Polycystic Ovary Syndrome- Chapter 07:

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Q 7. 1 What are polycystic ovaries – PCO ?

Polycystic ovaries are characterised by the presence of many small cysts (fluid filled swellings) around the surface of the ovaries. The cysts are quite small ranging from 2 to 8 mm (Figure 7.1). Polycystic ovaries are usually larger than normal ovaries and their central substance is generally more dense. Over recent years, with the advent of ultrasound examination, we have learned that about one woman in five has polycystic ovaries. At ultrasound examination, the ovaries appear larger and more dense and the cysts look like a “necklace” around the periphery of the ovaries.

References:

07-01-3379 Polycystic ovaries: A new ultrasonic classification.

Q 7. 1 What are polycystic ovaries (PCO)?
Q 7. 2 What is polycystic ovary syndrome (PCOS)?
Q 7. 3 What causes polycystic ovary syndrome?
Q 7. 4 How long will I have PCOS?
Q 7. 5 Is polycystic ovary syndrome a serious condition?
Q 7. 6 I have polycystic ovary syndrome. Is this a rare condition?
Q 7. 7 What hormone changes are typical of polycystic ovary syndrome?
Q 7. 8 What is the significance of elevated LH levels?
Q 7. 9 What is the importance of body weight in PCOS?
Q 7. 10 I have pelvic pain and ultrasound has shown polycystic ovaries. Are the polycystic ovaries causing the pain?
Q 7. 11 Does PCOS cause excessive body hair production (hirsutism)?
Q 7. 12 Are there any concerns if my periods are infrequent or absent in association with PCOS?
Q 7. 13 How can my polycystic ovary syndrome be treated?
Q 7. 14 I have heard there is a new treatment for PCOS – metformin. Could you explain this?
Q 7. 15 We are trying for a baby. Could metformin cause problems for our baby?
Q 7. 16 How should irregular or absent periods associated with PCOS be treated?
Q 7. 17 How is infertility associated with PCOS treated?
Q 7. 18 My periods are irregular and I have PCO. Do I need contraception?
Q 7. 19 Can PCOS be treated by surgery?
Q 7. 20 Where can I obtain more information?
Q 7. 21 Could I have some useful Web sites?
Women’s Health – Home Page

Q 7. 2 What is polycystic ovary syndrome (PCOS)?

When patients develop symptoms associated with their polycystic ovaries, they are said to have polycystic ovary syndrome. Of the 20% of women who have PCO only one in three will have symptoms – PCOS. In addition to abnormal menstrual cycles and infertility, some women may be troubled by skin problems, notably acne and greasy skin or unwanted hair production (hirsutism). PCOS was first described by Stein and Leventhal in 1935 and the condition is therefore also known as Stein-Leventhal syndrome.

Many women with PCOS find it difficult to understand why they have developed symptoms, such as irregular and infrequent periods (oligomenorrhoea), after many years of normal cycles. Usually, the key factor to account for the change is an increase in weight. In association with PCO there may be an increased level of insulin which encourages the body to lay down excessive amounts of fat tissue leading to obesity. This excess fat tissue aggravates the hormonal imbalance. A spiral may be set up as the hormone problems increase fat production and the excess fat has a further adverse effect on the hormone balance.

References:

07-02-3517 Definition of polycystic ovary syndrome

07-02-1691 The significance of polycystic-appearing ovaries versus normal-appearing ovaries in patients with polycystic ovary syndrome.

07-02-3199 Polycystic ovary syndrome in adolescence and early adulthood.

07-02-3228 Diagnosis of the polycystic ovary syndrome in adolescence: Comparison of adolescent and adult hyperandrogenism. 07-01-3376 Interrelationship between ultrasonography and biology in the diagnosis of polycystic ovarian syndrome.

Q 7. 3 What causes polycystic ovary syndrome?

Although a great deal is now known about the polycystic ovary syndrome, the exact cause has yet to be found. Polycystic ovary syndrome is probably an inherited condition. There has been one specific gene implicated and two others also seem to be involved. Premature balding in men is often a manifestation of the same gene that results in PCOS in women. The hormone chemistry of polycystic ovaries is often deranged. This may result in period problems, particularly reduced or absent periods. Polycystic ovaries tend not to release their eggs regularly and, without treatment, there may be problems with fertility.

