Sunday, September 16, 2007

Wellbeing of Women Show

Photograph shows PCOS

Yesterday I went to the 'WOW Show' or 'Wellbeing of Women show at the Royal College of Obstetricians and Gynaecologists. There were some useful sources of information there including stands from the Pelvic support group. There were also a number of informative and interesting seminars to attend. The one I chose (naturally!) was a talk by Consultant Gynaecologist Miss Gillian Rose about 'Endometriosis and PCOS'

Straight away, Miss Rose made the extremely valid point about the logic of combining two such very different gynaecological conditions, in a 30 minute time slot, when days of seminars and debates could be given to each topic. Nevertheless, she managed the task admirably and gave a succinct and very interesting account of both conditions.


PCOS (Polycystic Ovarian Syndrome)
· Commonest Endocrine disorder in women
· 1 in 5 have it or 15-22% of women

· Irregular/no periods
· Acne, increased facial hair
· Weight-gain
. Infertility
· None
· Insulin resistance
To ‘have’ PCOS definitely, a woman must have 2/3 of the below criteria:
· Irregular/no periods
· Hyperandrogenism (acne, increased hair and/or scalp hair loss)
· Polycystic ovaries – these measure only 2-9mm and look like small beads in a necklace.
PCOS Causes
· Inherited genetically
· Dominant gene can come from either the father or mother
· Highest prevalence in Asians

Does it matter having PCOS?
· Increased risk of having diabetes
· High blood lipids
· Increased risk of heart disease
· Increased risk of breast cancer
· Increased risk of endometrial cancer

Other Treatment
· Control periods via use of the Pill or cyclical progesterone
· Hair control –e.g. lazering/waxing or by use of hormones e.g. Yasmin.

Fertility and PCOS
· Weight loss is important – the higher the person’s Body Mass Index or BMI – (the lower their chance of conceiving. It is worth noting that Fertility clinics will not treat women with IVF who have a BMI of more than 30 as the success rate is virtually nil)
· Fertility drugs
· Laparoscopic ovarian drilling

Weight-loss is key in the management of PCOS. The higher the woman’s weight increases, the more the symptoms do including increasing problems with insulin resistance and infertility. It is hard for women with PCOS to lose weight, but it can be achieved if they limit their intake of fat and carbs and take regular exercise.

· Presence of the endometrium (lining of the womb) outside the womb.
· Flow back occurs via the fallopian tubes, one of the reasons for it forming.

Endo – who gets it?
· 10-15% of women. Interestingly, there is no actual increase in the % number of women who have endometriosis since the 1970s
· Peak age for endometriosis is 25-34 years old, but teenagers can have it and it is important for doctors not to ignore this.
· Endometriosis is oestrogen dependant

Where is it found?
· Pelvis
· Pouch of Douglas
· Ovaries
· Bowel
· Bladder
· Rarely – further afield – e.g. lungs

· Painful periods
· Painful sex
· Infertility
· Bowel symptoms
· Bladder symptoms
· Chronic pelvic pain
· Ovulation pain
· Backache
· Tiredness
· None!

Heavy periods are NOT a symptom of endometriosis, but a factor that leads to endometriosis

How to diagnose Endo
· Medical history of the patient
· Examination
· Ultrasound Scan
· Laparoscopy
· MRI Scan – useful if bowel endo is suspected. Needs a skilled Radiologist to interpret it or it can be missed.

Why is it so difficult to diagnose?
· Presents in many different ways
· Overlaps with many other conditions e.g. IBS

Who gets it?
· Age of first period is relevant – the more cycles you have, the greater the risk
· Shorter cycles increase the risk
· Family history – it is a genetic condition. If a family member has it, you are 7 x more prone to the condition
· We have many more periods than our Foremothers and mothers – about 450 to their 150 or so periods as they started their periods later, became pregnant earlier, had more children and breast fed a lot which all meant that they had much fewer periods than we do now.

Medical Treatments for Endo
· Continuous taking of the Pill with no breakthrough bleeding
· Progesterones – e.g Provera
· GnRH analogues – e.g. Zoladex + Addback HRT
· Mirena Coil which is loaded with progesterone. Periods get lighter and eventually stop.
It is important to manage endometriosis for it is a chronic disease.

How to treat it
· Stop periods! Reduce the number a woman has unless they are trying to conceive
· Surgical treatments – cut it out/remove it
· Pain Management – e.g. diet/drugs/complementary therapies
· Prevent disease recurrence – (stop periods)
· Support groups –e.g. Endometriosis UK
· Lifestyle changes –

Lifestyle Changes
· Diet can help –e.g. reducing wheat intake (reduces bloating),
· Not being constipated - codeine is a very constipating drug
· Drinking plenty of water – 2 litres a day which helps the bowels
· Exercise – very important in the management of chronic pain as it is very good for the immune system which releases endorphins and can help with tiredness. Push your energy levels!

There is no good reason for women to continue having periods unless she is trying to conceive. Stopping periods for women with Endometriosis is the best way to manage and prevent recurrence.


Anonymous said...

It's quite a sweeping generalisation to say that stopping periods is the best treatment. Every woman's endo treatment should be specifically suited to her, not some blanket approach. Comments like these about stopping periods aren't helpful as they try to over-simplify what is a complicated area.

MizzK said...

It could be considered a blanket term to 'stop periods' and for some women continuing to have periods is obviously fine, but the more periods that a woman has, the higher chance of a recurrence of the endometriosis, or the higher the chance of getting it in the first place.

Anonymous said...

Its true stopping ones period doesnt resolve the issue.... it just simplifies things a bit.... a doctor or other health professional who says to stop their periods has basically given up on the patient. Some patients have amenorhhea in the first place but could still develop endometriosis. There is an assumption that one who has endometriosis also has their periods.