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GYNAECOLOGY

Polycystic ovary syndrome is a disorder in which the ovaries (which make both female and male hormones) tend to make more male hormone than usual.

PCOS may cause problems such as:

  • Disruptions of the menstrual cycle including irregular, heavy or absent periods or spotting in between periods.
  • Slightly enlarged or “lumpy” ovaries with many small cysts in them.
  • Difficulty in becoming pregnant
  • Pregnancy problems such as gestational diabetes, pregnancy related high blood pressure or premature labour.
  • Loss of thinning of scalp hair (Alopecia)
  • Excessive hair growth (Hirsutism) which may occur on the face, chest, back, lower abdomen or thighs.
  • Acne and pimples on the face and body
  • Sleep apnoea
  • Weight gain, particularly at the waist area instead of the hips and thigh: difficulty in losing weight
  • High blood levels of insulin

Currently PCOS can be managed effectively in many patients. With early diagnosis and good management of the disorder, a patient’s long-term risks can often be prevented or significantly delayed.

Diagnosis of PCOS

PCOS is a common cause of infertility and subfertility. The syndrome can be difficult to diagnosis. Some symptoms of PCOS mimic those of other hormone disorders. Another difficulty is that no two women with PCOS have the same symptoms and signs. Not every woman with PCOS symptoms has polycystic ovaries. The reason for this is unclear. Diagnosis can require the following –

  • Your complete medical history
  • A physical examination
  • Blood tests to check hormone levels
  • Blood test to check blood sugars, insulin and lipids
  • Vaginal ultrasound to look for cysts on the ovaries and to check the thickness of the endometrium
  • Additional tests to help rule out other medical conditions.

Treatment options to manage PCOS

The aim of medical treatment is to manage PCOS symptoms and reduce risk of long-term complications such as diabetes, heart disease and uterine cancer. The treatment recommended depends on the type and severity of your symptoms and whether you wish to remain fertile. You may need a combination of treatments.

Lifestyle Changes – If a woman is over- weight, losing at least 5% of her body weight may improve PCOS symptoms.

Weight loss can help to:

  • Regulate blood sugars and insulin levels
  • Reduce the level of male hormone
  • Improve symptoms such as Hirsutism, acne and alopecia
  • Trigger ovulation
  • Regulate periods
  • Reduce the risk of PCOS complications such as heart disease

Avoid crash diets because you are likely to gain weight once you return to regular eating habits. A low (GI) diet is recommended which will help manage to stabilize blood sugar levels which in turn may reduce the amount of male hormones made by the ovaries. Regular exercise helps reduce insulin levels, aids in weight loss and may lessen the severity of PCOS symptoms.

Medication – PCOS symptoms can be managed with medications. However, medications do not cure PCOS and symptoms will return if you stop taking the medication.

Infertility Treatment – If pregnancy is desired initial treatment includes finding out whether you are ovulating. Testing will be required for this to determine whether PCOS is the only reason for your infertility. Fertility drugs may then be prescribed. IVF is the final option for PCOS women who desire pregnancy. However, it is rarely needed.

Surgery – No surgical procedure can treat PCOS, However it can help to induce ovulation in some women with PCOS. The type of surgery recommended depends on whether you wish to become pregnant.

Laparoscopic Ovarian Drilling – this procedure may be suitable in some cases for women who are of child-bearing age who do not ovulate. The aim is not to treat the cysts but to destroy a portion of each ovary. This procedure is usually performed using “Keyhole Surgery”.

Bilateral Salpingo-oophorectomy and Hysterectomy – Removal of both fallopian tubes and ovaries and the uterus may be used to treat severe cases of PCOS when pregnancy is not desired and bleeding cannot be controlled. These procedures may be undertaken using laparoscopic and vaginal techniques or open surgery (Laparotomy). Menstrual periods, ovulation and pregnancy are no longer possible after the operation. Surgical removal of the ovaries causes sudden menopause, depending on age and preference hormone therapy (HT) may be considered.

Gynaecology Gynaecologist Gosford

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