Endometriosis is a common disorder of women of reproductive age. The most frequent clinical presentation of endometriosis is painful menstruation.
What are the common symptoms of endometriosis?
Endometriosis commonly present with painful menstruation, pelvic pain, pain during intercourse, infertility, and pelvic mass.
How to know the severity of endometriosis?
The correlation between the symptoms of endometriosis and the severity of disease is poor. Currently available laboratory markers are of limited value. At present, the best marker, serum CA-125, is usually elevated only in advanced stages and therefore not suitable for routine screening. Severity of endometriosis is difficult to determine from its symptoms. Usually symptoms are expressed according to area of involvement not depth of disease.
Who are affected by endometriosis?
Endometriosis usually starts in the ovary, it also can happen in the abdomen cavity affecting fallopian tubes, uterus and other pelvic organs like bladder and bowel. It affects women of reproductive age. Usually starts at around the age of 15 to 20 years and slowly spreads destroying nearby organs. It can subside spontaneously at menopause.
What is the correlation of CA 125 to endometriosis?
Plasma concentrations of CA-125 are increased in women with cystic ovarian and deep endometriosis and plasma concentrations are higher during menses than during the follicular and luteal phases of the cycle.
How ultrasonography and MRI are useful in Endometriosis?
Transvaginal ultrasound and magnetic resonance imaging are often helpful, particularly in detection of endometriotic cysts. Recently, trans rectal ultrasound and magnetic resonance imaging were shown to be valuable in detection of deep infiltrating lesions, especially affecting the rectum.
What is the role of Laparoscopy in endometriosis?
Direct assessment of endometriotic foci at laparoscopy may be viewed as a “gold standard” for identifying endometriosis. Laparoscopic removal of endometriosis significantly reduces pain and improves quality of life. Early diagnosis, surgical confirmation and therapy of endometriosis by laparoscopic techniques is recommended as soon as symptoms occur, even in adolescent girls.
Can a clinical test detect deep endometriosis?
A clinical examination during menstruation is proposed as a simple and reliable test to diagnose deep endometriosis. It also helps to decide which women may require bowel surgery. In >60% of cases deep lesions are “unexpected” findings at laparoscopy, these women are the candidates for bowel preparation before laparoscopy.
What is needed for definite diagnosis of endometriosis?
Diagnosis of endometriosis requires a careful clinical examination in combination with judicious use and critical interpretation of laboratory tests, imaging techniques, and, in most instances, surgical evaluation combined with biopsy results of excised lesions.
Which group of patients present with less severe symptoms?
Endometriosis, characterised by the ectopic localisation Of the endometrium, can be present as superficial implants, deep peritoneal lesions, and ovarian endometriomas, with or without associated pelvic adhesions. The frequency of dysmenorrhea and the frequency and severity of dyspareunia is less in patients with endometriosis located only on the ovaries than in patients with lesions at other sites.
What is Cystic Ovarian Endometriosis?
In some women, more severe forms present as either cystic ovarian or deep infiltrating endometriosis. Cystic ovarian endometriosis always has been recognized as a severe form because of its association with pelvic adhesions, infertility, and pelvic pain. Clinical examination during menstruation can diagnose reliably deep endometriosis, cystic ovarian endometriosis, or cul-de-sac adhesions. This test, preferentially combined with a follicular phase CA-125 assay, should be used to decide whether a preparation for bowel surgery should be given.
How CA 125 helps in pre-treatment of endometriosis?
The presence of pelvic nodularity during menstruation or a CA125 concentration higher than 35 U/mL can be used to decide in which women bowel pre-treatment should be given with a sensitivity of 87%, whereas <13%, will get an unnecessary bowel pre-treatment.
How deep endometriosis is treated?
Deep pelvic endometriosis may lead to severe pain, the treatment of which may require complete surgical resection of lesions. Infiltration of bowel is a difficult therapeutic problem. Preoperative diagnosis is difficult and digestive infiltration may remain unknown before surgery. This may cause damage to the gut with incomplete resection during surgery and sometimes may require repeated surgery. Both magnetic resonance imaging (MRI) and endoscopic ultrasonography are able to detect rectal infiltration but their usefulness in the preoperative staging is still not evaluated.
