Dr Cathryn Chan, Astra Women’s Specialists

About 10% of women of childbearing age develop a potentially serious hormonal and metabolic disorder known as polycystic ovarian syndrome (PCOS). Usually, the cysts are not harmful but lead to hormone imbalances. The cause of these hormonal imbalances is unknown. Women with PCOS are at risk of developing medical problems such as diabetes, heart disease and pre-cancer and cancer of the endometrium (lining of the uterus)

The most common symptoms are:
• Acne
• Weight gain and trouble losing weight
• Facial and chest hair or male distribution of hair pattern
• Thinning hair on the scalp and male pattern baldness
• Irregular periods, some women have no periods for long intervals. Others have very heavy and prolonged bleeding.
• Infertility due to ovulatory problems
• Pigmentation or darkening of skin at the back of the neck, groyne and armpit

The Difference Between Ovarian Cysts and PCOS
Multiple small cysts in the ovaries are the hallmark of PCOS. These can be detected with an ultrasound scan which typically shows enlarged ovaries with a series of small cysts at the periphery hence looking like a pearl necklace. These cysts somehow do not regularly grow bigger or ovulate causing irregular menstruation, abnormal menstruation as well as difficulty conceiving.

Ovarian cysts can also be brought on without having a hormonal imbalance, so having ovarian cysts do not necessarily mean that a woman has PCOS. In fact, many women will have ovarian cysts at some point during their reproductive years, and in most cases, are without symptoms. Endometriotic cysts are ovarian cysts filled with blood and can cause severe pain during menstruation. Some cysts are filled with clear fluid and some are filled with mucoid substance. A type of ovarian cyst filled with hair, skin appendages, bone and brain is quite common among younger women.

Ovarian cysts can cause discomfort during intercourse, pelvic pain and abdominal distension. Ovarian cysts can also present as medical emergencies due to the complications of bleeding into the cyst, twisting and infection. Sudden or severe pelvic pain, especially with vomiting or a fever, should be treated immediately.

Some cysts can become cancerous, which are usually not painful. They can grow very large before they are discovered.

Among the best methods for detecting gynaecologic cancers early and in its most treatable stages are regular annual pelvic exams.

Diagnosis and Treatment
Ovarian cysts and PCOS can be diagnosed by your OBGYN using pelvic exams, ultrasounds and blood tests. The use of diagnostic imaging in the form of ultrasound or CT scan is helpful in assessing the features of the cyst
Patients with PCOS can have their menses regulated with hormonal pills such as the oral contraceptive pill. Their weight must be controlled. The insulin resistance can be treated with metformin and revosit. For those women desirous of fertility, ovulation induction with pills is achievable. However, some women with PCOS are not responsive to ovulation pills. The ovaries can then be stimulated to ovulate with hormonal injection.

Abnormal ovarian cysts may have to be treated surgically. The mode of surgery is dependent on the size of the cyst and the possibility of cancerous potential. Keyhole surgery or the open method can be used to remove the cyst(s).
Your OBGYN will discuss options with you after a full examination and assessment of the cyst.