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Dr. Andrew Rynne

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Diagnosed with PCOS and ultrasound showing both ovaries are minimally bulky. Should I be worried about the findings?

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Dr. Anjana Rao Kavoor

Psychiatrist

Practicing since :2008

Answered : 1197 Questions

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Posted on Fri, 15 Nov 2013 in Women's Health
Question: Hi I am 29 yrs of age. Recently I have diagnosed PCOS. My USG report after17days from 1st day of my period says " both ovaries are minimally bulky
multiple tiny peripherally cysts noted in both ovaries
no dominant follicle seen
stromal echogenecity is raised
rt ovary 3.84*3.16cm
lt ovary 3.85*2.45cm approx.
I am worried bcoz I dont have any dominant follicle which could mean that I am not ovulating. PLz suggest

doctor
Answered by Dr. Anjana Rao Kavoor 51 minutes later
Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi,
Thanks for writing in to us.

I have read through your query in detail.

PCOS gets its name from the changes seen in the ovary. Polycystic ovaries are enlarged and contain multiple (greater than 10) immature follicles. The immature follicles show a relative hyperplasia of theca cells, and fewer granulosa cells. Development of these follicles is arrested well before the point of dominant follicle selection, so no LH surge can occur, and therefore, no ovulation.

There are a wide range of treatments available including oral contraceptive pills, aromatase inhibitors, insulin sensitizers, clomiphene, gonadotropins and surgery.

Your doctor will give you a treatment based on your clinical symptoms.

Hope your query is answered.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Anjana Rao Kavoor 1 hour later
I have regular 35days cyle period sometimes of 28. Mild forms of hursutism. My recent dheas tsh testosterone level are normal only pp insulin is 147. Then why pcos
To add on my wt is 51kgs and I am 5ft in height
doctor
Answered by Dr. Anjana Rao Kavoor 2 hours later
Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi XXXX,
Thanks for writing in with an update.

Polycystic ovarian syndrome is a group of symptoms and all symptoms need not be seen in each patient. Weight gain, hirsutism, delayed or absent periods, are some of the symptoms seen. On ultrasound there is characteristic appearance of enlarged ovaries (more than 10 cc in volume) and ovarian stroma with peripheral necklace arrangement of small follicles. Apart from this hormonal imbalance and insulin resistance are also seen in PCOS.

Your doctor has diagnosed you as PCOS on various criteria including ultrasound scan.

Coming to your condition, if your cycles are 35 days, then ovulation most likely occurs 14 days before the first day of bleeding (21st day of cycle) and this is ulually constant in most women.

Your weight is acceptable as within normal range.

Please do not get worried as PCOS is treatable in most cases but may take variable amounts of time depending on treatment taken and hormone levels.

Hope your query is answered.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Anjana Rao Kavoor 41 minutes later
Thanks a lot for ur ans. Just one last question since I dnt have a dominant follicle on 17day seems dat I might not ovulate this time. Can there be other cause as well for follicles not mAturing other than pcos which I might have but no symptoms yet.
Like excess fsh level or premature ovary function. Actually I read a lot over the net abt all these so is a bit worried.
One thing which I am failing to understand is if my testosterone level is normal then how is that I am having mild hirsutism. As far as my unferstanding goes increase level of androgens cause it. And androgen level is checked with testosterone only. So I am bit confused is it only pcos that is causing hirsutism but again pcos occur from hormonal imbalance only
doctor
Answered by Dr. Anjana Rao Kavoor 15 hours later
Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi,
You are welcome and thanks for writing back.

1. I guess you got a transvaginal ultrasound scan done. If you got abdominal ultrasound done then it is difficult to evaluate follicle rupture at times.

2. Anvulation can occur as a result of a number of conditions:

i. Polycystic ovary syndrome (PCOS) is the commonest one (reduced production of FSH, and normal or increased levels of LH, oestrogen and testosterone).
ii. Thyroid problems associated with abnormal (high or low) thyroid hormone levels.
iii. Premature ovarian failure, where a woman’s ovaries stop working before she is 40.
iv. currently unexplained, "unruptured follicle syndrome" occurs in women who produce a normal follicle, with an egg inside of it, every month yet the follicle fails to rupture. The egg, therefore, remains inside the ovary and proper ovulation does not occur.

3. Normal testosterone determinations in the hirsute patient can be misleading, partially because of inherent variation in commercial testing methods. However, bioavailable (free) testosterone levels may support the diagnosis of PCOS.

Hope your query is answered.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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