Polycystic Ovary
What is ovulation?
Ovulation; every month in women of reproductive age. It is when one and sometimes two egg cells mature, are thrown out of the ovary, and are taken through the tubes and transported to the uterus. In order for ovulation to occur, the woman's hormone balance must be normal. If hormones are working regularly, ovulation occurs from one ovary every month. One month, one ovary occurs, while the other month the other ovary rests. In other words, ovulation cannot occur from both ovaries at the same time.
How can you tell if ovulation has occurred?
Ovulation pain occurs between the 13th and 17th days of a woman's menstrual period every month. A pain that we call occurs. The woman describes a temporary, non-severe pain on one side of her abdomen every month. This pain may indicate ovulation. All women experience this pain, but 60-70 percent can feel it distinctly. So, sometimes women can even feel ovulation themselves. In women, between the 13th and 17th days of menstruation, the amount and fluidity of the cervix increases as female hormones increase due to ovulation. Women notice an increase in mucus discharge during these periods. This is a symptom of ovulation in women. Apart from that, we doctors apply different methods. for example; We can detect whether ovulation occurs with ultrasound. We measure the development and diameter of the egg. When the egg reaches a diameter of 18-20 millimeters, it indicates that the woman is ovulating. In addition, body temperature in women is one of the indicators of ovulation in women. It is a very simple method. Women can measure their body temperature with a thermometer in the armpit or inside the mouth every evening, starting from the beginning of their menstrual period. Generally, between the 13th and 17th days of menstruation, the temperature gradually increases by half and 1 degree. This graph is evidence that ovulation occurs in women. In addition, increased intrauterine tissue development, that is, increased thickness of the tissue, is one of the indicators of ovulation. The increase in progesterone hormone between the 21st and 22nd day of a woman's menstrual period also shows us that ovulation is occurring. We also take a piece of the intrauterine tissue a day or two before the menstrual period and send it for analysis. As a result of the examination, we can understand whether ovulation has occurred by looking at the hormonal changes in the intrauterine tissue.
THE DISORDER IN THE BRAIN AFFECTS ovulation
Ovulation in women; the pituitary gland in our brain. It occurs in the form of hormones called FSH and LHsecreted from the gland stimulating the ovaries and the development of the egg cell in 10-12 days. If there is a disorder in this mechanism, that is, if there is a factor that disrupts the relationship between the pituitary gland in the brain and the ovary, then ovulation disorder occurs. We can summarize these factors as follows: If there are small tumors in the pituitary gland in our brain, if there are cysts and tumors in the ovary, if there are hormone disorders in the ovary itself, if there are goiter hormone disorders in our brain (especially hypothyroidism and hyperthyroidism) or if there is a disorder in the mechanism of the adrenal glands. These also disrupt ovulation. Male hormones, which we call androgen hormones, secreted from the adrenal gland, disrupt the structure of the ovary and prevent egg development and therefore ovulation. Except those; Situations such as stress, troubles, deaths, sorrows, divorces, separations, war or war, that is, situations related to anger and stress, also disrupt ovulation. Apart from that, Polycystic Ovary Syndrome (PCOS) is also one of the leading causes that disrupt ovulation. On the other hand, other hormone disorders, some medications used and ovarian tumors can also prevent ovulation.
Is there a treatment for ovulation disorder?
There is a treatment for ovulation disorder. If the patient has no tumors in her ovaries, brain and pituitary gland, no cysts and her tubes are normal, then ovulation treatment can be applied to this patient. The most important step in ovulation treatment is to identify and eliminate the underlying cause of the disease, then switch to drug treatment. If the patient has goiter hormone disorder, diabetes or adrenal gland disorder, these problems are first treated and eliminated. Afterwards, the woman becomes pregnant spontaneously, but if she does not, then we apply ovulation treatment. In ovulation treatment, we first apply medication in the form of oral pills. We start on the fifth day of menstruation, after five days of ovulation treatment. The result is 80 percent ovulation. But pregnancy occurs in 40-45 percent of cases. If pregnancy does not occur despite ovulation pills, then we give the hormones FSHand LH, which grow the egg, to the patient through an external injection in certain doses and monitor them. When the egg develops, we make an injection to crack the egg and ovulation occurs. We recommend that partners be together 24-36 hours after ovulation. Or we can help these patients get pregnant by applying IUI treatment during this period.
BEWARE OF GENETIC MENOPAUSE AND SMOKING!