Can Endometriosis affect fertility?
Endometriosis is a chronic, progressive disease and may lead to severe destructions of reproductive organs and infertility in advanced stages.
Approximately 30% to 50% of women that have the diagnosis of endometriosis also struggle with infertility. Twenty five percent to 50% of women diagnosed with infertility also have endometriosis, but the endometriosis may not be severe enough to be the primary cause of infertility. White women have been reported to be more likely than African American women to have endometriosis. In addition, risk factors for endometriosis include below average body mass index, smoking, and alcohol use.
How ovulation is affected by endometriosis?
After ovulation, peritoneal fluid contains concentrations of progesterone and of 17 beta-estradiol that are 5 to 20 times higher than plasma concentrations in women with ovulatory cycles but not in women with unruptured luteinized follicles. Since viable endometrial cells were found in the peritoneal fluid of over 50% of women, both with and without endometriosis, a new hypothesis is presented about the cause of pelvic endometriosis and the association of pelvic endometriosis and infertility: pelvic endometriosis could be the consequence of infertility caused by the unruptured luteinized follicle.
Many times, a woman who has difficulty conceiving will have a case of endometriosis that does not come with severe symptoms. This is known as silent endometriosis. These silent sufferers eagerly crowd into the waiting rooms of in vitro fertilisation (IVF) clinics and reproductive specialists with the hope of conceiving. However, these women may have endometriosis, and the in vitro attempts they take may fail.
How endometriosis can lead to infertility in a woman and how it is treated?
Infertility due to endometriosis could be due to several abnormalities like tubal dysfunction, impaired ovarian reserve, worsening egg quality, defect in implantation and decreased sperm motility inside the female reproductive system. Infertility due to endometriosis at the earlier stages can be treated by simpler treatment like ovulation induction and IUI. However, at advanced stages it requires IVF / ICSI as the disease spreads rapidly and destroys the ovaries. At later stages, usually the women are completely depleted of their eggs and have to go through egg donation programme.
What are the precautions for women trying to conceive with endometriosis?
If you are experiencing severe pain during cycles it may be due to endometriosis, you must consult local gynaecologist. Diagnosis of endometriosis is usually done with pelvic ultrasound which may show chocolate cysts in the ovaries. It is always better to undergo a laparoscopy to check patency of tubes at this stage . If you are trying to conceive then it is a better option. If you are diagnosed as mild to moderate case of endometriosis you should regularly follow up with AMH levels. This can indicate extent of destruction of ovaries. Severe endometriosis needs immediate attention for fertility preservation, you may need IVF at this stage for optimum results.
Which is the most common hormone disorder found in women?
PCOS is extremely prevalent and probably constitutes the most frequently encountered endocrine (hormone) disorder in women of reproductive age. Having the disorder may significantly impact the quality of life of women during the reproductive years, and it contributes to morbidity and mortality by the time of menopause.
What are the disorders associated with PCOS?
Polycystic ovary syndrome women are at increased risk for coronary heart disease and type 2 diabetes mellitus. Their risk factors include central obesity, hypertriglyceridemia, low levels of high-density lipoprotein (HDL) cholesterol, hypertension, and elevated fasting plasma glucose concentrations. Polycystic ovary syndrome women should undergo screening for hypertension, abnormal lipid profiles, insulin resistance, and reproductive disorders including cancer of endometrium.
What is PAO?
A subgroup of women (up to 30%) may have subtle abnormalities resembling Polycystic ovary syndrome called PAO. While PCOS occurs in at least 5% of the population, the isolated finding of polycystic-appearing ovaries (PAO), which meets the classic ultra-sonographic criteria, occurs in 16–25% of the normal population without evidence of the full-blown syndrome. These characteristics include androgenic ovarian responses to stimulation with gonadotropins, as well as metabolic changes such as lowered high density lipoprotein-C levels and evidence of insulin resistance. While these data generated by our group need further assessment, these findings suggest that important yet silent abnormalities may exist in otherwise normal women who have a trait of Polycystic ovary syndrome (namely PAO).
