When we read or hear the word ovaries, the first thought that pops up in our heads is, fertility. Ovary is the primary female reproductive organ which stores ovum (egg cells) and protects them until they’re ready for use.
They aid in ovulation by releasing an egg every month once puberty is reached for possible fertilization and look after the female reproductive health. Quite like a few other organs in our body, ovaries have also achieved the status of being an endocrine gland. It’s because they secrete two groups of sex hormones; progesterone and estrogen. These two hormones are extremely essential in maintaining a steady reproductive development and fertility.
However, polycystic ovarian syndrome (PCOS) is one of the most commonly treated hindrances in a woman’s fertility. Presence of numerous small fluid filled cysts in the ovaries which are seen as dark circles on an ultrasound image, originally gave the condition its name but aren’t necessarily always present in the patient with PCOS. It is a widespread heritable hormonal disorder, caused by the imbalance of the female sex hormones that can affect any woman of childbearing age.
Our ovaries are a part of the female reproductive system along with fallopian tubes, uterus and vagina. They’ve a lifetime supply of eggs which are immature and are stored in tiny fluid filled underdeveloped sacs called follicles. It’s in these follicles wherein our eggs start developing for the purposes of menstruation and fertilization once a female hits puberty.
There’re a couple of hormones responsible for the disruption of a synchronized flow leading to PCOS. Pituitary gland which is located at the base of our brain, secretes certain hormones that direct the function of ovaries.
It releases a hormone called gonadotropin-releasing hormone (GnRH), this hormone triggers the release of two very important hormones; follicle stimulating hormone (FSH) and luteinizing hormone (LH). Each month this gland secretes FSH and LH into our bloodstream. In men, these two hormones cause the testicles to make testosterone whereas in women they aid in production of the two sex hormones; progesterone and estrogen.
Every month, when FSH travels through our bloodstream and reaches the ovaries, several eggs start to mature expanding to the size of follicles. As the eggs mature, the follicle secretes estrogen. Once the amount of estrogen in the blood reaches a certain level the pituitary gland sends a surge of LH to the ovaries causing the most mature follicle to open and release its egg in a process called ovulation.
The free egg travels through the fallopian tube where it awaits fertilization. Subsequently, the remaining immature follicles and eggs dissolve. If the egg is not fertilized, the egg and the lining of the uterus is shed in the next menstrual period.
Those with PCOS may have FSH deficiency, which obstructs the follicular maturation. The follicles stop halfway through their development and do not mature. Some of the immature follicles do not dissolve and remain as fluid filled sacs or cysts.
Impaired follicular development means no mature egg produced or released. Hence, the absence of ovulation. The abnormally high amounts of LH in the bloodstream of PCOS patients also disturbs normal menstrual cycle, leading to irregular periods and infertility. In addition, your doctor may observe high levels of insulin in your blood.
It is a hormone produced by the pancreas which controls your blood sugar levels. Too much insulin combined with high levels of LH, can induce excess production of the male hormone called testosterone in your ovaries. Abnormally high levels of testosterone can also prevent ovulation leading to infertility.
Furthermore, high levels of testosterone cause various physical characteristic features associated with the PCOS; severe acne, abnormal hair growth or balding in some cases. PCOS raises your risk of developing type 2 diabetes due to high levels of insulin and insulin resistance, heart disease, high bp, cholesterol abnormalities in the blood and endometrial cancer.
Treating insulin resistance is generally recommended for all women with PCOS. Lifestyle changes such as exercise, diet and weight loss are always advantageous. Diabetes medications such as metformin can lower both insulin and testosterone levels while regulating menses.
When fertility is not the goal of treatment, hormonal birth controls are usually prescribed to regulate the menstrual cycle and reduce risks of endometrial cancer. This treatment may also help improve acne and reduce extra body hair by reducing the testosterone production in the ovaries. When fertility is the goal of treatment, medication which can stimulate ovulation leading to pregnancy is advisable.
Writer’s note: Ladies, bear in mind your disease doesn’t define you but your courage does. Sometimes we all need to go through certain struggles to stumble upon our greatest strengths.
-Parul Budhraja Khanna
Entrepreneurial Biotechnologist with a strong passion for quality healthcare, patient advocacy & patient education.