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Re: Polycystic OvariesFrom: Thomas (anonymous@obgyn.net)Tue, 29 Dec 1998 05:02:07 -0600 (CST)
Diana I'm sorry to hear of your problems. Chronic pelvic pain can be a crippling disease and regrettably we are not good at treating it. The problem with your case is that cysts on ovaries are normal. Follicles are produced monthly in each cycle meaning that small cysts are produced in normal women. It would therefore be imprudent to start removing ovaries or cysts in women who are found to have them at an ultrasound scan as many women will have them normally. When they grow or persist then we are more likely to be suspicious of them as a cause of pain. Polcystic ovaries occur in 1 in 5 women and the syndrome (hairiness, irregular cycle, acne, subfertility, and hormone imbalance) occurs in about 1 in 15. What you describe doesn't sound like polycystic ovaries as these classically show a ring of bead-like cysts of a few millimeters around a thickened ovarian centre on ultrasound not just 2,3 or 4 solitary cysts. Furthermore, they can cause pain but uncommonly. So the eventual diagnosis is likely to be one of endometriosis, adhesions, irritable bowel syndrome or idiopathic (idiopathic is a medical word for don't know - some gynaecologists put these women into a category of something called pelvic congestion on the basis of enlarged congested pelvic veins however this as an entity causing pelvic pain is still disputed). There are of course other possible diagnoses. The first step would be to make a diagnosis. You already have had a diagnosis of endometriosis so only your OBGYN can decide whether a repeat laparoscopy will be worthwhile in your individual case. If it is endometriosis this can be treated medically in some cases and surgically in others. Diathermy, laser or excision of endometriosis can sometimes help and the end of the line would be a total hysterectomy and removal of ovaries. However, this is drastic action especially if you are young and may consider having children or if you are far away from your menopause when the estrogens your ovaries produce are important for preventing osteoporosis and heart disease. You can therefore see why the diagnosis is so important to prevent committing yourself to major surgery when it may not work due to an incorrect diagnosis. In many cases obliterating your menstrual cycle using drugs such as the continuous use of the BCP, GnRH analogues (eg Zoladex), or high dose progesterones will stop pain related to your cycle such as endometriotic pain and those associated with 'pelvic congestion'. If it doesn't then one has to consider other diagnoses such as those that may be caused by the presence or your cysts, adhesions (eg from endometriosis) or from irritable bowel sydrome. The long and short of it is that this is a complex problem that temporary medical measures can often address while investigations are underway. Major surgery should be reserved for a condition which we know can be cured from such. Otherwise you should not embark apon surgery without the full understanding that it may not work. Best of luck and keep us updated.
-- Thomas Ind MB BS MD MRCOG St George Hospital Kogarah Sydney Australia
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