Polycystic Ovary Syndrome

It is possible that the main title of the report Polycystic Ovary Syndrome is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

• Bilateral Polycystic Ovarian Syndrome
• Ovarian Hyperthecosis
• Ovarian Syndrome
• PCOS
• Polycystic Bilateral Ovarian Syndrome
• POS
• Sclerocystic Ovarian Disease
• Stein-Leventhal Syndrome
• anovulation with hyperandrogenism

Disorder Subdivisions

• None

General Discussion

Polycystic ovary syndrome (PCOS) affects women and is a complex of symptoms that are not necessarily all present in all cases. Some, but not all, affected women have multiple cysts on the ovaries (polycystic ovaries). Other characteristics include the absence of menstruation (amenorrhea) or irregular menstruation, failure of the ovary to release eggs (anovulation), elevated levels of the male hormones known as androgens (hyperandrogenism), excessive amounts of body hair (hirsutism), a high rate of miscarriage, and infertility. Three criteria often used for a diagnosis are menstrual irregularity, hyperandrogenism, and exclusion of other disease. There is some evidence that PCOS is an inherited condition.

Breast Lumps

Breast mass

Definition
A breast lump is a swelling, protuberance, or lump in the breast.

Considerations

Normal breast tissue is present in both males and females of all ages. This tissue responds to hormonal changes and, therefore, certain lumps can come and go.

Breast lumps may appear at all ages:

* Infants may have breast lumps related to estrogen from the mother. The lump generally goes away on its own as the estrogen clears from the baby's body. It can happen to boys and girls.
* Young girls often develop "breast buds" that appear just before the beginning of puberty. These bumps may be tender. They are common around age 9, but may happen as early as age 6.
* Teenage boys may develop breast enlargement and lumps because of hormonal changes in mid-puberty. Although this may distress the teen, the lumps or enlargement generally go away on their own over a period of months.
* Breast lumps in an adult woman raises concern for breast cancer, even though most lumps turn out to be not cancerous.

Causes

Lumps in a woman are often caused by fibrocystic changes, fibroadenomas, and cysts.

Fibrocystic changes can occur in either or both breasts. These changes occur in many women (especially during the reproductive years) and are considered a normal variation of breast tissue. Having fibrocystic breasts does not increase your risk for breast cancer. It does, however, make it more difficult to interpret lumps that you or your doctor find on exam. Many women feel tenderness in addition to the lumps and bumps associated with fibrocystic breasts.

Fibroadenomas are non-cancerous lumps that feel rubbery and are easily moveable within the breast tissue. Like fibrocystic changes, they occur most often during the reproductive years. Usually, they are not tender and, except in rare cases, do not become cancerous later. A doctor may feel fairly certain from an exam that a particular lump is a fibroadenoma. The only way to be sure, however, is to remove or biopsy them.

Cysts are fluid-filled sacs that often feel like soft grapes. These can sometimes be tender, especially just before your menstrual period. Cysts may be drained in the doctor's office. If the fluid removed is clear or greenish, and the lump disappears completely after it is drained, no further treatment is needed. If the fluid is bloody, it is sent to the lab to look for cancer cells. If the lump doesn't disappear, or recurs, it is usually removed surgically.

Other causes of breast lumps include:

* Milk cysts (sacs filled with milk) and infections (mastitis), which may turn into an abscess. These typically occur if you are breastfeeding or have recently given birth.
* Breast cancer, detectable by mammogram or ultrasound, then a biopsy. Men can get breast cancer.
* Injury -- sometimes if your breast is badly bruised, there will be a collection of blood that feels like a lump. These tend to resolve on their own in a matter of days or weeks. If not, the blood may have to be drained by your doctor.
* Lipoma -- a collection of fatty tissue.
* Intraductal papilloma -- a small growth inside a milk duct of the breast. Often occurs near the areola, the colored part of the breast surrounding the nipple, in women between the ages of 35 and 55. It is harmless and frequently cannot be felt. In some cases the only symptom is a watery, pink discharge from the nipple. Since a watery or bloody discharge can also be a sign of breast cancer, this must be evaluated by your doctor.

Home Care

Treatment of a breast lump depends on the cause. Solid breast lumps are often removed surgically, or at least a biopsy is taken. The biopsy is to check whether it is cancerous or not. Cysts can be drained. Breast infections require antibiotics.

For fibrocystic changes, birth control pills are often helpful. Other women are helped by:

* Avoiding caffeine and chocolate
* Taking vitamin E, vitamin B complex, or evening primrose oil supplements
* Limiting fat and increasing fiber in the diet

If breast cancer is diagnosed, most women receive a combination of surgery, radiation, chemotherapy, and hormonal therapy. These options would be carefully assessed and thoroughly discussed with your doctor.

When to Contact a Medical Professional

Call your doctor if:

* You find a new breast lump during your monthly self-exam
* You have bruising on your breast but did not experience any injury
* You have nipple discharge, especially if bloody or pinkish (blood tinged)
* The skin on your breast appears dimpled or wrinkled (like the peel of an orange)
* Your nipple is inverted (turned inward) but normally is not inverted

Also call if:

* You are a woman, age 20 or older, and want guidance on how to perform a breast self-examination
* You are a woman over age 40 and have not had a mammogram in the past year

What to Expect at Your Office Visit

Your doctor will obtain a complete history from you, with special attention to factors that may increase your risk of breast cancer. A thorough breast examination will be performed. If you don't know how to perform breast self-examination, ask your health care provider to teach you the proper method.

