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Done USG pelvis, report showed ovaries are bulky, show multiple small cysts in peripheral part and slightly echogenic stroma. Guide?

Mar 2016
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Hi Doctor, recently we have done USG pelvis for my wife (age 28) and the report stating that both ovaries are bulky, show multiple small cysts in peripheral part and slightly echogenic stroma, possibility of changes of polycystic ovaries. Her hormone test show as FSH 11.41 , Lh-9.15 , Prolactin - 98, estradiol-70.4. Her pregnancy test is negative and some sort of while fluid is oozing from her breasts after pressing them. Please guide us on the same.
Posted Sat, 9 Nov 2013 in Women's Health
Answered by Dr. S Patra 1 hour later
Brief Answer:

Detailed Answer:

Thanks for writing to us. Followings are my guideline:

From your given history and test reports, I can assume that she has Poly Cystic Ovarian Disease (PCOD) with increased Prolactin level (98 ng/ml).

1) High prolactin level is called hyperprolactinemia and it is responsible for oozing of white fluid or breast milk. This condition is named as GLACTORRHEA.

Little amount milky discharge is quite physiological. However, large amount on regular basis or spontaneously is significant and underlying pathological causes are needed to investigate properly. 50% of the cases are without any pathology.

Here, we need to exclude pituitary adenomas through CT scan or MRI, causing overproduction of prolactin or compression of the pituitary stalk. Ultrasound scan of breast is also advisable to rule out other causes.

Most adenomas of the anterior pituitary are prolactinomas. Increased prolactin level is related to amenorrhea or irregular late period and infertility.

TREATMENT: I would treat her with dopamine agonist like BROMOCRIPTINE to suppress prolactin level. It is quite effective and prevents oozing of breast milk in absence of pregnancy. You have to consult with her gynecologist for proper dosing and prescription after clinical assessment.

In addition, unnecessary breast handling should be avoided and she must wear slight loose breast support to reduce pressure over breast.

2) For PCOD, she needs to follow a key treatment protocol. This is as follows:

a) Low carbohydrate diet (avoid fatty or sugary beverage) with more green vegetables.

b) Regular moderate to heavy physical exercise by means of running/ jogging/ treadmill/ walking to reduce body weight.

c) Hormonal medication like combined birth control pill or Progesterone pill from D16 to D25 to regularize monthly period.

d) Avoid mental stress by regular yoga or meditation for 15 to 30 min. Take adequate bed rest or sound sleep.

e) Insulin sensitiser drug like Metformin to trigger ovulation and prevent type 2 Diabetes (given in some cases).

f) Hypothyroidism should be ruled out in addition to above by undergoing one thyroid function test (TSH, T3, T4).

To summarize, you must visit to her gynecologist for proper guidance and medication after clinical examination and relevant investigation (if required).

Hope, I have answered your query. If you need any clarification, you can freely ask me.

Wish her good health and take care yourself.

Dr Soumen

For future query, you can directly approach me through
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