There are some situations in which the ovaries do not work in those people. The first of these is caused by genetic problems. Some women may enter menopause early (between the ages of 25-35) due to a genetic disorder. Since egg production stops completely during menopause, they do not menstruate and do not ovulate. Secondly, patients have tumors etc. If her ovaries are removed for some reason, ovulation cannot occur. Thirdly, an intervention has been made in the ovaries, the cyst or tumor has been removed, but although the ovary is preserved, sometimes the ovaries deteriorate due to surgery-related reasons and lose their normal function, go bankrupt and stop working. In addition, the causes we call immunological, allergic substances that disrupt the immune system (viruses, etc.) can cause immunological ovarian failure. Chemotherapy or radiation methods used during cancer treatment may also cause early menopause, thus causing ovarian failure. I would like to emphasize one point in particular here; Smoking in women severely impairs ovarian functions. And this causes menopause early; that is, it brings the age of menopause at least 5-6 years earlier. In addition, even if she does not enter menopause and continues to menstruate, it may reduce the chance of getting pregnant by disrupting ovarian functions. Therefore, smoking is a serious risk factor.
What is Polycystic Ovary Syndrome (PCOS)?
PCOS is the name of the most common ovulatory dysfunction in women. Normally, nearly a thousand egg cells continue to develop in women's ovaries every month, but when it comes to the final selection period, 20 to 50 of them are selected. These constitute the developing egg group that month. This is 50 After the next egg develops for 5-6 days, one of them matures and continues its development to become the egg that will be ovulated that month. After 18-20 millimeters, it cracks and ovulation occurs. Other eggs regress and disappear. There are some situations where this mechanism is broken. When the egg cells in the ovaries reach a diameter of 8-10 millimeters, they cannot develop and grow any further. These remain as small cysts in the ovary. Their diameters vary between 5 and 10 millimeters. As the name suggests, polycystic, that is, many small egg cysts are formed. Since the egg cannot fully develop and ovulate, the ovaries begin to grow after PCOS. As he grows, male hormones are secreted from the ovary. This disrupts the structure of the ovary and the patient's sugar metabolism. Their menstrual patterns are disrupted and they have delayed periods (2-6 months). We call this condition PCOS. PCOS; It is not a real cyst.
PATIENTS WITH PCOS NEED CLOSE LIFETIME FOLLOW-UP
Why does this disease occur and how does it cause infertility? What happens?
There are some enzymes in the body that regulate hormone secretion. Those enzymes create female hormones from cholesterol and ensure hormone balance. But sometimes, a disorder occurs in these enzymes while in the womb, and since this disrupts the structure of female hormones, a deviation occurs in the ovaries and the hormone balance is disrupted. As a result, the ovaries grow, there are many small egg cells in them, menstruation is delayed, ovulation does not occur and causes infertility problems.
What other problems does it cause besides infertility?
PCOS; is not only an infertility or ovulation problem, but can also cause various health problems in patients. PCOS, apart from the absence of ovulation in a short time, delayed menstruation and infertility, causes patients to gain moderate weight. because male hormones secreted from the ovaries disrupt sugar metabolism and increase the tendency to gain weight; Patients gain between 6 and 15 kilos. In addition, 60 percent of patients have diabetes in the long term (in their 40-50s). They appear as stones. Again, in the long term, blood pressure and heart disease may develop. Some of these patients may develop uterine and breast cancer in the following years.
FORGET WHITE FLOUR, DON'T STICK WITH VEGETABLES
Our aim in the treatment is primarily to help patients lose weight and achieve weight control. For this reason, we recommend that they avoid bread, white flour and sugar and consume foods with plenty of fiber and fiber. However, diet alone is not enough. PCOS patients have a tendency to gain weight compared to their peers, even if they eat less, because their hormone balance is disrupted. Because their energy and sugar metabolism is disrupted, they eventually convert and store what they eat into fat tissue in the body, causing them to gain weight. That's why we recommend the patient to increase their movements after the diet. We want them to be active in daily life. We recommend very fast walks (and sometimes jogging) for at least half an hour, at least three times a week. We protect the general health of the patient with diet and exercise.
If the patient expects a child; We lose weight and give drugs that regulate sugar metabolism. In 40-50 percent of them, pregnancy occurs spontaneously. But if they can't get pregnant, then we use ovulation drugs. However, there are some patients; they have children, they do not expect to get pregnant, but they have health problems due to PCOS (late menstruation, blood pressure, sugar, risk of breast and uterine cancer, etc.) they are alive. In these conditions, the patient must be treated. In such patients, we measure their cholesterol, sugar, triglyceride and fat levels and treat them accordingly. Our aim in this treatment is to ensure that patients have regular menstrual periods and to reduce the risk of developing uterine cancer in the future by preventing excessive development in the uterus.
STRUCKING DOCTOR FOLLOW-UP IS A MUST DURING PREGNANCY
We do not always perform surgery in PCOS. But there are some situations; Even though we treat the patient, ovulation does not occur and the hormone balance is irregular. So, despite everything, it does not get better... If the patient has an infertility problem and is expecting a child, and cannot get pregnant despite ovulation medications, then there are two options; We either take her to in vitro fertilization treatment or have surgery. A.
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