Medical history questions regarding breast lumps include:

* When and how did you first notice the lump?
* Do you have other symptoms such as pain, nipple discharge, or fever?
* Where is the lump located?
* Do you do self-breast exams and is this lump a recent change?
* Have you had any type of injury to your breast?
* Are you taking any hormones, medications, or supplements?

Tests that may be performed include:

* Study of nipple discharge under the microscope
* Needle aspiration of a cyst with examination of the fluid under a microscope
* Biopsy of the lump
* Ultrasound to see if the lump is solid or cystic
* Mammogram

If you have a family history of breast cancer, your doctor may also suggest testing for genes that predispose you to breast cancer.

Prevention

Breast cancer screening is an important way to find breast cancer early, when it is most easily treated and cured.

* If you are over age 20, consider doing a monthly breast self-exam. See: Breast self exam
* If you are over age 20, have a complete breast exam by your provider at least every 3 years -- every year if you are over 40.
* If you are over age 40, get mammogram once a year. If you are high risk, experts say you should start getting a mammogram at age 30.

Having fibrocystic breast tissue, mastitis, or breast tenderness related to PMS does NOT put you at greater risk for breast cancer. Having fibrocystic breasts does, however, make your self-exam more confusing since there are many normal lumps and bumps.

To prevent breast cancer:

* Exercise regularly
* Reduce fat intake
* Eat lots of fruits, vegetables, and other high fiber foods
* Do not drink more than one or one and a half glasses of alcohol a day

Mittelschmerz

Mittelschmerz (German: "middle pain") is a medical term for "ovulation pain" or "midcycle pain". About 20% of women experience mittelschmerz, some every cycle, some intermittently.

Mittelschmerz is characterised by lower abdominal and pelvic pain that occurs roughly midway through a woman's menstrual cycle. The pain can appear suddenly and usually subsides within hours, although it may sometimes last two or three days.^[1] In some women, the mittelschmerz is localized enough so that they can tell which of their two ovaries provided the egg in a given month. Because ovulation occurs on a random ovary each cycle, the pain may switch sides or stay on the same side from one cycle to another.

Diagnosis of mittelschmerz is generally made if a woman is mid-cycle and a pelvic examination shows no abnormalities. If the pain is prolonged and/or severe, other diagnostic procedures such as an abdominal ultrasound may be performed to rule out other causes of abdominal pain.

The pain of mittelschmerz is sometimes mistaken for appendicitis and is one of the differential diagnoses for appendicitis in women of child-bearing age.

The pain is not harmful and does not signify the presence of disease. No treatment is usually necessary. Pain relievers (analgesics) may be needed in cases of prolonged or intense pain.

Hormonal forms of contraception can be taken to prevent ovulation -- and therefore ovulatory pain -- but otherwise there is no known prevention.

Mittelschmerz is believed to have a variety of causes:

• The swelling of follicles in the ovaries prior to ovulation. While only one or two eggs mature to the point of being released, a number of follicles grow during the follicular phase^[2] of the menstrual cycle (non-dominant follicles atrophy prior to ovulation). Because follicles develop on both sides, this theory explains mittelschmerz that occurs simultaneously on both sides of the abdomen.

• The ovaries have no openings; at ovulation the egg breaks through the ovary's wall. This may make ovulation itself painful for some women.^[2]

• At the time of ovulation, blood or other fluid is released from the ruptured egg follicle. This fluid may cause irritation of the abdominal lining.^[1][2]

• After ovulation, the fallopian tubes contract (similar to peristalsis of the esophagus), which may cause pain in some women.^[1]

• At ovulation, this pain may be related to smooth muscle cell contraction in the ovary as well as in its ligaments. These contractions are in response to an increased level of prostaglandin F2-alpha mediated by the surge of leutinizing hormone (LH).^[3]

Women charting with some form of fertility awareness may find mittelschmerz to be a helpful secondary sign in detecting ovulation. Because normal sperm life is up to five days, however, mittelschmerz alone does not provide sufficient advance warning to avoid pregnancy. Because other causes of minor abdominal pain are common, mittelschmerz alone also cannot be used to confirm the beginning of the post-ovulatory infertile period.

Women may notice other physical symptoms associated with their mittelschmerz, or near ovulation. The most common sign is the appearance of fertile cervical mucus in the days leading up to ovulation. Cervical mucus is one of the primary signs used by various fertility awareness methods. Other symptoms are sometimes called secondary fertility signs to distinguish from the three primary signs.^[2]

• Mid-cycle or ovulatory bleeding is thought to result from the sudden drop in estrogen that occurs just before ovulation. This drop in hormones can trigger withdrawal bleeding in the same way that switching from active to placebo birth control pills does. The rise in hormones that occurs after ovulation prevents such mid-cycle spotting from becoming as heavy or long lasting as a typical menstruation. Spotting is more common in longer cycles.^[2]

• A woman's vulva may swell just prior to ovulation, especially the side on which ovulation will occur.^[2]

One of the groin lymph nodes (on the side on which ovulation will occur) will swell to about the size of a pea, and may become tender.