In recent years it has become recognised that many of the metabolic (body chemical) changes seen in PCOS may be related to insulin resistance. Insulin is produced by the pancreas, which is a gland found in the abdomen. This gland has two functions, both related to the way the body deals with food. It secretes enzymes (chemical catalysts) into the small bowel allowing food to be broken down into the basic components that can be absorbed. The pancreas also secretes insulin into the blood stream. Insulin is a hormone (Q2.8) that reduces the blood sugar level, mainly by converting sugar into fat. Diabetes occurs when the pancreas can no longer produced sufficient insulin to prevent the blood sugar level rising too high. It turns out that most women with PCOS are resistant to insulin. Hormones work like a key in a lock. Insulin resistance means that the insulin hormone receptors are defective and a stronger key is required. The result is an increased output of insulin and it is the higher levels of insulin that seems to result in the typical problems of PCOS. Women with PCOS are not diabetic and so there is no difference in their response to a glucose (sugar) load (Figure 7.2). Typically, women with PCOS require greater output of insulin from the pancreas to prevent their sugar rising too high (Figure 7.3).

It is becoming recognised that some patients have symptoms and blood chemistry (hormone levels) typical of polycystic ovary syndrome, although their ovaries do not have a typical PCO picture.

References:

Function of the polycystic ovary. (2000) 07-03-3196

The genetic basis of polycystic ovary syndrome. (1997) 07-03–3139

Q 7. 4 How long will I have polycystic ovary syndrome?

Unfortunately, PCOS is a problem that does not disappear. It is almost certainly an inherited condition. Just like the colour of your eyes, it cannot be changed.

References:

Women with polycystic ovary syndrome gain regular menstrual cycles when ageing. (2000) 07-04-3000

Q 7. 5 Is polycystic ovary syndrome a serious condition?

There is a spectrum of severity ranging from a little irregularity of the menstrual cycle to troublesome excess body hair and anovulatory infertility. Early suggestions that PCOS is a cause of heart disease seems to have been unfounded. Obesity, however, is associated with heart problems and many women with PCOS are overweight.

Between 20 and 40% of women found to have polycystic ovary syndrome will develop diabetes in later life. As PCOS is associated with anovulation, the endometrium may be subjected to long-term oestrogen without cyclical progesterone protection increasing the risk of endometrial cancer (Q32.20).

References:

Long-term consequences of polycystic ovary syndrome: Results of a 31 year follow-up study. (2000). 07-05-3200

Increased risk of non-insulin dependent diabetes mellitus, arterial hypertension and coronary artery disease in perimenopausal women with a history of the polycystic ovary syndrome. (2000) 07-05-3063

Hyperinsulinemia in polycystic ovary syndrome correlates with increased cardiovascular risk independent of obesity. (2000) 07-05–3007

Mortality of women with polycystic ovary syndrome at long-term follow-up. (1998) 07-05-3008

Q 7. 6 I have polycystic ovary syndrome. Is this a rare condition?

Polycystic ovary syndrome is one of the most common endocrine (hormone) disorders. Ultrasound examination provides an excellent window to look at ovarian structure. The ovaries are close to the top of the vagina and therefore transvaginal scanning shows of ovarian structure more clearly than transabdominal scanning. In adult women, transvaginal scanning reveals an incidence of PCO in the order of 20%. Before sexual activity has commenced ultrasound is performed by the transabdominal route. Evidence of PCO can be found in 6% of six year old girls and, by the age of ten, 18% of girls have evidence of PCO.

References:

How common are polycystic ovaries in normal women and what is their significance for the fertility of the population? (1992) 07-06-3378

Polycystic ovaries – A common finding in normal women. (1988) 07-06-3377

Q 7. 7 What hormone changes are typical of polycystic ovary syndrome?

