of the cyst. They can become large and cause pain.
  • Polycystic ovaries. 
  • These cysts are caused when eggs mature within the sacs but are not released. The cycle then repeats. The sacs continue to grow and many cysts form.

 What is polycystic ovary syndrome (PCOS)?

Polycystic  ovary syndrome (PCOS) is a health problem that can affect a woman's:
  • Menstrual cycle
  • Ability to have children
  • Hormones
  • Heart
  • Blood vessels
  • Appearance
With PCOS, women typically have:
  • High levels of androgens .
  • These are sometimes called male hormones, though females also make them.
  • Missed or irregular periods (monthly bleeding)
  • Many small cysts  (fluid-filled sacs) in their ovaries

How many women have PCOS?

Between 1 in 10 and 1 in 20 women of childbearing age has PCOS. As many as 5 million women in the United States may be affected. It can occur in girls as young as 11 years old.

What causes PCOS?

The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.
A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.
Researchers also think insulin may be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen.

 High androgen levels can lead to:
  • Acne
  • Excessive hair growth
  • Weight gain
  • Problems with ovulation

What are the symptoms of PCOS?

The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:
  • Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.
  • Infrequent, absent, and/or irregular menstrual periods
  • Hirsutism 
 increased hair growth on the face, chest, stomach, back, thumbs, or toes
  • Cysts on the ovaries
  • Acne, oily skin, or dandruff
  • Weight gain or obesity, usually with extra weight around the waist
  • Male-pattern baldness or thinning hair
  • Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
  • Skin tags — excess flaps of skin in the armpits or neck area
  • Pelvic pain
  • Anxiety or depression
  • Sleep apnea —
 when breathing stops for short periods of time while asleep

Why do women with PCOS have trouble with their menstrual cycle and fertility?
The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.
In women with PCOS, the ovary doesn't make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman's menstrual cycle is irregular or absent. Plus, the ovaries make male hormones, which also prevent ovulation.


  polycystic ovary

Does PCOS change at menopause?

Yes and no. PCOS affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOS, such as heart attack, stroke, and diabetes, increase as a woman gets older.
How do I know if I have PCOS?
There is no single test to diagnose PCOS. Your doctor will take the following steps to find out if you have PCOS or if something else is causing your symptoms.
Medical history. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.
Physical exam. Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.
Pelvic exam. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.
Blood tests. Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.
Vaginal ultrasound (sonogram). Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium (en-do-MEE-tree-uhm) (lining of the womb). This lining may become thicker if your periods are not regular.

How is PCOS treated?

Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant, and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:
Lifestyle modification. Many women with PCOS are overweight or obese, which can cause health problems. You can help manage your PCOS by eating healthy and exercising to keep your weight at a healthy level. Healthy eating tips include:
  • Limiting processed foods and foods with added sugars
  • Adding more whole-grain products, fruits, vegetables, and lean meats to your diet
This helps to lower blood glucose (sugar) levels, improve the body's use of insulin, and normalize hormone levels in your body. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular.


Birth control pills. For women who don't want to get pregnant, birth control pills can:
  • Control menstrual cycles
  • Reduce male hormone levels
  • Help to clear acne
Keep in mind that the menstrual cycle will become abnormal again if the pill is stopped. Women may also think about taking a pill that only has progesterone , like Provera, to control the menstrual cycle and reduce the risk of endometrial cancer (See Does PCOS put women at risk for other health problems?). But, progesterone alone does not help reduce acne and hair growth.
Diabetes medications. The medicine metformin (Glucophage) is used to treat type 2 diabetes. It has also been found to help with PCOS symptoms, though it isn’t approved by the U.S Food and Drug Administration (FDA) for this use. Metformin affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels. Metformin will not cause a person to become diabetic.
Fertility medications. Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used. Also, some fertility medications increase the risk for multiple births (twins, triplets). Treatment options include:
  • Clomiphene
The first choice therapy to stimulate ovulation for most patients.
  • Metformin taken with clomiphene — may be tried if clomiphene alone fails. The combination may help women with PCOS ovulate on lower doses of medication.
  • Gonadotropins
Given as shots, but are more expensive and raise the risk of multiple births compared to clomiphene.
Another option is in vitro fertilization (IVF). IVF offers the best chance of becoming pregnant in any given cycle. It also gives doctors better control over the chance of multiple births. But, IVF is very costly.



