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.
- 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
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.
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.
- 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
- 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
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
- 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
- Changes in your period
- Pain in the pelvic area
- Any of the major symptoms of cysts
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