Polycystic Ovary Syndrome MUST NOT BE OPERATED

Good morning, we want to talk a little more about polycystic ovary syndrome. We have received many questions in our YouTube videos regarding this topic. Sometimes simple ovarian cysts are confused with polycystic ovary syndrome.

Obviously the name is what makes it confusing, but polycystic ovary syndrome is a very particular endocrinological situation, it is actually more common than we imagine, it is estimated that around 20% or 30% of young women may have it. polycystic ovary syndrome and it is a condition that affects them not only from the point of view of fertility but also in their gynecological health.

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Many times they write to us on our YouTube channel that they have gone 3, 6 or even 9 months or even a year without seeing menstruation and they present it in a way that is even joking, saying “Well, it’s better this way that I don’t have to worry about “take care of my menstruation” but it is really important because there is a commitment to endometrial health. In other videos (Sexuality for adolescents and adults part 2) we have explained how the menstrual cycle works, that is, how the ovarian cycle correlates with that of menstruation and it is important to take it into account to understand this concept.

Yes, these girls have high levels of estrogen throughout all months and probably for several years, without the contrast of progesterone since their cycles are anovulatory. What’s going on with this? These high levels of estrogen are stimulating your endometrium every day in a continuous, sustained manner, so an endometrium that does not shed every month is susceptible to getting sick and this is how endometrial polyps end up appearing and can develop hyperplasia. endometrial.

Endometrial hyperplasia is an abnormal development of the endometrium that, if left to evolve, can even lead to endometrial cancer. Other aspects that have been related to girls who have polycystic ovary syndrome, as I told you before, are insulin resistance. People who have insulin resistance and do not take control of this issue have a higher risk of developing diabetes mellitus later in life. Then, all the alterations that have to do with the metabolism such as the increase in cholesterol, triglycerides, glycemia also affect the health of the small vessels, that is, they affect cardiovascular health and this is why women with Polycystic ovary patients also have a higher risk of having high blood pressure even in later stages of their life.

So, if you are under 30 years of age, you have anovulatory cycles and they talk to you about polycystic ovary syndrome, it is important that you know that after 35 years of age you will have a greater risk of developing diabetes, developing hypertension, and having health problems. endometrial hyperplasia or endometrial cancer, so it is as important as the issue of fertility to know that polycystic ovary syndrome can affect your general health. Obviously, if the patients have long cycles and are not ovulating, well that is where the origin of the infertility that these girls usually have comes from, then they have ovaries that have many eggs but the natural process by which the pool of eggs that they recruit is not activated. Finally one matures but… On the contrary, it ends up being a relatively favorable condition because they have many eggs.

So what do we do in the clinic? Well, we give them ovulation inducers from treatments with tablets, combinations with gonadotropin, it is very rare that a patient with polycystic ovary syndrome finally does not have a response to the medications.

Achieving a pregnancy with Polycystic Ovary Syndrome P.C.O.S.

We are going to present you a clinical case that reports that it brings together all the data that I have mentioned. This is a 29-year-old girl. She consulted for infertility for approximately 5 or 6 years and when we were doing the questioning we saw that her menstrual cycles were very irregular. She had cycles that took at least 3 months to arrive, when the most common thing was which will take up to 6 and 9 months. He was overweight, more or less a body mass index of 34 and had clear signs of hyperandrogenism, he had a little hair on his skin, he had a little hair at the level of the abdominal line, that is, all the clinical symptoms of syndrome. polycystic ovaries. We performed the ultrasound and confirmed the ultrasound diagnosis by having more than 12 follicles in each ovary and then in that way we began to organize her diagnostic protocol. When I did the transfer test I identified that her endometrium looked very thick, very hyperechogenic, very white… Much more than expected and then we decided to proceed to the evaluation by transvaginal ultrasound. In the transvaginal ultrasound we see that the endometrium is indeed very thick, measuring more than 15 millimeters, and we decided to perform a hysterosonography. In hysterosonography we pass a little physiological solution liquid through the catheter and then imagine that you have the uterus with the liquid inside the cavity, this allows us to define much better the appearance of the uterine cavity and we could actually see how the image was drawn of an endometrial polyp, that is, the endometrium was very thick in a localized area. With this ultrasound diagnosis, we decided to take the patient for a hysteroscopy.