Blood tests to evaluate PCOS should be scheduled early in the menstrual cycle. Some prefer the third day of the cycle and others the eighth day. Elevated LH (Q2.14) concentrations, seems to be the most common finding. The androgenic hormones (Q2.12) testosterone and androstenedione tend to be increased and these higher levels tend to be associated with decreased SHBG levels (Q 2.10). Prolactin levels (Q 2.14; Q 6.10) are often just above the normal range. As hormone levels fluctuate there may be merit in repeating the tests. After food insulin levels rise higher than normal (Q7.3). Figure 7.3).

References:

The role of inhibin in polycystic ovary syndrome. (2000) 07-07-3197

Hyperinsulinaemia and polycystic ovary syndrome. (2000) 07-07-3198

Classification of polycystic ovary syndrome into three types according to response to human corticotropin-releasing hormone. (1999) 07-07-2719

Insulin resistant and non-resistant polycystic ovary syndrome represent two clinical and endocrinological subgroups. (1995) 07-07-3023

Gynaecology: Insulin resistance and the polycystic ovary syndrome (1990) 07-07-602

Q 7. 8 What is the significance of elevated LH levels?

Increased levels of LH can be found in 40% of women with PCO. We know that raised LH levels are associated with difficulty conceiving and increased miscarriage rates.

Q 7. 9 What is the importance of body weight in PCOS?

PCO encourages weight gain and fat has an adverse effect on the hormone balance leading to an escalating spiral of the problems. Obesity reduces the chances of pregnancy and increases the risk of pregnancy complications including miscarriage, high blood pressure and thromboembolism.

In the long-term obesity, is a major risk factor for heart disease. Every effort to maintain a normal weight by diet as well as exercise is to be encouraged.

There is some evidence that women with PCOS lay down fat more easily. They may be overweight without indulging in excessive calorie intake.

Bibliography:

Relationship between polycystic ovaries, body mass index and insulin resistance(2003) 3570

Q 7. 10 I have pelvic pain and ultrasound has shown polycystic ovaries. Are the polycystic ovaries causing the pain?

 Pelvic pain and PCO are both common and not surprisingly many patients with pelvic pain also have evidence of PCO. However, PCO does not seem to be a cause for pelvic pain.

References:

Polycystic ovaries: A new ultrasonic classification. (1995) 07-10-3379

Uterine size and endometrial thickness and the significance of cystic ovaries in women with pelvic pain due to congestion. (1990) 07-10-3380

Q 7. 11 Does PCOS cause excessive body hair production (hirsutism)?

PCOS is one of the more common reasons for women becoming hirsute. The biochemical changes associated with PCOS include increased levels of testosterone and reduced levels of SHBG which may result in increased male pattern hair distribution particularly on the moustache and beard areas of the face, the chest, back and lower abdomen. This may respond to medical treatment (Q 8.13).

References:

Tackling polycystic ovary syndrome. (2001). 07-11-3382

Polycystic ovary syndrome: An endocrine and metabolic disease. (2000). 07-11-3383

Q 7. 11 Does PCOS cause excessive body hair production (hirsutism)?

References:

Tackling polycystic ovary syndrome. (2001). 07-11-3382

Polycystic ovary syndrome: An endocrine and metabolic disease. (2000). 07-11-3383

Q 7. 12 Are there any concerns if my periods are infrequent or absent in association with PCOS?

If you are a sexually active woman you may be anxious that you could be pregnant. It must be stressed that PCOS associated with infrequent or absent periods only means that the chance of pregnancy is reduced, but this can by no means be considered as a guarantee against pregnancy.

In the longer term, if the endometrium is being stimulated by oestrogen without the cyclical intervention of progesterone, there is a risk of the endometrium becoming hyperplastic (unduly thickened) and occasionally this could lead to malignant change (Q32.20). Cancer of the lining of the womb tends to be a problem around the age of fifty or sixty but can occur earlier.

Twenty or thirty years ago, we would have investigated a woman with absent or infrequent periods and if no problem was found no treatment would have been recommended. Nowadays, we recommend checking that oestrogen levels are adequate and offer oestrogen with cyclical progestogen if the levels are persistently low.

