Dr Virochana Kaul
FRANZCOG MRCOG MD DNB
View Dr Kaul’s biography here
Polycystic ovaries is a common ailment effecting a large number of women (one in three) in Australia. Despite its prevalence; many women simply haven’t heard about polycystic ovaries and its effect on the female body and reproductive ability.
Every month, your body goes through normal and natural changes that assist your ovaries in releasing an egg, which may or may not get fertilised during the month. This process is known as the menstrual cycle.
The typical menstrual cycle begins with your period during which time your low hormone levels signal to your body to begin producing more hormones. Eggs are produced within the follicles in the ovaries which will begin to develop as many as 20 eggs, normally in the cycle; one follicle matures and grows to form the egg which is then released into your fallopian tube (ovulation).
In polycystic ovaries this cycle fails so plenty of tiny follicles grow at the same rate and give the ovary a multi follicular appearance; however the lead egg fails to mature and ovulation does not occur.
What’s going wrong in my body?
Polycystic Ovaries can be attributed to a hormonal imbalance in your body. The male hormones (testosterone) are in high levels as is Insulin, the sugar controlling hormone. This results in clinical symptoms, changes within the blood and irregular menstrual cycles.
What symptoms and signs should I be looking for?
Different age groups have different set of symptoms including:
- Irregular Menstrual Cycles: long periods of amenorrhea (skipped periods) followed by heavy bleeding or sometimes scant bleeding
- Weight gain and trouble losing weight
- Extra hair: especially hair on the face, back or midline abdomen
- Thinning hair on the scalp
For the reproductive age group, symptoms also include fertility problems. Many women who have PCOS have trouble getting pregnant (infertility).
For middle age and beyond, symptoms also include metabolic syndrome, with higher risk of abnormal sugars, risks of snoring and abnormal lipids.
Is the condition genetic?
Although the cause of Polystic Ovaries is unclear; it has been known to be hereditary, however this is not always the case. It has also been associated with weight gain.
How do you diagnose PCOS?
The criteria for establishing a PCOS diagnosis include:
Blood tests showing an increase in male hormones
No abnormality in Thyroid or Prolactin
Pelvic ultrasound showing the presence of follicles in 1 or both ovaries
Is there anything I can do to help my prognosis?
The loss of body weight, even by just 5% will help in restoring your menstrual cycles and mitigate the hormonal imbalance. In addition, regular walking, healthy eating, exercise, and quitting smoking are the easy starts to remedy.
Will I need any Medication?
You might need some help in the form of medication. The medication is directed towards the predominant symptoms and can include Metformin, an insulin sensitising medicine which can help in balancing the hormonal imbalance, and restoring ovulation. It also helps with loss of weight and can be prescribes either to control
cycles or as adjuvant to other medication.
If no contraindication to oral pills, these are the best treatment for not only cycle control, but in reducing acne, reversing hair growth. Oral pills have the benefit of reducing pain, STI, endometriosis, fibroids, and ovarian and uterine concerns without having any untoward effect on fertility and is often the treatment of choice.
Clomiphene: is an oral medication which tricks the brain into assuming a paucity of female hormones and this generates the brain to produce more naturally, therefore helping in ovulation and conception.
Ovulation Induction (OI) drugs: Sometimes there is resistance to the action of clomiphene and then we might have to use injections (same hormones as produced in the brain) to cause ovulation.
LOD (Laparoscopic ovarian drilling): Laparoscopy and making tiny punctures in the ovary (4 in each) rectifies the hormonal imbalance and restores ovulation in 40% of cases.
IVF: The high success rates of IVF with 50-60% pregnancy rates can be a desirable treatment option for the small fraction of cases who do not respond to clomiphene or OI.
When should I seek help?
It is prudent to get evaluated early; first to establish the diagnosis and then to determine when to initiate treatment. Not all women with cysts / follicles on ultrasound scan will have PCOS, with 20% of such cases having no additional criteria.
Young women <35 years of age usually respond beautifully to treatment and success rates in achieving pregnancy are high. With increase in age there is a decline in fertility and this compounds the treatment.
Are there any complications in pregnancy for women with PCO?
- Risk of miscarriage
- Abnormal sugars
- High blood pressure
What are some long term precautions I can take?
- Weight and diet control
- Sugars evaluated every 2 years
- Active lifestyle
- It is important to have at least 3 bleeds per year in your reproductive years as prolonged amenorrhea (skipped periods) increases the risk of uterine cancer, so either OCPs or withdrawal bleed with progesterone is recommended.
Dr Virochana Kaul is a consultant obstetrician and fertility specialist with Monash IVF. She has a special interest in laparoscopic surgery, and reproductive endocrinology and infertility and consults at Northpark Private Hospital, Mitcham, Bundoora, Richmond and Wantirna.
If you would like to book an appointment with Dr Kaul, please complete our online booking form.