Ovarian Health

1- Ovarian Pain: Causes, Diagnosis, Treatments
2- Cysts on the Ovaries
3- Polycystic Ovary Syndrome (PCOS) and Weight Gain

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1- Ovarian Pain: Causes, Diagnosis, Treatments

Ovarian Pain: Possible Causes, Diagnosis, and Treatments

The ovaries are an important part of the female reproductive system. Their job is twofold. They produce the hormones, including estrogen, that trigger menstruation. They also release at least one egg each month for possible fertilization.

A number of different conditions, from cysts to tumors, can cause ovarian pain. The ovaries are located in the lower abdomen. That means if you have ovarian pain, you'll most likely feel it in your lower abdomen -- below your belly button -- and pelvis. It's important to have any pelvic pain checked out by your regular doctor or obstetrician/gynecologist. Several different conditions can cause it.

Pain in the ovaries can either be acute or chronic. Acute ovarian pain comes on quickly (over a few minutes or days) and goes away in a short period of time. Chronic ovarian pain usually starts more gradually. Then it last for several months.

Ovarian pain may be continuous. Or it may come and go. It may get worse with certain activities, such as exercise or urination. It can be so mild that you don't notice it. Or pain in the ovaries can be so severe that it interferes with daily life.

The methods your doctor uses to diagnose ovarian pain will vary. They will be based on what the suspected cause might be. Regardless, your doctor will take a complete medical history, do a physical exam, and ask questions about your pain. The questions might include:

• Where are you feeling the pain?
• When did it start?
• How often do you feel pain?
• Does an activity make the pain better or worse?
• How does it feel -- mild, burning, achy, sharp?
• How does the pain affect your day-to-day life?

Diagnostic tests, such as ultrasound and other types of imaging, can zero in on the cause of the pain. Here is a rundown of some possible causes of ovarian pain and how they are diagnosed and treated.

Ovarian Cysts

Cysts are fluid-filled sacs that can form in the ovaries. They are very common in women, especially during the childbearing years. Often they form during the process of ovulation. It can happen when the egg is not released or when the sac -- follicle -- holding the egg doesn't dissolve after the egg is released. Ovarian cysts usually cause no symptoms and dissolve on their own. They can, though, create a dull ache or a sharp pain if the cyst is large and twists or ruptures.

Other symptoms of ovarian cysts:

• Irregular menstrual periods
• Pain during intercourse or bowel movements
• Nausea or vomiting
• Feeling full after eating a small amount
• Bloating

How ovarian cysts are diagnosed

• Pelvic exam. This exam may reveal a lump in the pelvic area.
• Ultrasound. This scan uses sound waves to create an image of the ovaries. This helps the doctor determine the size and location of a cyst.

Treatment of ovarian cysts

• Watchful waiting. Most ovarian cysts will go away on their own. If you don't have any bothersome symptoms, especially if you haven't yet gone through menopause, your doctor may advocate "watchful waiting." The doctor won't treat you. Instead, the doctor might check you periodically to see if there has been any change in your condition.
• Laparoscopy. This is a form of surgery that uses small incisions and a tiny, lighted camera on the end of a metal tube that's inserted into the abdomen. A surgeon can use tools on the end of the tube to remove some cysts. This technique works for smaller cysts. Larger cysts, though, may need to be removed through a bigger incision in the abdomen. This is done with a technique called laparotomy.
• Birth control pills . Birth control pills prevent ovulation. That, in turn, reduces the formation of new cysts.

Ovarian Tumors

Tumors can form in the ovaries, just as they form in other parts of the body. They can be either noncancerous (benign) or cancerous (malignant).

Other symptoms of ovarian tumors

• Bloating or pressure in the abdomen
• Urgent need to urinate
• Indigestion
• Diarrhea or constipation
• Loss of appetite
• Unintentional weight loss or gain in the stomach area

How ovarian tumors are diagnosed

• Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography(PET). These are detailed imaging scans that the doctor can use to find ovarian tumors. They allow the doctor to determine whether and how far the ovarian tumors have spread.
• CA-125. This is a blood test to look for a protein that tends to be higher in some (but not all) women with ovarian cancer. CA-125 isn't effective as a screening test for ovarian cancer. But it can be checked in women with symptoms that might be caused by ovarian cancer.