References:

Polycystic ovary syndrome: It’s not just infertility. (2000) 07-12-3384

The importance of diagnosing the polycystic ovary syndrome. (2000). 07-12-3385

Q 7. 13 How can my polycystic ovary syndrome be treated?

If you are overweight, you should make every effort to lose weight. In addition to calorie control, regular exercise is to be encouraged. Weight reduction improves the hormone balance, the chances of pregnancy when required and also the chance of a successful pregnancy outcome.

Traditionally, treatment has depended on your presenting problems. If your main concern is infrequent periods and you do not wish to conceive, cyclical hormone treatment such as the combined oral contraceptive pill or hormone replacement therapy may be indicated (Q 6.19). If there are associated skin problems then again the pill (perhaps with cyproterone) may be prescribed.

If you want to start a family, treatment is directed towards encouraging your ovaries to release their eggs (ova) regularly (ovulation induction – Q7.17; Q 10.3).

Q 7. 14 I have heard there is a new treatment for PCOS – metformin. Could you explain this?

Yes, there is a new treatment for PCOS – (polycystic ovary syndrome). In Q 7.3 the recently discovered relationship between PCOS and insulin resistance has been presented. Metformin is a drug that increases sensitivity to insulin and it therefore reverses the insulin resistance of PCOS. Metformin has been used since the 1950s in the treatment of diabetes. There is accumulating evidence that metformin has a significant part to play in the treatment of PCOS, whether the symptoms are amenorrhoea (absent periods), oligomenorrhoea (infrequent periods), obesity, hirsutism (excessive hair production) or anovulation (failure to release eggs resulting in infertility).

Metformin 500mg tablets are taken two or three times daily after meals. Although metformin has been available for more than forty years, its application for PCOS is new and it has yet to be licensed for this indication. We therefore provide metformin for PCOS only with informed consent (Q33.28).

Some women may be initially troubled by bowel disturbance and flatulence but these problems improve after a couple of weeks. The tablets can be split into two. We have found that if patients are having a lot of problems it may be worth taking only half a tablet daily for a few days and gradually increasing the dose over two or three weeks. At this time there is no substitute for metformin as a drug to increase insulin sensitivity but there is a new class of insulin-sensitising agents due to be launched soon – the thiazolidinediones

It will be some years before the true value of metformin for patients with PCOS will be determined. Initial experience has shown that it is beneficial for women with hirsutism and absent or infrequent periods and infertility. It may assist in weight reduction.

There is theoretical reason for optimism that metformin prescribed for women with PCOS will have several long-term benefits. It has been suggested that metformin may reduce:

• ovarian hyperstimulation syndrome (Q10.16).

• miscarriages (Q12.11).

• heavy periods.

• maturity onset diabetes.

• endometrial cancer (Q32.20).

Controlled trials (Q33.26) will be required to establish a clearer picture of the potential benefits.

A thirty-five year old woman had stopped seeing her periods (amenorrhoea) for a year and her weight had been increasing. Her only other problem was IBS (Q23.34). Her BMI was 38 (Q9.8) showing that her weight was 50% greater than it should have been. Ultrasound examination of her pelvis showed no abnormality and in particular there was no suggestion of polycystic ovaries. Her LH was 8.4 IU/l and FSH 4.8 IU/l which are normal readings and her thyroid tests and prolactin were normal. The testosterone was 3.2 nmol/l which is towards the upper level of normal but her SHBG was low at 14 nmol/l. Her fasting blood sugar was 4.8 mmol/l (normal) but her fasting insulin was 18.7 mU/L which is high. Metformin was commenced.

This case is an example of a patient presenting with two problems that can be associated with polycystic ovary syndrome namely amenorrhoea and obesity although the ultrasound was reported as showing normal ovaries. Her LH was not high and even her testosterone was just within the normal range. The low SHBG is a strong pointer to the diagnosis. Although the high fasting insulin in this case seems reassuring that metformin is likely to prove beneficial the value of insulin tests in clinical management remains to be determined.