What is the most important reproductive concern in women with PCOS?
The most frustrating reproductive concern for women with PCOS is pregnancy loss. The spontaneous abortion rate in Polycystic ovary syndrome is approximately one third of all pregnancies. This is at least double the rate for recognized early abortions in normal women (12–15%). Reasons for this are unclear although hypotheses include elevated LH levels, deficient progesterone secretion, abnormal embryos from atretic oocytes, and an abnormal endometrium.
How PCOS negatively impact psychosocial development of young women?
Women with PCOS, particularly those with hirsutism, have an increased prevalence of reactive depression and minor psychological abnormalities. There is also evidence of increased psychological stress and an increased catecholamine response to provoked stress. The overall quality of life is decreased in hirsute women. The presence of hirsutism and menstrual irregularities, especially in younger patients, is extremely distressing and has a significant negative impact on their psychosocial development.
Which cancer has increased risk in women with PCOS?
Women with Polycystic ovary syndrome are at increased risk of endometrial cancer. Chronic unopposed estrogen exposure is probably the proximate risk factor. This may be confounded by obesity, hypertension, and diabetes, which are known correlates of endometrial cancer risk. It is imperative to screen all women with Polycystic ovary syndrome, even those who are considered too young to develop endometrial hyperplasia and carcinoma.
Can low grade inflammation be a risk factor of PCOS?
Women with Polycystic ovary syndrome have significantly increased CRP concentrations relative to those in healthy women with normal menstrual rhythm and normal androgens. Inflammatory marker like CRP concentrations is more with PCOS. It correlates with the degree of obesity and inversely with insulin sensitivity, although not with total testosterone concentrations.
Which is a better predictor of metabolic syndrome in PCOS?
Obesity, a key determinant of insulin concentrations, appeared to have an independent effect on risk for the metabolic syndrome. In Anovulatory Polycystic ovary syndrome women a waist circumference of >83.5 cm along with biochemical evidence of hyperandrogenism is a powerful predictor of the presence of metabolic syndrome and insulin resistance. Age and central obesity (waist-hip ratio/waist circumference) are better predictors of metabolic syndrome in women with Polycystic ovary syndrome compared to other parameters including BMI.
How Metformin helps in PCOS?
Metformin is the most thoroughly investigated insulin-lowering agent used to treat PCOS; it enhances insulin sensitivity in the liver, where it inhibits hepatic glucose production, and in muscle, where it improves glucose uptake and use.
The persistence of regular ovulatory menstrual cycles in the 6 months after the end of treatment demonstrates that metformin treatment provides lasting benefits. All girls maintain a BMI <25 kg/m2, and this can play a role in normal ovulation menstrual cycles.
What is the role of AMH in diagnosis of Polycystic ovary syndrome ?
Serum anti-Mullerian hormone (AMH), produced in the ovaries by small follicles, is usually elevated in women with PCOS and correlates with the severity of this syndrome. AMH plays an important role in inhibiting follicular development by decreasing the sensitivity of the follicles to FSH and by inhibiting granulosa cell aromatase. Serum AMH appears as a sensitive and specific parameter that predict Polycystic ovary syndrome than antral follicle count and ovarian volume.
What is the source of DHEA in Polycystic ovary syndrome ?
Serum DHEAS has been found to be elevated in some women with polycystic ovary syndrome . In Polycystic ovary syndrome , it has been found that there are actually two different sources of androgens, the ovary and the adrenal. In women with PCOS, the theca cells are overactive and proliferate excessively, producing too much testosterone. Unfortunately, in 40-50% of women with PCOS, there is also another source of androgens, which is the adrenal glands. The adrenal glands produce all of the DHEA in the body.
What causes PCOS in non-obese women?