Surgery. "Ovarian drilling" is a surgery that may increase the chance of ovulation. It’s sometimes used when a woman does not respond to fertility medicines. The doctor makes a very small cut above or below the navel (belly button) and inserts a small tool that acts like a telescope into the abdomen (stomach). This is called laparoscopy
The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. But, these effects may only last a few months. This treatment doesn't help with loss of scalp hair or increased hair growth on other parts of the body.
Medicine for increased hair growth or extra male hormones. Medicines called anti-androgens may reduce hair growth and clear acne. Spironolactone  First used to treat high blood pressure, has been shown to reduce the impact of male hormones on hair growth in women. Finasteride  A medicine taken by men for hair loss, has the same effect. Anti-androgens are often combined with birth control pills.  These medications should not be taken if you are trying to become pregnant.
Before taking Aldactone, tell your doctor if you are pregnant or plan to become pregnant. Do not breastfeed while taking this medicine. Women who may become pregnant should not handle Propecia.
Other options include:
  • Vaniqa  cream to reduce facial hair
  • Laser hair removal or electrolysis to remove hair
  • Hormonal treatment to keep new hair from growing
Other treatments. Some research has shown that bariatric (weight loss) surgery may be effective in resolving PCOS in morbidly obese women. Morbid obesity means having a BMI of more than 40, or a BMI of 35 to 40 with an obesity-related disease. The drug troglitazone  was shown to help women with PCOS. But, it was taken off the market because it caused liver problems. Similar drugs without the same side effect are being tested in small trials.
Researchers continue to search for new ways to treat PCOS. To learn more about current PCOS treatment studies,  Talk to your doctor about whether taking part in a clinical trial might be right for you.

How does PCOS affect a woman while pregnant?

Women with PCOS appear to have higher rates of:
  • Miscarriage
  • Gestational diabetes
  • Pregnancy-induced high blood pressure (preeclampsia)
  • Premature delivery
Babies born to women with PCOS have a higher risk of spending time in a neonatal intensive care unit or of dying before, during, or shortly after birth. Most of the time, these problems occur in multiple-birth babies (twins, triplets).
Researchers are studying whether the diabetes medicine metformin can prevent or reduce the chances of having problems while pregnant. Metformin also lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.
Metformin is an FDA pregnancy category B drug. It does not appear to cause major birth defects or other problems in pregnant women. But, there have only been a few studies of metformin use in pregnant women to confirm its safety. Talk to your doctor about taking metformin if you are pregnant or are trying to become pregnant. Also, metformin is passed through breastmilk. Talk with your doctor about metformin use if you are a nursing mother.

Does PCOS put women at risk for other health problems?

Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:
  • More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.
  • The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.
  • Women with PCOS are at greater risk of having high blood pressure.
  • Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
  • Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.
Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.
Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.

I have PCOS. What can I do to prevent complications?

If you have PCOS, get your symptoms under control at an earlier age to help reduce your chances of having complications like diabetes and heart disease. Talk to your doctor about treating all your symptoms, rather than focusing on just one aspect of your PCOS, such as problems getting pregnant. Also, talk to your doctor about getting tested for diabetes regularly. Other steps you can take to lower your chances of health problems include:
  • Eating right
  • Exercising
  • Not smoking

How can I cope with the emotional effects of PCOS?

Having PCOS can be difficult. You may feel:
  • Embarrassed by your appearance
  • Worried about being able to get pregnant
  • Depressed
Getting treatment for PCOS can help with these concerns and help boost your self-esteem. You may also want to look for support groups in your area or online to help you deal with the emotional effects of PCOS. You are not alone and there are resources available for women with PCOS

What are the symptoms of ovarian cysts?

