Suppressing ovulation with medications is generally speaking going to result in endometriomas which will also resolve the pain. The polycystic ovary disease, again, is something that is associated with a lot of symptoms, the ovary cysts themselves do not cause a problem, but it's all the symptoms with it, the hirsutism, the real problem with diabetes, it's just now becoming a little bit more watched, the obesity, the hirsutism. Probably for the polycystic ovary disease, the number one thing you're going to try to do is to try to get the patient to lose weight. If the obese patient loses weight, most of the time the symptoms of polycystic ovary disease resolve.
The hirsutism of course, and once the hair follicle changes and you've got certain types of hair that develop through alflife. Once the male hormone, which I failed to mention, ovaries also produce various types of male hormones like testosterone and once the -
Most women don't know that, that there's all types of precursors to as well as the male of course produces certain types of estrogen as well. Estrogen, oh yes, in fact we see it in there's an interest in certain types of, the liver tears down estrogen products and then, in patients, in male patients who have bad livers for instance, severe alcoholics, they can't break that estrogen down that's naturally formed, and they get certain symptoms from estrogen. They can get larger breasts. They can get certain lesions on the face from enlarged blood vessels from high estrogen. Just like women who have the testosterone DEHA [sic], dehydroepiandrosterone, all of the testosterone precursors, many of these are produced in the ovary.
And these for a lot of complex reasons, the polycystic ovary patient is more sensitive to this testosterone, and once she starts to have the hirsutism develop, the birth control pill will not generally decrease the hirsutism. It can stop the hair from growing, but once the follicles change, then she's going to have to seek out electrolysis or the more expensive, but more effective, treatment of laser. She may use creams, but the polycystic ovary disease itself is often palliated or reversed by the weight loss, which is important because then that in itself can decrease or eliminate the diabetes tendency which is a complication of the polycystic ovary disease.
New York OB/GYN Christopher Freville mentions something about cysts in general that I should've mentioned earlier when I mentioned the ganglion cyst. Cysts don't spread or cause other cysts and I've had patients come to me and say, “Doctor, I once had an ovary cyst and now I've got a cyst in my vagina. Please tell me, did it spread?" And cysts are female genital tract can develop various cystic lesions, and again many of these are remnants from the development embryo process. These can be vaginal wall cysts. A lot of these show up in the women when they're in their 30s and 40s.
A Bartholin's gland cyst is a rather large gland that starts growing and the cyst, but benign but it's at the opening of the vagina. You've got all kinds of occlusion cysts. These cysts have nothing to do with ovary cysts, nor do breast cysts. Breast cysts, that's another common question that we doctors get. “Doctor I've got a breast cyst. Is it because of my ovaries?" The answer is no. And of course you've got the cysts, skin cysts, ganglion cysts, all of these cysts are unrelated to anything in the ovary. They certainly haven't spread and it's not a tumor, and I think that's where a lot of the confusion comes in until somebody's properly educated -
Then they go draw all kinds of bad conclusions, they avoid the doctor. Unfortunately they make things worse both in anxiety and treatment. When we find something on exam, let's talk about, we're finding something cystic. There are other things it can be. It doesn't have to be an ovary. Some of these are benign and can be, some of these are diseased states. There can be tube ovary abscesses caused from an old tube infection. Usually these are painful conditions but these are cystic and can show up as cystic on sonar and on exam. You can also have a condition where the tube, itself, fills up with liquid and seals, called a hydrosaplinx. And these can feel like a giant cystic mass, a giant sausage like soft balloon, but these are benign. But sometimes we don't have a way of knowing until we actually get in at the time of surgery. Or, we actually can image it on ultrasound. And most of the time you're going to go in and relieve that hydrosalpinx.