Polycystic appearing ovary

Polycystic-appearing ovary is diagnosed based on its enlarged size usually twice normal—with small cysts present around the outside of the ovary. This condition can be found in “normal” women and in women with endocrine disorders. An ultrasound is used to view the ovary in diagnosing this condition.
Polycystic ovarian syndrome is associated with infertility, abnormal bleeding, increased incidences of pregnancy loss, and pregnancy-related complications.
Polycystic ovarian syndrome is extremely common and is thought to occur in 4-7% of women of reproductive age and is associated with an increased risk for endometrial cancer.
More tests than an ultrasound alone are required to diagnose polycystic ovarian syndrome.

New Treatments

Traditional treatments have been difficult, expensive and have limited success when used alone. Infertility treatments include weight loss diets, ovulation medications (clomiphene,letrozole, Follistim, Gonal-F), ovarian drilling surgery and IVF. Other symptoms have been managed by anti-androgen medication (birth control pills, spironolactone, flutamide or finasteride).
Ovarian drilling can be performed at the time of laparoscopy. A laser fibre or electrosurgical needle is used to puncture the ovary 10-12 times. This treatment results in a dramatic lowering of male hormones within days. Studies have shown that up to 80% will benefit from such treatment. Many who failed to ovulate with letrozole or metformin therapy will respond when rechallenged with these medications after ovarian drilling. Interestingly, women in these studies who are smokers, rarely responded to the drilling procedure. Side effects are rare, but may result in adhesion formation or ovarian failure if the procedure is performed by an inexperienced surgeon.
For women in the reproductive age range, polycystic ovary syndrome is a serious, common cause of infertility, because of the endocrine abnormalities which accompany elevated insulin levels. There is increasing evidence that this endocrine abnormality can be reversed by treatment with widely available standard medications which are leading medicines used in this country for the treatment of adult onset diabetes, metformin (Glucophage 500 or 850 mg three times per day or 1000mg twice daily with meals), pioglitazone (Actos 15-30 mg once a day), rosiglitazone (Avandia 4-8 mg once daily) or a combination of these medications.
These medications have been shown to reverse the endocrine abnormalities seen with polycystic ovary syndrome within two or three months. They can result in decreased hair loss, diminished facial and body hair growth, normalization of elevated blood pressure, regulation or menses, weight loss, reduction in cardiovascular risk factors, normal fertility, and a reduced risk of miscarriage. We have seen pregnancies result in less than two months in woman who conceived in their very first ovulatory menstrual cycle. By six months over 90% of women treated with insulin-lowering agents, diet and exercise will resume regular menses.
The medical literature suggests that the endocrinopathy in most patients with polycystic ovary syndrome can be resolved with insulin lowering therapy. This is clinically very important because the therapy reduces hirsutism, obesity, blood pressure, triglyceride levels, elevated blood clotting factors and facilitates reestablishment of the normal pituitary ovarian cycle, thus often allowing resumption of normal ovulatory cycles and pregnancy. We know the polycystic ovary syndrome is associated with increased risk of heart attack and stroke because of the associated heart attack and stroke risk factors, hypertension, obesity, hyperandrogenism, hypertriglyceridemia, and these are to a large degree resolved by therapy with these medications.

Are these medications safe?

Side effects are rare. Although metformin, rosiglitazone and pioglitazone lower elevated blood sugar levels in diabetics, when given to nondiabetic patients, they only lower insulin levels. Blood sugar levels will not change. In fact, episodes of “hypoglycemic attacks” appear to be reduced.

How Is Polycystic Ovary Syndrome Diagnosed?

If you’ve taken your concerns about your body to your doctor, you’re on the right track. Your doctor may refer you to a gynecologistgynecologistor an endocrinologistendocrinologistfor a diagnosis.
The gynecologist or endocrinologist will ask you about any concerns and symptoms you have, your past health, your family’s health, any medications you’re taking, any allergies you may have, and other issues. He or she will also ask you lots of questions specifically about your period and its regularity.
A doctor may also perform blood tests to diagnose PCOS or other conditions, such as thyroid or other ovarian or gland problems. Blood tests allow doctors to measure androgen, insulin, and other hormone levels. The results of these tests can help doctors to determine the type of treatment a girl will receive. Your doctor may also order another test, called an ultrasound, to look at your ovaries and to determine if you have cysts or other abnormalities of the ovaries. Because cysts are not always visible, this test is not always used.
Early diagnosis and treatment for PCOS are important because the condition can put girls at risk for long-term problems. Getting treated for PCOS is a good idea if you want to have a baby someday PCOS often causes infertility if it’s not treated. But when PCOS is treated properly, many women with the condition have healthy babies.
Also, many girls with PCOS can get pregnant. If you are sexually active and do not want to become pregnant, be sure to use condoms every time you have sex even if you have PCOS. This is important even if you are not being treated for PCOS.

Sources Wikipedia, Kids Health

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