Hysteroscopy allows us to visualize the cavity directly, we use an endoscope through the cervix, we see the uterus from the inside and we can directly identify the lesion and we observed that it had a large endometrial polyp implanted towards the left lateral wall, but it was free and occupied practically all the useful space of the endometrium. Even if we had tried ovarian stimulation to generate ovulation, surely this girl was not going to get pregnant because her uterine cavity was occupied by a large endometrial polyp that was not only going to affect implantation but also a possible evolution of the pregnancy, the advantage of hysteroscopy is that it allows us not only to identify and confirm the diagnosis, but also to immediately treat it, so we proceeded to completely resect the polic and dissect its base to finally extract it. So, we identified an endometrial problem, we already solved it, your uterine cavity is already in a position to prepare for a pregnancy, then we had mentioned that polycystic ovary syndrome is characterized by irregular cycles because they do not ovulate, so after the hysteroscopy, a Once we generate menstruation we begin fertility treatment.

We did? We did ovulation induction, in her case with gonadotropin, it was injected daily for 11 or 12 days and that allowed her follicles to mature. We managed to mature 3 follicles and once we did the ovulation induction, we then performed intrauterine insemination. By performing intrauterine insemination we have a greater probability of generating pregnancy, so as a clinical case we have: A patient with anovulatory cycles that we resolved with ovulation induction medications, we have a better pregnancy prognosis when preparing the semen sample with insemination, We are placing the sample inside a uterus that we already know is healthy Because we already solved the problem it had! So in this way we are combining factors in order to improve the prognosis and solve their original problem, which is the search for pregnancy. So, the patient goes to the consultation, we put together the clinical case, we discover that she has polycystic syndrome, we identify the endometrial problem, then we take her to the hysteroscopy, we solve her endometrial problem with those conditions, we do the ovulation induction treatment, finally since It didn’t start until we did the insemination because it ended up taking a month and a half. In a month and a half she had already resolved a gynecological problem, we did the fertility treatment and finally after 15 days after the insemination we now have a positive pregnancy test. So, with good guidance with an adequate diagnosis, notice that in a month and a half this girl solved a gynecological problem and we achieved pregnancy.

Should I have surgery if I have polycystic ovaries?

I mention this because one of the things that they also tell us a lot on YouTube is that they have polycystic ovary syndrome and they are told to have surgery. Actually, surgery for polycystic ovary syndrome is not indicated because we are talking about a functional problem, an endocrinological problem. When we say polycystic I know that the name sounds scary like “Many cysts” but the word cyst in this case has to do with the appearance it has on the ultrasound, a cyst is a collection of fluid, therefore, any area of the body is that it has activity that cycles is likely to develop cysts.

So what’s up? You have many small follicles in that ovary so that is why we talk about polycystic ovaries, there are many cysts but they are really follicles, they are follicles that have an egg. It is different when you have a cyst related to a type of tumor, they are generally much larger, generating pain, generating other types of symptoms, that is, it is a totally different gynecological condition. So one of the ideas that I want to make quite clear is that the cysts in polycystic ovarian syndrome MUST NOT BE OPERATED, it is a functional disorder, there is a disorder of regulation of your hormones.

Surgery is not going to cure polycystic ovary syndrome, just as there are people who are right-handed, there are people who are left-handed, there are people who have the uterus forward or have it backward… We are simply different, so there are women who have polycystic ovary syndrome where their ovaries work in a different way, they are slower, they do not mature and that is why cysts form, so surgery cannot solve a natural condition, you have an ovary that works in a different way, So many patients write to us telling us that they want to have surgery. Or that they have already had surgery and after six months the cysts reappeared! Yes, that’s why… They also tell us “No, it’s just that I was on my medical treatment, it went very well, I saw my period every month but I got bored and decided to stop it and when I stopped the medication again I started to have irregular cycles or I gained weight or the characteristics of my skin worsened”… Yes, that’s how it is, that’s what’s going to happen… Because it’s important for you to be clear that this is not a disease that you’re going to cure, it’s It’s about a condition that you have and that you have to manage.

There are people who have chronic diseases, for example diabetics or some types of hypertension, so they need to be taking their treatment every day to function normally, the same happens with polycystic ovary syndrome: You have to follow your medical treatment so that your body is functioning in a normal way, in an adequate way and above all… If it is not your plan to get pregnant, it is still important that you take control of polycystic ovary syndrome to address possible health problems that you may have, such as We already mentioned it, preventing diabetes, hypertension, and endometrial cancer are very important situations.

You can attend our in-person or online consultations if you need more information on how to manage polycystic ovary syndrome. Remember that knowledge is success

“Take control of polycystic ovary syndrome to address the possible health problems you may have, such as diabetes, hypertension and endometrial cancer”

Dr. Otto Paredes
Dr. Otto Paredes
Fertility Expert

Reproductive medicine and gynecological endocrinology
Instituto Valenciano de Infertilidad, Spain.

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