The name,
polycystic
ovaries, refers to the characteristic ultrasound
appearance of the ovaries. Because of the abnormal
follicular development, the ovaries have multiple small
follicles, usually less than 5 mm, distributed around
the outer edge of the ovary in a pattern often described
as a "string of pearls." Polycystic ovaries are found in
one out of every four women. They are not particularly
bothersome and in many cases there are no clinical
symptoms apparent. However, in some women the cysts
cause a hormonal imbalance, leading to a constellation
of other symptoms. These symptoms are the difference
between polycystic ovarian syndrome and polycystic
ovaries.
Most
polycystic ovaries are incidental findings during a
routine pelvic exam or an ultrasound for related or
unrelated reasons. At times, they may resolve by
themselves and not require any treatment. Some common
symptoms are overweight, acne, heavy body hair, mood
swings, irregular menstruation, recurrent miscarriages
and other fertility issues. Women with polycystic
ovarian syndrome are seven times more likely to develop
diabetes because of insulin
resistance.
The first
and often the most effective line of treatment of
polycystic ovaries appears to be weight reduction.
Reduction in weight causes normalization of ovarian
function and control of some symptoms. Treatment of
polycystic ovaries is different for patients not
desiring pregnancy and those that are actively seeking
pregnancy.
For
younger patients desiring pregnancy use of
insulin-sensitizing agents allow for a better response
to the insulin in the circulation and many women begin
to ovulate and have a return of normal menses. These
medications are discontinued after achieving pregnancy.
In some patients ovulation has to be induced using drugs
like Clomid, and subsequently gonadotropins, may be
required. But this carries a risk of ovarian
hyperstimulation and multiple pregnancies. Patients not
seeking pregnancy are generally treated with oral
contraceptive pills which allow the endometrium to cycle
normally, reduce acne, and reduce hair growth.
Additional drugs like spironolactone, Reglan,
finasteride are also used. Insulin sensitizing agents
include metformin and Avandia. Ovarian drilling is a
process where 4 to 30 tiny holes are made in the cystic
ovary is helpful in about 80% of the cases. Newer
surgical techniques minimize previous problems of
scaring and adhesions, but they still remain a risk.
Very rarely, if the cysts are large and cause problems,
ovaries are surgically removed.
Conventional treatment of polycystic ovaries is generally aimed at controlling symptoms and obtaining a balance of the various hormones involved in the disease. In most cases, the medical therapy needs to be continued indefinitely. It has undesirable side effects, uncertain long-term health effects, and can be expensive. Hence holistic medicine is a better option. It considers each woman unique and complements natural therapy with conventional therapy. For example, natural therapy could be in the form of a physical therapy, or a food or herb that can be helpful but is without dangerous side effects.