All women with PCOS are not obese. Between 20–50% of women with PCOS are normal weight or thin, and the pathophysiology of the disorder in these women may differ from that in obese women. It has been suggested that PCOS develops in non-obese women because of a hypothalamic-pituitary defect that results in increased release of LH, and that insulin plays no role in the disorder.
These women tend to have an increased waist to hip ratio and are insulin resistant and hyperinsulinemic compared to their normal counterparts.
How the lean PCOS are treated?
Even normal weight and thin women with PCOS respond to pharmacological measures to improve insulin sensitivity, such as administration of agents like metformin, with decreases in ovarian androgen production and serum androgens. Administration of myoinositol (3 g per day) reduce luteinizing hormone (LH), high-sensitivity C-reactive protein (hs-CRP) (inflammation), and androgens, as well as improve insulin tolerance test, in lean patients with PCOS.
How infertility in PCOS treated?
Lifestyle modification is very important in the treatment for PCOS, because weight loss and exercise have been shown to lead to improved fertility and the lowering of androgen levels. Ovarian stimulation along with insulin sensitizers help in many instances. IVF is an alternative option in Polycystic ovary syndrome . GnRH antagonist protocol appears to significantly reduce the rate of severe OHSS in these women. The average number of oocytes recovered is higher but rate of immature oocytes is more and fertilization rate is lower in the PCOS group.
Does IVM help in PCOS?
In-vitro maturation treatment can now be offered as a successful option to infertile women with polycystic ovaries or polycystic ovary syndrome. It is possible to combine natural cycle in-vitro fertilization with immature oocyte retrieval followed by in-vitro maturation, and thus offer women with various causes of infertility reasonable pregnancy and implantation rates without recourse to ovarian stimulation.
What is the effect of bariatric surgery in PCOS?
Bariatric surgery has been increasingly popular to treat morbid obesity associated with PCOS. In the larger population as the surgery has become safer with primarily a laparoscopic approach and selection of a healthier population for surgery, long-term survival is now superior with versus without the surgery.
[su_quote style=”default” cite=”” url=”” class=””]Ischaemic heart disease and stroke are the world’s biggest killers. These diseases have remained the leading causes of death globally in the last 15 years.[/su_quote]
Why we should be worried about heart disease?
Ischaemic heart disease and stroke are the world’s biggest killers, accounting for a combined 15.2 million deaths in 2016. These diseases have remained the leading causes of death globally in the last 15 years.
Leading cause of death
What are the traditional risk factors for Heart disease in women?
What are the Non-traditional risk factors for Heart disease in women?
Pregnancy-Related Disorders and CVD Risk Association
Hypertensive Pregnancy Disorders
Persistence of Weight Gain After Pregnancy
Autoimmune Diseases: Rheumatoid Arthritis and Systemic Lupus Erythematosus
Radiation and Chemotherapy for Breast Cancer
[su_quote style=”default” cite=”” url=”” class=””] Symptoms of heart disease in women can also be confused with other conditions, such as depression, menopause, and anxiety. [/su_quote]
What are the symptoms of heart disease in women?
Symptoms of heart disease in women can also be confused with other conditions, such as depression, menopause, and anxiety.
Common heart disease symptoms in women include:
indigestion or gaslike pain in the chest and stomach
shortness of breath or shallow breathing
fainting or passing out
Neck, jaw, back pain
What is Broken Heart Syndrome?
Stress-induced cardiomyopathy was first described in Japan in 1990 and was named after the octopus trapping pot with a round bottom and narrow neck, which resembles the left ventriculogram during systole in these patients.
It mainly affects postmenopausal women and is often preceded by extreme physical or emotional triggers. The clinical presentation, electrocardiographic findings, and biomarker profiles are often similar to those of ACS, but the coronary artery anatomy is found to be without significant obstructive disease at angiography.
The cause of Takotsubo cardiomyopathy remains unknown, but is thought to be related to a disproportionate distribution and activation of myocardial sympathetic receptors. The ventricular dysfunction, which usually involves the left, but may also involve the right ventricle, generally resolves within several weeks with supportive therapy, including β-blockade; however, especially in the presence of significant comorbidities, the outcome may not be benign.
