Polycystic Ovary

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Question Received:

  1. I have "cysts" in my inner thigh area (lots of them - all the time) with the color of the skin now a dark purplish color (I am also white of European decent). The crease in my neck has also discolored somewhat... though not-so-much under the arm for me. What kind of doctor should one see regarding this problem? Also, is anyone familiar with PCOD/PCOS? My doctor suggests I have this. He did no tests whatsover. I told him I hadn't had a menstrual cycle for almost 2 years (went off the pill because I smoke) probably because of the 110 I gained very rapidly. And he came to the conclusion that I had PCOD. Who would be a good specialist to see about this? My other half and I would like to start having children, but at this point, I don't know if that's possible.... If I take birth control pills, I will have a period... but if I go off them, I won't. Any suggestions would help.

Response:

I have "cysts" in my inner thigh area (lots of them - all the time) with the color of the skin now a dark purplish color (I am also white of European decent). The crease in my neck has also discolored somewhat... though not-so-much under the arm for me. What kind of doctor should one see regarding this problem? Also, is anyone familiar with PCOD/PCOS? My doctor suggests I have this. He did no tests whatsover. I told him I hadn't had a menstrual cycle for almost 2 years (went off the pill because I smoke) probably because of the 110 I gained very rapidly.

And he came to the conclusion that I had PCOD. Who would be a good specialist to see about this? My other half and I would like to start having children, but at this point, I don't know if that's possible.... If I take birth control pills, I will have a period... but if I go off them, I won't. Any suggestions would help.

It is likely that your doctor has come to the diagnosis of polycystic ovary syndrome (or polycystic ovary disease) on the basis of the following signs and symptoms that you have presented: skin changes, lack of menstrual cycles except when taking the contraceptive pill, infertility, and increase in weight. If you feel that further confirmation of the diagnosis is required, then an ultrasound examination of your ovaries and blood tests to determine the levels of insulin and reproduction-related hormones will be required. Research into this quite common syndrome has increased in recent years, and some of the findings are summarised below. Consultations with a gynaecologist should be able to help you and your partner achieve your dream of having children. However, you will probably have to make some difficult lifestyle changes, including weight-reduction and cessation of smoking.

Main Features

Polycystic ovary syndrome (PCOS) was first described by Stein and Leventhal in 1935. This syndrome is quite common, being diagnosed in 5%-10% of women between late adolescence and the menopause (Kidson, 1998). Women with polycystic ovary syndrome come to the gynaecologist with a variety of signs and symptoms, including irregular menstrual cycles, increased body hair, acne, weight gain, and infertility (Tan, Yap, and Tan, 2001). Blood tests often reveal increased levels of circulating insulin and male-type hormones.

Cause(s)

The underlying cause or causes of polycystic ovary syndrome remain unclear. There is clearly a genetic component in some cases (Kahsar-Miller et al, 2001). There are also links with obesity. Recent research has implicated insulin resistance of the body tissues and a compensatory hyperinsulinemia (Galtier-Dereure et al, 1997; Slowey, 2001). This has an adverse effect on multiple organ systems and inhibits ovulation, leading to the characteristic features of the syndrome. In addition, autoimmune reactions have been detected in women with reproductive failure due to polycystic ovary syndrome (Reimand et al, 2001).

Polycystic ovary syndrome may place the patient at long-term risk for the development of endometrial cancer and cardiovascular disease. Women with the syndrome have at least seven times the risk of myocardial infarction and ischaemic heart disease of other women, and by the age of 40 years up to 40% will have type 2 diabetes or impaired glucose tolerance (Kidson, 1998).

Treatments

The lack of a clear understanding of the causes of the condition has led to a multitude of symptom-oriented treatments (Legro, 1998). First-line management of polycystic ovary syndrome includes diet modification, weight loss, and stress management (Galtier-Dereure et al, 1997; Marantides, 1997; Pasquali, Casimirri, and Vicennati, 1997). Other treatment options include oral contraceptives, gonadotropin-releasing hormone analogues, anti-androgens, ovulation-inducing agents, electrolysis or laparoscopic ovarian drilling of the ovarian cysts, exercise, and glucocorticoids (Lefebvre et al, 1997; Berga, 1998; Guzick, 1998; Slowey, 2001; Tan, Yap, and Tan, 2001). More recently, the administration of treatments such as metformin to improve insulin sensitivity and restore menstrual cyclicity and ovulation have become established (Kidson, 1998; Pugeat and Ducluzeau, 1999; Diamanti-Kandarakis and Zapanti, 2000; Nardo and Rai, 2001). Long term administration of metformin might also reduce the risk of developing type 2 diabetes and cardiovascular disease in women with polycystic ovary syndrome. The new treatments for polycystic ovary syndrome have also led to improvements in fertility (Hunter and Sterrett, 2000).

References

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