Polycystic Ovaries

Polycystic Ovary Treatment London | Kent UK

This is a common condition in about 10% of women. It is an ultrasound diagnosis in which the ovaries are somewhat enlarged and contain multiple small cysts around the edge of the ovary. These are the developing eggs which are trapped inside the ovary due to the thickened ovarian skin keeping them from bursting out. The condition also has 1 or more of the following:

  • A tendency to put on weight easily
  • A reduction in the number of periods i.e. less often than 1 in 28 days
  • A tendency to have increased hair growth, which can be on the breasts, face or abdomen.
  • A reduction in the chances of becoming pregnant without treatment.
Polycystic Ovary Treatment London | Kent UK
Ultrasound Scan of a Typical Polycystic Ovary, showing the egg sacs arranged around the edge trying to burst out but trapped inside due to the thickened outer skin of the Ovary.

Treatment of Polycystic Ovaries

It is a condition which a woman is born with and permanent treatment is not possible. However the symptoms can often be relieved by one or more of the following.

Medical Treatment

As there is an increased chance of developing type 2 Diabetes {i.e. a resistance to the effects of Insulin, a hormone which controls the metabolism of glucose (sugar)}. This can be successfully treated with a tablet Metformin, which increases the body’s sensitivity to Insulin again. This is normally prescribed at a dose of 500mg at night when in bed for 1 week then 850 mg at night for the next week, then the routine maintenance dose of 850mg tablets 1 twice a day. If there are side effects to this then it is also available as a long acting slow release preparation Glucophage where the combined dose is the same but once a day; up to a maximum of 2 grams per day.

The alternative medical treatment is the tablet Clomid (an anti oestrogen that works in exactly the opposite way to the contraceptive pill, i.e. a lowered oestrogen levels stimulates egg production, whereas a raised oestrogen level in the contraceptive pill switches it off). The dose is between 1 to 4 of these tablets each day, from the 2nd to the 6th day of the period. The effects of this medication in terms of the number of eggs being produced and the thickness of the lining of the womb is monitored by a Vaginal ultrasound scan between days 10 to 14 of the menstrual cycle (counted as the first day of proper bleeding as day 1). This is to ensure that there are not too many eggs being produced with the risk of a high order multiple pregnancy (i.e. triplets or above). A normal twin rate is 1 in 80 for a Caucasian woman but this can be as high as 10% with clomid treatment. Intercourse should be timed for between days 12 to 14, with the assumption that the eggs will be released on day 14. Clomid is an old established treatment of nearly 50 years. It can have side effects of abdominal bloating due to the ovaries swelling. It can cause hot flushes and mood changes on the days that it is taken, and rarely visual disturbances when it should be stopped. Its chance of producing a baby depending on the correct diagnosis and nothing else being wrong (i.e. checking that the tubes are open and no endometriosis is present) is in the order of 60% in a year.

Surgical Treatment

This involves a laparoscopy under general anaesthetic gas introduced into the abdomen via a needle under an anesthetic. A 5 mm telescope introduced to view the pelvic organs. Complications and side effects of some mild abdominal pain for up to 1 week. Shoulder tip pain if any gas gets trapped inside the abdomen for a few hours, and rare less than 1% risk of bowel or vessel damage or an infection usually in women who have had multiple previous operations, complex extensive disease e.g. endometriosis or are significantly overweight with a BMI in excess of 35. 35 watts of energy is typically used to ‘drill’ 4 or 5 holes in each ovary to allow exit holes for the eggs through the thickened ovarian skin. This also reverses the hormone imbalance for up to 2 years. At the same time the fallopian tubes will be flushed with blue dye and any co-existing endometriosis or pelvic scar tissue will be treated. This has an 80% chance of producing a baby in the first year

Its main advantages are that it reverses the hormone levels to normal, which means that usually no medication is required with side effects. Also the chances of a single rather than a multiple pregnancy are normal, so regular scanning to count the number of follicles (egg sacs) is not required.

If it fails to work within a year or there are no signs of the follicles growing then it also has the advantage that it makes the ovaries more sensitive to the effects of Clomid, (i.e. Clomid will produce egg production even if it failed to do before).