Heart disease in women
What is the summary of healthy diet ?
A healthy diet is low in:
Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
What is DASH diet or eating plan?
The DASH eating plan requires no special foods and instead provides daily and weekly nutritional goals. This plan recommends:
Eating vegetables, fruits, and whole grains
Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils
Limiting sugar-sweetened beverages and sweets.
How to choose healthy foods ?
When following the DASH eating plan, it is important to choose foods that are:
Low in saturated and trans fats
Rich in potassium, calcium, magnesium, fiber, and protein
Lower in sodium
What are the symptoms should not be ignored in women as warning of heart disease?
Dramatic chest pain may not be there for a women.
You are suddenly worn out after your typical exercise routine.
You aren’t exerting yourself, but have fatigue or a “heavy” chest.
Simple activity like making the bed, walking to the bathroom or shopping makes you excessively tired.
Although you feel exceptionally tired, you also experience sleep disturbance.
2. Sweating and/or shortness of breath:
Sudden sweating or shortness of breath without exertion
Breathlessness that continues to worsen over time after exertion
Shortness of breath that worsens when lying down and improves when propping up.
What are the symptoms you should look out for heart disease?
Chest pain may not be there for a women. If it is there it may suggests heart disease. If chest pain is not there then it does not exclude heart disease.There may be only discomfort , heaviness, sense of pressure or heavy weight.
You should carefully look out for the following findings:
Women, in particular, can have pain in either arm — not just the left one like many men.
Pain in the lower or upper back often starts in the chest and spreads to these areas.
The pain is sometimes sudden, not due to physical exertion, and can wake you up at night.
You may feel pain that is specific to the left, lower side of the jaw.
Pregnancy Risk increases with age . IVF Success rate decreases with age.
[su_quote style=”default” cite=”” url=”” class=””]Success rate is less for women with IVF at age more than 40 years because the quality of the eggs harvested in assisted techniques such as IVF deteriorates with age.[/su_quote]
After which age fertility of a woman starts to fall by IVF and natural process ?
The ability to conceive starts to fall around the age of 32 years. IVF Pregnancy risk increases with age.
What are the chances of getting pregnant without IVF with respect to age?
After the age 32, a woman’s chances of conceiving decrease gradually and significantly.
After age of 35, the fertility reduces fast
By age 40, fertility has fallen by 50%.
At the age of 30 years, the chance of conceiving is about 20%.
At the age of 40 the chance of conceiving is around 5% only.
What are the risks of Pregnancy for older mothers?
Evidence demonstrates that it is increasingly difficult for women to become pregnant after the age of 35. It also said that women over 35 have a higher risk of miscarriage.
As women get older the number and quality of egg cells that are produced by the ovaries declines.
How successful is IVF for older women?
While in vitro fertilisation (IVF) can potentially help many women conceive, much like unassisted conception it is far less successful as women get older. The live birth rate for women under 35 undergoing IVF is 31%, but the success rate is less than 5% for women over 42 years of age.
Why success rate is less for women with IVF at age more than 40 years?
Success rate is less for women with IVF at age more than 40 years because the quality of the eggs harvested in assisted techniques such as IVF deteriorates with age. These techniques stimulate the release of more egg cells but cannot compensate for the effects of reproductive ageing on egg quality.
Can I postpone my pregnancy for few years
Newer preservation techniques are designed to freeze eggs from younger women and allow postponed pregnancy at a later age. Human oocyte cryopreservation (egg freezing) is a procedure to preserve a woman’s eggs (oocytes). This technique was mainly developed to enable women who, due to studies or any other complication can´t deal with pregnancy during their most fertile years, to postpone their maternity until their personal situation is the right to form a family.
Femelife Fertility : Know about IVF
What are the health risks of late pregnancy?
Greater difficulty in initially conceiving a child.
Personal and psychological difficulties.
Increased risk of complications for both mother and infant during pregnancy and delivery .
Greater risk of general maternal health problems, such as high blood pressure, which can contribute to complications.
Higher risk of miscarriage in women above the age of 35.