Bibliography:

Should patients with polycystic ovary syndrome be treated with metformin?: Benefits of insulin sensitizing drugs in polycystic ovary syndrome-beyond ovulation induction. (2002) 3555

Should patients with polycystic ovarian syndrome be treated with metformin?: an enthusiastic endorsement. (2002-3543)

Should patients with polycystic ovarian syndrome be treated with metformin? (07-14-3524)

Should patients with polycystic ovarian syndrome be treated with metformin? A note of cautious optimism.(2002) 07-14-3520

Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebo-controlled 6-month trial, followed by open, long-term
clinical evaluation. (2000) 07-14–3069

Effects of the insulin sensitizing drug metformin on ovarian function, follicular growth and ovulation rate in obese women with oligomenorrhoea. (1999) 07-14–3231

Insulin action in the normal and polycystic ovary. (1999) 07-14-3232

The effects of metformin on insulin resistance and ovarian steroidogenesis in women with polycystic ovary syndrome. (1999) 07-14-3230

Metformin-induced resumption of normal menses in 39 of 43 (91%) previously amenorrheic women with the polycystic ovary syndrome. (1999) 07-14-2840

Metformin therapy improves the menstrual pattern with minimal endocrine and metabolic effects in women with polycystic ovary syndrome. (1998) 07-14-2693

Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. (1998) 07-14-2838

Use of metformin in the management of adolescents with polycystic ovary
syndrome]. (1997) 07-14-2981

Menstrual cyclicity after metformin therapy in polycystic ovary syndrome. (1997) 07-14-2980

Menstrual cyclicity after metformin therapy in polycystic ovary syndrome. (1997) 07-14-2836

Can metformin reduce insulin resistance in polycystic ovary syndrome? (1996) 07-14-2979

Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, while facilitating normal menses and pregnancy. (1994) 07-14-2837

Q 7. 15 We are trying for a pregnancy. Could metformin cause problems for our baby?

Metformin has been used for many years by diabetic patients and there is no evidence that it causes such problems. Once pregnancy has been confirmed, there is no advantage in continuing treatment and it should be discontinued.

References:

Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion: A pilot study. (2001) 07-15-3348

Congenital malformations in offspring of diabetic women treated with oral

hypoglycaemic agents during embryogenesis. (1994) 07-15-3349

Q 7. 1 What are polycystic ovaries (PCO)?

Q 7. 2 What is polycystic ovary syndrome (PCOS)?

Q 7. 3 What causes polycystic ovary syndrome?

Q 7. 4 How long will I have PCOS?

Q 7. 5 Is polycystic ovary syndrome a serious condition?

Q 7. 6 I have polycystic ovary syndrome. Is this a rare condition?

Q 7. 7 What hormone changes are typical of polycystic ovary syndrome?

Q 7. 8 What is the significance of elevated LH levels?

Q 7. 9 What is the importance of body weight in PCOS?

Q 7. 10 I have pelvic pain and ultrasound has shown polycystic ovaries. Are the polycystic ovaries causing the pain?

Q 7. 11 Does PCOS cause excessive body hair production (hirsutism)?

Q 7. 12 Are there any concerns if my periods are infrequent or absent in association with PCOS?

Q 7. 13 How can my polycystic ovary syndrome be treated?

Q 7. 14 I have heard there is a new treatment for PCOS – metformin. Could you explain this?

Q 7. 15 We are trying for a baby. Could metformin cause problems for our baby?

Q 7. 16 How should irregular or absent periods associated with PCOS be treated?

Q 7. 17 How is infertility associated with PCOS treated?

Q 7. 18 My periods are irregular and I have PCO. Do I need contraception?

Q 7. 19 Can PCOS be treated by surgery?

Q 7. 20 Where can I obtain more information?

Q 7. 21 Could I have some useful Web sites?

Women’s Health – Home Page

Q 7. 16 How should irregular or absent periods associated with PCOS be treated?

The combined oral contraceptive pill is often the most appropriate method for providing cycle control, assuming that conception is to be avoided. If oestrogen levels are satisfactory, regular withdrawal bleeds are likely to follow cyclical progestogen administration (Q 5.12; Q 24.17). When the patient is a young teenager, parents often feel happy with this rather than knowing that their daughter has started a contraceptive agent. Another option is the use of a cyclical HRT (Q 28. 9). Metformin should also be considered.

