Ovarian Conditions

Ovaries are a part of the female reproductive system. They produce female hormones — estrogen and progesterone — and eggs that can be fertilized to create a baby. Women have an ovary on each side of their uterus.

Problems in your ovaries can lead to ovarian conditions, including:

• Ovarian cancer
• Ovarian cysts
• Polycystic ovary syndrome

Ovarian Cysts

Ovarian cysts are fluid-filled sacs in or on your ovary. In many cases, cysts are discovered during a routine pelvic exam. They’re very common, especially during childbearing years. Most cysts aren’t cancerous; however, cysts that develop during or after menopause have a higher risk of being cancerous.

Most ovarian cysts are called functional cysts, caused by your monthly menstrual cycle. As a normal part of your cycle, a follicle grows on your ovary each month. Follicles produce an egg and release it during ovulation. When a follicle keeps growing, it becomes a functional cyst. Functional cysts usually don’t cause pain and often disappear on their own within two or three months.

There are two types of functional cysts:

• Follicular cyst. If your egg isn’t released midway through your cycle (ovulation), the follicle will continue to grow and form a follicular cyst. 
• Corpus luteum cyst. After your egg is released, the ruptured follicle — called a corpus luteum — begins producing hormones to promote conception. Sometimes the opening of the follicle seals off and fluid accumulates inside, causing a corpus luteum cyst.

Symptoms

Most women don’t experience symptoms from ovarian cysts, but when symptoms are present, they include:

• Pelvic pain – Pain right before or after your period or during sex.
• Abnormal menstrual bleeding – Heavy flow, bleeding between periods or periods lasting more than seven days.
• Stomach discomfort – Nausea, vomiting, fullness or heaviness in your abdomen.
• Breast tenderness – Similar to what you may feel in the beginning of pregnancy.
• Bowel trouble – Pressure felt in your bowels or painful bowel movements.
• Bladder trouble – Pressure on your bladder that may cause you to urinate more frequently or have trouble completely emptying your bladder.

Complications of ovarian cysts are rare, but can occur if a cyst grows too large. A large cyst can cause your ovary to move out of place and twist, leading to a painful condition called ovarian torsion. Cysts can also rupture, causing significant pain and internal bleeding.

Diagnosis

Often times, ovarian cysts are discovered during a routine pelvic exam. If a cyst is found, your doctor may order further testing to determine the size and consistency of the cyst. Those that are solid or a combination of solid and liquid may need further testing to rule out cancer.

In addition to a blood test that looks for cancer (CA 125), your doctor may perform additional testing, including:

• Pelvic ultrasound. This technique can help your doctor determine the size and location of the cyst, and whether the cyst is solid or liquid filled. 
• Laparoscopy. This minimally invasive surgical procedure uses a thin tube with a lens and a light (laparoscope) to examine internal pelvic structures. The laparoscope is inserted through a small incision in your abdominal wall. Sometimes your doctor can remove your cyst during the exam by inserting specialized surgical tools through another small incision.

Treatment

The majority of ovarian cysts go away on their own within a few months. If your doctor finds a cyst, you may need to have another pelvic exam in two or three months to look for changes.

In some cases, ovarian cysts can be treated with oral contraceptives, which stop ovulation and reduce your risk for developing new cysts. If you’re postmenopausal (no longer having periods), have large or painful cysts or cysts that don’t go away within a few menstrual cycles, surgery may be needed.

Common surgeries offered at El Camino Health include:

• Laparoscopy. Your cyst may be removed during a diagnostic laparoscopic procedure if the cyst is small and appears benign. During this surgery, your doctor removes your cysts through tiny incisions in your abdomen. 
• Laparotomy. A more extensive surgery than laparoscopy, a laparotomy is used to remove larger cysts that may be cancerous. It requires larger incisions than a laparoscopic procedure. Once the cysts are removed, they’re sent to the lab to test for cancer. 
• Oophorectomy. In some cases, your doctor may suggest removing your fallopian tubes and ovaries. If cysts are confined to one ovary, your doctor may remove the single ovary and fallopian tube to preserve your ability to become pregnant.

If your cyst is found to be cancerous, your doctor will discuss treatment options with you.

Polycystic Ovary Syndrome

Polycystic ovary syndrome, also called PCOS or Stein-Leventhal syndrome, is an endocrine system disorder. It’s the most common hormonal and reproductive condition affecting women of childbearing age. PCOS often begins shortly after a woman’s first period. For some, it develops later in life, sometimes following substantial weight gain.

Women with PCOS have at least two of the following characteristics:

• Irregular menstrual cycles.
• Elevated levels of androgens (male hormones).
• Inflamed ovaries covered in small cysts.

The cause of polycystic ovary syndrome is unknown, but these factors may play a role:

• Excess insulin. Insulin is a hormone that allows cells to use sugar (glucose) for energy. Excess insulin may increase the production of androgens (male hormones), which may interfere with your ability to ovulate. Obesity can increase insulin levels.
• Chronic inflammation. Women with PCOS tend to have low-grade swelling that stimulates their ovaries to produce androgens.
• Family history. Many women who have PCOS have a close family member who also has the condition, though researchers haven’t found a specific gene linked with PCOS.

Symptoms

The symptoms associated with polycystic ovary syndrome are usually related to hormonal imbalances, insulin resistance and menstrual cycle difficulties.

In addition to pain or pressure in your lower abdomen, symptoms can include:

• Irregular menstrual periods – The production of too few female hormones and too many male hormones may prevent ovulation, causing periods to occur infrequently or stop. 
• Infertility – Going extended periods of time without ovulating makes it difficult to get pregnant.
• Hair growth changes – More hair than usual on your face and body (hirsutism) and/or thinning hair on your head.
• Ovarian cysts – Cysts on your ovaries. 
• Skin abnormalities – Acne, oily skin or dandruff; thick dark patches of skin; or skin tags often found on your armpits or neck.
• Weight gain – Unexplained weight gain, often with extra weight gained around the waist. 
• Anxiety or depression – Commonly accompany PCOS because of hormone issues or stress related to other symptoms.
• Sleep apnea – A sleep disorder which causes you to stop breathing for short periods of time while you sleep.

Women with PCOS also have higher rates of complications during pregnancy, and appear to be at increased risk for heart attacks, high blood pressure, diabetes and cholesterol issues.

Diagnosis and Treatment

There’s no single test that diagnoses PCOS. Instead, your doctor evaluates all your symptoms to rule out other possible conditions. Your doctor may perform a pelvic exam to check your ovaries for swelling, a blood test to measure your hormone and glucose levels, or a pelvic ultrasound to look for cysts and tissue abnormalities.

At El Camino Hospital, your doctor will develop a treatment plan that manages your unique symptoms. For women who want to become pregnant, treatment is often focused on promoting ovulation through ovulation-induction medications. Weight loss can also improve blood sugar levels, which can promote ovulation.

For women who don't want to become pregnant, treatment is often focused on correcting hormone levels and managing symptoms that affect appearance. Weight loss can also help improve symptoms. Treatment may include:

• Oral contraceptives. Birth control pills can help regulate your menstrual cycles and decrease androgen levels, which could help control acne and hair issues.
• Diabetes medications. Medication used to treat type 2 diabetes can decrease insulin resistance in women with PCOS and also help reduce symptoms related to androgen levels — such as excessive facial and body hair growth — to increase ovulation. 
• Medications to treat hair growth. Medications are available that can slow excessive facial and body hair growth.