Many ovarian cysts don't cause symptoms. Others can cause:
  • Pressure, swelling, or pain in the abdomen
  • Pelvic pain
  • Dull ache in the lower back and thighs
  • Problems passing urine completely
  • Pain during sex
  • Weight gain
  • Pain during your period
  • Abnormal bleeding
  • Nausea or vomiting
  • Breast tenderness
If you have these symptoms, get help right away:
  • Pain with fever and vomiting
  • Sudden, severe abdominal pain
  • Faintness, dizziness, or weakness
  • Rapid breathing

How are ovarian cysts found?

Doctors most often find ovarian cysts during routine pelvic exams. The doctor may feel the swelling of a cyst on the ovary. Once a cyst is found, tests are done to help plan treatment. Tests include:
  • An ultrasound. This test uses sound waves to create images of the body. With an ultrasound, the doctor can see the cyst's:
    • Shape
    • Size
    • Location
    • Mass — if it is fluid-filled, solid, or mixed
  • A pregnancy test. This test may be given to rule out pregnancy.
  • Hormone level tests. Hormone levels may be checked to see if there are hormone-related problems.
  • A blood test. This test is done to find out if the cyst may be cancerous. The test measures a substance in the blood called cancer-antigen 125 (CA-125). The amount of CA-125 is higher with ovarian cancer. But some ovarian cancers don't make enough CA-125 to be detected by the test. Some noncancerous diseases also raise CA-125 levels. Those diseases include uterine fibroids  and endometriosis. Noncancerous causes of higher CA-125 are more common in women younger than 35. Ovarian cancer is very rare in this age group. The CA-125 test is most often given to women who:
    • Are older than 35
    • Are at high risk for ovarian cancer
    • Have a cyst that is partly solid

 How are cysts treated?

Watchful waiting. If you have a cyst, you may be told to wait and have a second exam in 1 to 3 months. Your doctor will check to see if the cyst has changed in size. This is a common treatment option for women who:
  • Are in their childbearing years
  • Have no symptoms
  • Have a fluid-filled cyst
It may be an option for postmenopausal women.
Surgery. Your doctor may want to remove the cyst if you are postmenopausal, or if it:
  • Doesn't go away after several menstrual cycles
  • Gets larger
  • Looks odd on the ultrasound
  • Causes pain
The two main surgeries are:
  • Laparoscopy 
Done if the cyst is small and looks benign (noncancerous) on the ultrasound. While you are under general anesthesia, a very small cut is made above or below your navel. A small instrument that acts like a telescope is put into your abdomen. Then your doctor can remove the cyst.
  • Laparotomy 
Done if the cyst is large and may be cancerous. While you are under general anesthesia, larger incisions are made in the stomach to remove the cyst. The cyst is then tested for cancer. If it is cancerous, the doctor may need to take out the ovary and other tissues, like the uterus. If only one ovary is taken out, your body is still fertile and can still produce estrogen.
Birth control pills. If you keep forming functional cysts, your doctor may prescribe birth control pills to stop you from ovulating. If you don’t ovulate, you are less likely to form new cysts. You can also use Depo-Provera®. It is a hormone that is injected into muscle. It prevents ovulation for 3 months at a time.

Can ovarian cysts be prevented?

No, ovarian cysts cannot be prevented. The good news is that most cysts:
  • Don't cause symptoms
  • Are not cancerous
  • Go away on their own
Talk to your doctor or nurse if you notice:
  • Changes in your period
  • Pain in the pelvic area
  • Any of the major symptoms of cysts

When are women most likely to have ovarian cysts?

Most functional ovarian cysts occur during childbearing years. And most of those cysts are not cancerous. Women who are past menopause (ages 50­–70) with ovarian cysts have a higher risk of ovarian cancer. At any age, if you think you have a cyst, see your doctor for a pelvic exam.