1. Polycystic ovary syndrome (PCOS): what is it and which are the symptoms?
  2. Ovarian cysts: are there different types?
  3. Multifollicular ovary: which are the symptoms?

Polycystic ovary syndrome (PCOS): what is it and which are the symptoms?

Polycystic ovary syndrome (PCOS) is considered a disorder of the ovarian function in which a combination of menstrual dysfunction and hyper secretion of androgen takes place. A single cause to this disorder has not been identified yet and different tests suggest that it this syndrome is correlated to the interaction of genetic and environmental factors. Polycystic ovary syndrome enhances androgen production. In particular, adolescents with this syndrome show an increase in the gonadotrophin-releasing hormone (GnRH) and in the luteinising hormone (LH) and an increase in the ratio between LH and FSH, causing an enlargement of the ovaries that then produce some small liquid cysts. It is the most common cause of feminine infertility for the absence of ovulation. Polycystic ovary syndrome is the most common gynaecological disorder in women of childbearing age. The most important cause of the polycystic ovary is a hormonal alteration that causes an excessive production of male hormones, like testosterone, in women. Women normally produce low levels of testosterone and problems arise when they start producing higher levels due to hormonal imbalance.

Polycystic ovary syndrome is characterised by different symptoms that can have different intensity, the most common of which are:

  • Alterations of the menstrual cycle, with cycles longer than 35 days or absence of menstruation
  • Long periods of premenstrual syndrome
  • Ovarian cysts
  • Infertility or recurrent miscarriage
  • Acne, greasy skin or seborrheic dermatitis
  • Low levels of male hormones (androgen) in the blood

Pelvic ultrasound is a key diagnostic tool but it isn’t the only one because of the need to exclude other dysfunctions. It is in fact important to check family history, general health conditions and blood tests to evaluate particularly high androgen hormonal levels. Given the variety of symptoms, it may be possible to solve the problem by changing lifestyle, with a low protein diet and physical activity associated to taking the contraceptive pill to lower hormonal levels.

Ovarian cysts: are there different types?

Ovarian cysts are primarily developed in women of childbearing potential and are small fluid-filled sacs that can be formed inside or on the surface of an ovary. Many are the women that have to deal with ovarian cysts during their life. The majority of these cysts are harmless and do not cause particular disorders. In addition, the majority of ovarian cysts are sorted in few months and without the need for treatments. If a cyst becomes very big, it can cause strong abdominal pain and other symptoms like an increased need to urinate or difficulties in completely emptying the bladder, sense of abdominal fullness or heaviness, pelvic pain before the period that can irradiate to the back and legs, pelvic pain during sexual intercourse (dyspareunia).

There are two types of cysts:

  • Follicular cysts: usually do not cause problems and spontaneously disappear in a few weeks.
  • Lutein cysts: after ovulation, the follicle that contained the egg starts producing hormones for conception (oestrogen and progesterone) and becomes a corpus luteum. In case no fertilization occurs and the corpus luteum does not self-destruct, it can be accumulated in the blood or in other liquids and is responsible of the formation of the cyst. There are other types of cysts that are not connected to the menstrual cycle such as: dermoid cysts, cystadenoma and endometriomas. It is important to wait and monitor cysts to see if they resolve spontaneously. Birth-control pill can be taken to reduce the formation of new cysts or surgical removal may be necessary when the cyst is quite big and continues growing during the next menstrual cycles.

Multifollicular ovary: which are the symptoms?

Multifollicular ovary is a condition in which one or both ovaries is affected by a number of cysts, usually 6 to 10, that are bigger than those normally present in the ovary. Women of childbearing potential, including adolescents, are those mainly affected by this condition.

The most common symptoms of multifollicular ovaries are:

  • Hormonal imbalances: usually the first sign to undergo an ultrasound and therefore to notice the multifollicular ovary;
  • Polymenorrhea: shorter cycle length or abnormal uterine bleeding with higher than average blood loss;
  • Amenorrhea: absence of menstruation;
  • Oligomenorrhea: a condition during which the distance between menstrual cycles increases and the bleeding during the days of the menstrual cycle decreases.

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