Polycystic ovaries that are not pathological... what?

October 17, 2012 2:32 PM

My "ovaries are polycystic, but this is not a significant pathological process" -what?

This is a direct quote (and almost the entirety of) a letter my specialist sent me. My follow up isn't for several weeks. Anyone have any idea of what the implications of this are? (We are starting to think about having kids.) I take it this is different that polycystic ovarian syndrome (which I do not have symptoms of)? You might be a doctor, or maybe you just have some personal experience with this? I've done some google/webmd searching but nothing talks about cysts that aren't pathological.

He is a urogynocologist/obstetrician that I've been seeing for urinary tract/bladder pain, which has all but entirely cleared up through trigger point therapy and myofacial release. (YAY) Thanks!

posted by jrobin276 to health & fitness (8 answers total)

Hi there, I am a doctor but not your doctor, and I also have PCOS.

Ovarian cysts are definitely not always pathological. Ovarian cysts are really common. Many people who have ovarian cysts do not have PCOS. PCOS is diagnosed by something called the Rotterdam criteria, which are as follows:
1) Elevated androgenic hormones (like testosterone/androstenedione)/clinical signs of hyperandrogenism like hirsutism etc - note that you can have the elevated hormones without the clinical symptoms.
2) Irregular/anovulatory menstrual cycles
3) Polycystic ovaries on ultrasound

You need two of the 3 for the diagnosis of PCOS. So what this ultrasound tells you is that you might have PCOS, but you don't necessarily have it. Memail me if you have other questions.
posted by treehorn+bunny at 2:40 PM on October 17, 2012 [2 favorites]

Just as an aside....since you mentioned pregnancy, I had a firm PCOS diagnosis and with a couple of shots of follistem (long story short) had two perfect pregnancies. It's scary when you first hear it but there are lots of treatments and the technology is moving fast.....Best of luck!
posted by pearlybob at 3:27 PM on October 17, 2012 [1 favorite]

Another symptom-free PCOSer here. I got pregnant within the first year of trying with the help of metformin. This is likely not a big deal at all. If you're not on hormonal BC or when you stop it, take your temp every day to determine whether you are ovulating and talk with your doctor about it, but it's unlikely you have anything to worry about. Non pathological cysts are very common, and probably even more common than we realize because people with problem-free cysts and no other medical conditions aren't getting ultrasounds that show them.
posted by peanut_mcgillicuty at 3:59 PM on October 17, 2012

It sounds like you don't have PCOS but if you did and were concerned about having kids, I would tell you that I know two women with PCOS who are currently pregnant. Both are having great pregnancies. One got pregnant really easily and the other took a few times but is doing very well now. So I wouldn't worry too much right now.
posted by kat518 at 5:23 PM on October 17, 2012

I don't know the stats, but plenty of women with PCOS are still able to have children, albeit often they require medical help. There's a spectrum here, so how "serious" that help is depends on the patient's specific needs.

But unless your gyn has seen test results or other symptoms of PCOS as outlined above, you may not even have it--just cysts on the ovaries (which, in fact, you don't even need to technically have PCOS!), and they don't sound serious from what you've said here. Talk with your doc for sure, but I wouldn't sweat it in the meantime.
posted by asciident at 5:47 PM on October 17, 2012

Thanks everybody! I have no idea if I have PCOS, but it sounds "better" than having endometriosis, which is what my GP suspected.... Cheers!
posted by jrobin276 at 6:04 PM on October 17, 2012

FWIW, I have had PCOS for over twenty years. I have the hormonal symptoms, irregular menstrual cycles and polycystic ovaries. I was told I would most likely be infertile. I have gotten pregnant twice and they were both unplanned pregnancies. Neither resulted in a live birth for reasons unrelated to PCOS. Fertility and PCOS is a crapshoot; it can make it difficult to conceive but that is by no means a given.
posted by crankylex at 7:43 PM on October 17, 2012

To share further my personal experience, it is definitely true what people say about fertility being a crapshoot with PCOS. I know many women with PCOS do not need assistance to conceive, but I did about 6 IUIs with Clomid (a fertility pill) and then with Femara (another fertility pill) and using metformin, and eventually got pregnant using injectable medications, specifically Menopur. I missed the part where you were thinking about having kids so did not mention this! If you have any trouble with fertility then definitely consider going to a reproductive endocrinologist instead of your regular OB/GYN.

Regarding endometriosis, I agree that PCOS could be "better" depending on the case, endometriosis is also a spectrum and some women find the pain caused by endometriosis disabling, and of course that can also affect your fertility. Keep in mind that a normal pelvic ultrasound does not rule out endometriosis. Ultrasound can only see large/advanced endometriosis lesions. For a definitive diagnosis, someone would actually have to open up your abdomen and look inside, i.e. laparoscopy. If your pain is under good control and if you've got no other issues, hopefully you won't need further workup.
posted by treehorn+bunny at 1:30 AM on October 18, 2012