Treatment of ovarian tumors

• Laparotomy. This is surgery performed through an incision into the abdomen. The surgeon will remove as much of the tumor as possible. The removal of tumor tissue is called debulking. If the tumor is cancerous and has spread, the surgeon may also remove the ovaries, uterus, fallopian tubes, omentum (fatty tissue covering the intestines), and nearby lymph nodes. Laparoscopy and robotic surgery may also be used.
• Chemotherapy. Chemotherapy involves drugs given through a vein (IV), by mouth, or directly into the abdomen. The drugs kill cancercells. Because they kill normal cells as well, chemotherapymedications can have side effects. These can include nausea and vomiting, hair loss, kidney damage, and increased risk of infection. These side effects should go away after the treatment is stopped.
• Radiation. This treatment uses high-energy X-rays to kill or shrink cancer cells. Radiation is either delivered from outside the body, or placed inside the body near the site of the tumor. This treatment also can cause side effects. These can include inflamed skin, nausea, diarrhea, and fatigue. Radiation is not often used to treat ovarian cancer.

Ovarian Pain Caused by Endometriosis

Every month, the lining of the uterus builds up in preparation to nourish a growing fetus. When an egg is not fertilized, that lining sheds and is released from the body via menstruation. In some women, tissue like the lining of the uterus develops elsewhere in the body. This tissue swells and bleeds each month. It has nowhere to shed, though, and may form scar tissue that can be very painful.

Other symptoms of endometriosis

• Painful periods
• Pain during intercourse
• Heavy menstrual periods
• Infertility
• Pain with bowel movements

How endometriosis is diagnosed

• Medical history and physical exam.
• Ultrasound and MRI. These scans may help the doctor to spot endometriosis, if there is an endometrioma, a benign cyst, on the ovary or ovaries.
• Laparoscopy. This procedure uses a thin lighted scope inserted into a tiny hole in the abdomen to allow the doctor to visualize the ovaries. The doctor may possibly remove a small sample of tissue for biopsy, a procedure in which the endometriosis may also be removed entirely.

Treatment of endometriosis

• Pain medications. Drugs such as ibuprofen (Advil, Motrin) can help relieve some of the discomfort of endometriosis.
• Birth control pills. The pill prevents the monthly buildup of uterine tissue on the ovaries and anywhere else the endometriosis may be in the abdomen and pelvis. This makes periods lighter and reduces the symptoms of endometriosis.
• Gonadotropin-releasing hormone agonists (GnRH agonists). These drugs reduce the amount of the hormone estrogen in the body. By slowing the growth of endometriosis, they limit its symptoms.
• Laparoscopy and laparotomy. These are surgical procedures that let the doctor remove endometriosis on the ovaries and other places. If the endometriosis is extensive, the doctor may recommend a hysterectomy. This procedure removes the uterus and sometimes also the ovaries and fallopian tubes.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection in the ovaries, uterus, or fallopian tubes. It is most often caused by sexually transmitted diseases like gonorrhea or chlamydia. It is one of the most common causes of pelvic pain in women.

Other symptoms of PID

• Pain during intercourse
• Fever
• Vaginal discharge that may have a smell
• Irregular menstrual bleeding
• Diarrhea
• Vomiting
• Fatigue
• Difficulty urinating

How PID is diagnosed

• Pelvic exam. The exam will enable your doctor to look for any lumps, abnormal discharge, or tenderness in the pelvis.
• Blood and urine tests. These lab tests can help identify the infection. So can cultures of any discharge seen during a pelvic exam.
• Ultrasound. This test creates an image of the pelvic area so the doctor can see if the reproductive organs are enlarged. The doctor can also see if there is a pocket of infection known as an abscess.
• Laparoscopy. Occasionally this procedure, which uses a thin lighted scope inserted into a tiny hole in the abdomen, is used to confirm the diagnosis.