References:

Sensitization to insulin in adolescent girls to normalize hirsutism, hyperandrogenism, oligomenorrhea, dyslipidemia, and hyperinsulinism after precocious pubarche. (2000). 07-16-3451

Effects of the insulin sensitizing drug metformin on ovarian function, follicular growth and ovulation rate in obese women with oligomenorrhoea. (1999) 07-16-3452

Metabolic effects of oral contraceptives in women with polycystic ovary syndrome. (1995) 07-16-3453

Hormonal responses to physical exercise in patients with polycystic ovarian syndrome. (1993) 07-16-3455

Q 7. 17 How is infertility associated with PCOS treated?

PCOS is associated with ovulation problems and therefore ovulation induction is often required. The ovaries will often respond to tablets; Tamoxifen (Q10.10) is thought to provide a good balance of hormone production although clomiphene (Clomid – Q10.6) may also prove to be effective. If the ovaries do not respond to tablets more powerful agents (gonadotrophins e.g. Pergonal, Humegon or Metrodin – Q10.13) given by injection will almost invariably prove to be successful.

Increased levels of LH occur in 40% of women with PCOS and this seems to reduce the chance of conception and there is also an increased risk of miscarriage. LH levels can be suppressed by GnRH agonists (Q33.16) but disappointingly studies in these situations have shown no improvement. Ovarian drilling (Q7.19) may have a part to play when ovulation stimulation proves difficult to achieve with drugs.

Before commencing ovulation stimulation, it seems sensible to ensure reasonable male fertility by checking a semen analysis. Many authorities recommend testing Fallopian tube patency before commencing treatment. My own view is that if there is clear evidence of PCOS and anovulation, a few months of treatment before confirming tubal patency will save many women from an uncomfortable procedure.

References:

The use of metformin to augment the induction of ovulation in obese infertile patients with polycystic ovary syndrome. (2001) 07-17-3460

Laparoscopic treatment of polycystic ovaries with insulated needle cautery: A reappraisal. (2000) 07-17-3463

Minilaparoscopic ovarian drilling under local anesthesia in patients with polycystic ovary syndrome. (2000) 07-17-3461

Ovulation induction with low dose alternate day recombinant follicle stimulating hormone (Puregon). (1999) 07-17-3462

Management of anovulatory infertility. (1999) 07-17-3474

A cost comparison of infertility treatment for clomiphene resistant polycystic ovary syndrome. (1999) 07-17-3464

The impact of insulin resistance on the outcome of ovulation induction with low-dose follicle stimulating hormone in women with polycystic ovary syndrome. (1998) 07-17-3466

Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility.(1998) 07-17-3465

Dual suppression with oral contraceptives and gonadotrophin releasing-hormone
agonists improves in-vitro fertilization outcome in high responder patients. (1997) 07-17-3467

The number of follicles and ovarian volume in the assessment of response to clomiphene citrate treatment in polycystic ovarian syndrome. (1996) 07-17-3469

Development, pharmacology and clinical experience with clomiphene citrate. (1996) 07-17-3468

Effect of short-term gonadotropin releasing hormone agonist protocol in polycystic ovary syndrome. (1995) 07-17-3470

Cumulative conception and live birth rates after the treatment of anovulatory infertility: Safety and efficacy of ovulation induction in 200 patients. (1994) 07-17-3472

Treatment of anovulation with pulsatile gonadotropin-releasing hormone: Prognostic factors and clinical results in 600 cycles. (1994) 07-17-3471

Clomiphene-dexamethasone treatment of clomiphene-resistant women with and without the polycystic ovary syndrome. (1992) 07-17-3473

Q 7. 18 My periods are irregular and I have PCO. Do I need contraception?

You can never rely on irregular periods as a symptom of anovulation (eggs not being released). The best advice is that you should not take unnecessary chances.

References:

Contraceptive choices for women with endocrine complications. (1993) 07-18-3475

Q 7. 19 Can PCOS be treated by surgery?