Treatment of PID

Antibiotics. These drugs are given by mouth or through an injection. They can kill the bacteria that are causing PID. If you are taking antibiotics for PID, your sexual partner or partners should also get treated. There is a high likelihood that your partner has the same sexually transmitted infection.

Ovarian Remnant Syndrome

Surgery to remove the uterus and ovaries is known as hysterectomy and oophorectomy. A bilateral salping oophorectomy is a procedure in which both fallopian tubes and ovaries are removed. In rare cases, a small piece of the ovary may accidentally be left behind. The remnant can grow and develop painful cysts.

Other symptoms of ovarian remnant syndrome

• Pain during intercourse
• Difficulty urinating

How ovarian remnant syndrome is diagnosed

Ultrasound, CT, and MRI. These scans create images of the area. They help the doctor locate the remaining piece of ovary tissue.

Treatment of ovarian remnant syndrome

Laparotomy or laparoscopy. These procedures are done to remove the remaining piece or pieces of ovary.

2- Cysts on the Ovaries

What Is an Ovarian Cyst?

Ovarian cysts are common, especially with woman who still get their period. They’re solid or fluid-filled pockets in or on your ovary. Most of the time they’re painless and harmless. You might get one every month as part of your cycle and never know it. They usually go away on their own without treatment. Cysts are also common when you’re pregnant.

A cyst becomes a problem when it doesn’t go away or gets bigger. It can become painful. There’s also the possibility of cancer, but it’s rare. The chances go up as you get older.

What Are the Symptoms?

Most ovarian cysts are small and don’t cause any problems. When there are symptoms, you might have pressure, bloating, swelling, or pain in the lower abdomen on the side of the cyst. This pain may be sharp or dull, and it can come and go.

Sometimes a cyst may need emergency attention. See your doctor right away if you have these symptoms:

• Sudden, severe belly pain
• Pain with fever and throwing up
• Dizziness, weakness, feeling faint
• Fast breathing

These signs could mean your cyst has caused the ovary to twist.

Is My Pain Caused By An Ovarian Cyst?

Sometimes your doctor finds cysts during a pelvic (female) exam. Your doctor will ask questions about your pain and other symptoms.

She might give you an ultrasound. This is a device that uses sound waves to take pictures inside your body. It can show the details of a cyst.

She also may do some blood tests to:

• Find out if you are pregnant
• See whether your problems are caused by hormones
• Check for cancer (if you are past menopause)

What Kind of Cyst Is It?

Most cysts are considered “functional.” They’re a part of your monthly cycle.

• Follicle cyst. Your ovaries usually release one egg each month. It grows inside a tiny sac called a follicle. When the egg is ready, the follicle breaks open and releases it. If the sac doesn’t open, it causes a follicle cyst. These often go away in 1 to 3 months.
• Corpus luteum cyst. Once the egg is released, the empty follicle usually shrinks and helps get ready for the next egg. It becomes a cyst when it closes back up and fluid collects inside. It may go away in a few weeks. But it may bleed or cause pain as it grows.
• Nonfunctional. In some women, their ovaries make a lot of small cysts. This condition is called polycystic ovary syndrome (PCOS). It can make it hard to get pregnant.Other nonfunctional cysts may be caused by cancer. Ovarian cysts in women after menopause(once your period has stopped) are more likely to be cancerous than those in younger women.

What Is the Treatment?

Most cysts need no treatment. They go away on their own. If a cyst is large or causes problems, then your doctor may want to watch it. That means you don’t do anything right away. She’ll check it again later.

Your doctor may suggest medicine for the pain. Sometimes she’ll prescribe birth control pills. The hormones in the pills won’t make the cysts go away, but they can help prevent new ones.

Some ovarian cysts will need surgery. That includes cysts that are large, do not go away, or cause symptoms. Cysts in women near menopause may need surgery. That’s because they may be cancerous. The surgeon may take just the cyst, or the ovary. It depends on your cyst.

There are different types of surgery:

• Laparoscopy is for smaller cysts. The doctor makes a tiny cut above or below your belly button. A small tool with a camera allows your doctor to see inside, and a different tool removes the cyst or ovary. You probably won’t have to stay in the hospital overnight.
• Laparotomy is for cysts that may be cancerous. It is done with a bigger cut in the belly.

3- Polycystic Ovary Syndrome (PCOS) and Weight Gain

Polycystic Ovary Syndrome (PCOS) and Weight Gain

Most women at some point have to contend with weight gain. But for women with polycystic ovary syndrome (PCOS), losing weight can become a constant struggle.

PCOS is the most common hormonal disorder in women of childbearing age and can lead to issues with fertility. Women who have PCOS have higher levels of male hormones and are also less sensitive to insulin or are "insulin-resistant." Many are overweight or obese. As a result, these women can be at a higher risk of diabetes, heart disease, sleep apnea, and uterine cancer.

If you have PCOS, certain lifestyle changes can help you shed pounds and reduce the disease's severity.

Why does polycystic ovary syndrome cause weight gain?

PCOS makes it more difficult for the body to use the hormone insulin, which normally helps convert sugars and starches from foods into energy. This condition -- called insulin resistance -- can cause insulin and sugar -- glucose -- to build up in the bloodstream.

High insulin levels increase the production of male hormones called androgens. High androgen levels lead to symptoms such as body hairgrowth, acne, irregular periods -- and weight gain. Because the weight gain is triggered by male hormones, it is typically in the abdomen. That is where men tend to carry weight. So, instead of having a pear shape, women with PCOS have more of an apple shape.

Abdominal fat is the most dangerous kind of fat. That’s because it is associated with an increased risk of heart disease and other health conditions.

What are the risks associated with PCOS-related weight gain?

No matter what the cause, weight gain can be detrimental to your health. Women with PCOS are more likely to develop many of the problems associated with weight gain and insulin resistance, including:

• Type 2 diabetes
• High cholesterol
• High blood pressure
• Sleep apnea
• Infertility
• Endometrial cancer

Many of these conditions can lead to heart disease. In fact, women with PCOS are four to seven times more likely to have a heart attack than women of the same age without the condition.

Experts think weight gain also helps trigger PCOS symptoms, such as menstrual abnormalities and acne.

What can I do to lose weight if I have polycystic ovary syndrome?

Losing weight not only can help reduce your risks and make you look better -- it can also make you feel better. When you have PCOS, shedding just 10% of your body weight can bring your periods back to normal. It can also help relieve some of the symptoms of polycystic ovary syndrome.

Weight loss can improve insulin sensitivity. That will reduce your risk of diabetes, heart disease, and other PCOS complications.

To lose weight, start with a visit to your doctor. The doctor will weigh you and check your waist size and body mass index. Body mass index is also called BMI, and it is the ratio of your height to your weight.

Your doctor may also prescribe medication. Several medications are approved for PCOS, including birth control pills and anti-androgen medications. The anti-androgen medications block the effects of male hormones. A few medications are used specifically to promote weight loss in women with PCOS. These include:

• Metformin (Glucophage). Metformin is a diabetes drug that helps the body use insulin more efficiently. It also reduces testosteroneproduction. Some research has found that it can help obese women with PCOS lose weight.
• Thiazolidinediones. These should be used with contraception. The drugs pioglitazone (Actos) and rosiglitazone (Avandia) also help the body use insulin. In studies, these drugs improved insulin resistance. But their effect on body weight is unclear. All patients using Avandia must review and fully understand the cardiovascular risks. Research has found that Flutamide (Eulexin), an anti-androgen drug, helps obese women with PCOS lose weight. It also improves their blood sugar levels. The drug can be given alone or with metformin.

In addition to taking medication, adding healthy habits into your lifestyle can help you keep your weight under control:

• Eat a high-fiber, low-sugar diet. Load up on fruits, vegetables, and whole grains. Avoid processed and fatty foods to keep your blood sugar levels in check. If you’re having trouble eating healthy on your own, talk to your doctor or a dietitian.
• Eat four to six small meals throughout the day, rather than three large meals. This will help control your blood sugar levels.
• Exercise for at least 30 minutes a day on most, if not all, days of the week.
• Work with your doctor to track your cholesterol and blood pressurelevels.
• If you smoke, get involved in a program that can help you quit.