The doctors who first described PCOS removed part of the ovaries (wedge resection), for microscopic examination. They observed that the menstrual cycle and fertility were often restored following these operations. More recently, it has been shown that drilling tiny holes in the ovaries (ovarian drilling) at the time of laparoscopy (Q23.24), may improve their chemistry although it is too early to know how long this improvement will be sustained. Whilst ovarian drilling may have a part to play in PCOS patients with infertility, this treatment is not proven to have a definite place in treatment for hirsutism.

Ovarian drilling may result in spontaneous ovulation. Unlike ovulation stimulation, there is no increased risk of multiple pregnancy or ovarian hyperstimulation (enlargement of the ovaries with the possibility of other problems such as excess fluid in the abdominal cavity). We do not know why ovarian drilling works. For those patients who respond to ovarian drilling there appears to be a reduction in LH levels which suggests that the drilling must in some way alter the hormone feedback to the hypothalamus and pituitary possibly by the release of a factor not yet identified. Interestingly, in one study where four patients had drilling of just one ovary, there was evidence of ovulation from the other ovary in the first cycle after treatment in three of the patients.

One study has shown that the insulin response to sugar is not altered following ovarian drilling.

References:

Effects of laparoscopic ovarian drilling on serum vascular endothelial growth factor and on insulin responses to the oral glucose tolerance test in women with polycystic ovary syndrome. (2000) 07-19-3180

Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility (1998) 07-19-2538

Late endocrine effects of ovarian electrocautery in women with polycystic ovary syndrome. (1998) 07-19-3050

Comparison of the effects of ovarian cauterization and gonadotropin- releasing hormone agonist and oral contraceptive therapy combination on endocrine changes in women with polycystic ovary disease (1996) 07-19-1336.

A prospective study comparing unilateral and bilateral laparoscopic ovarian diathermy in women with the polycystic ovary syndrome (1994) 07-19-410

Laparoscopic treatment of polycystic ovarian disease (1994) 07-19-380

Laparoscopic ovarian diathermy: An effective treatment for anti-oestrogen resistant anovulatory infertility in women with the polycystic ovary syndrome (1993) 07-19-563

Q 7. 20 Where can I obtain more information?

PCO Association

Q 7. 21 Could I have some useful Web sites?

Evaluation of the quality of Web sites is discussed in Q4.27. You may find that several general women’s health sites may help you (Q4.28). The following are more specialised Web sites on topics found in this chapter.

Page Last updated: May 18, 2002

Q 7. 1 What are polycystic ovaries – PCO ?

References:

Q 7. 2 What is polycystic ovary syndrome (PCOS)?

References:

Q 7. 3 What causes polycystic ovary syndrome?

References:

Q 7. 4 How long will I have polycystic ovary syndrome?

References:

Q 7. 5 Is polycystic ovary syndrome a serious condition?

References:

Q 7. 6 I have polycystic ovary syndrome. Is this a rare condition?

References:

Q 7. 7 What hormone changes are typical of polycystic ovary syndrome?

References:

Q 7. 8 What is the significance of elevated LH levels?

Q 7. 9 What is the importance of body weight in PCOS?

Bibliography:

Q 7. 10 I have pelvic pain and ultrasound has shown polycystic ovaries. Are the polycystic ovaries causing the pain?

References:

References:

Q 7. 11 Does PCOS cause excessive body hair production (hirsutism)?

References:

Q 7. 12 Are there any concerns if my periods are infrequent or absent in association with PCOS?

References:

Q 7. 13 How can my polycystic ovary syndrome be treated?

Q 7. 14 I have heard there is a new treatment for PCOS – metformin. Could you explain this?

Bibliography:

Q 7. 15 We are trying for a pregnancy. Could metformin cause problems for our baby?

References:

Q 7. 16 How should irregular or absent periods associated with PCOS be treated?

References:

Q 7. 17 How is infertility associated with PCOS treated?

References:

Q 7. 18 My periods are irregular and I have PCO. Do I need contraception?

References:

Q 7. 19 Can PCOS be treated by surgery?

References:

Q 7. 20 Where can I obtain more information?

Q 7. 21 Could I have some useful Web sites?

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