Higher risk of having twins or triplets, which is itself associated with higher risk of complications.
More chance of having a baby with a congenital abnormality, such as Down’s syndrome.
Elevated risk of pre-eclampsia.
Higher risk of complications during delivery, such as prolonged labor.
Need for assisted delivery or Cesarean section is more.
Higher chances of stillbirth.
The risks of pregnancy and birth complications, caesarean section, increase with age.
Older women are more likely to have a baby with birth defects or genetic abnormalities.
A woman over 35 is nearly 2.5 times more likely than a younger woman to have a stillbirth.
By age 40, she is more than five times more likely to have a stillbirth than a woman under 35.
For a woman aged 40 the risk of miscarriage is greater than the chance of a live birth.
Why risk of cesarean section is higher in elderly pregnant women?
Most older mothers experience normal labor and delivery. However, certain problems are more common in this age group, for example, placental abruption (premature separation of the placenta). Therefore, the rate of cesarean section is somewhat higher in older mothers.
What are the Genetic risks associated with pregnancy of elderly women?
Certain genetic risks present more often in pregnancy as women age. For example, the rate of having a baby with Down syndrome accelerates with maternal age.
While the rate of an embryo having Down syndrome at the 10-week mark of pregnancy is 1 in 1,064 at age 25, this rises to 1 in 686 at age 30 and 1 in 240 by the age of 35 years. At the age of 40, the Down syndrome rate increases still to 1 in 53, and down to 1 in 19 embryos at age 45.
What are the indications of egg freezing?
Oocyte cryopreservation can increase the chance of a future pregnancy for three key groups of women:
those diagnosed with cancer who have not yet begun chemotherapy or radiotherapy;
those undergoing treatment with assisted reproductive technologies who do not consider embryo freezing an option; and
those who would like to preserve their future ability to have children, either because they do not yet have a partner, or for other personal or medical reasons.
What is the success rate of egg freezing followed by IVF?
The percentage of transferred cycles is lower in frozen cycles compared with fresh cycles (approx. 30% and 50%). Such outcomes are considered comparable.
Is genetic defect affected with egg freezing and IVF ?
Two recent studies showed that the rate of birth defects and chromosomal defects when using cryopreserved oocytes is consistent with that of natural conception.
[su_quote style=”default” cite=”” url=”” class=””]Excessive growth of facial or body hair on women may be symptom of an underlying disorder. Dark and coarse hair may appear on the face, chest, abdomen, back, upper arms, or upper legs due to excess androgens in blood. Most common medical disorder causing hirsutism is PCOS (Polycystic Ovary Syndrome) accounting up to 10% of all cases.[/su_quote]
Excessive growth of facial or body hair on women
Excessive growth of facial or body hair on women may be symptom of an underlying disorder. Dark and coarse hair may appear on the face, chest, abdomen, back, upper arms, or upper legs due to excess androgens in blood. Most common medical disorder causing hirsutism is PCOS (Polycystic Ovary Syndrome) accounting up to 10% of all cases. Prompt medical attention often improves the condition whereas delaying medication makes the treatment more difficult and may have long-term health consequences.
The Human Hair
The human hair follicle is a complex structure and much has not been learnt about it. The hair follicle can be divided into 3parts: the lower segment (bulb and suprabulb), the middle segment (isthmus), and the upper segment (infundibulum). The lower segment around 4mm in length stays below the skin surface. The middle segment is a short section and the upper segment extends from the entrance to the skin to outside. Hair grows continuously in a cyclical fashion and rate of hair growth differs according to its position. Human body is covered by small vellus hair throughout except the palm and sole. In contrast the scalp is covered by lengthy terminal hair. The number of hair follicle at birth is fixed for life and it is around 100000 follicles in the scalp and 50 million on the body on an average.
Growth Cycle of Hair
Each hair grows from a follicle deep inside skin. Hair continues to grow even if it is plucked or removed as long as hair follicles are not completely destroyed. The number of hair follicles slowly begins to decrease at around age 40. Hair density varies by ethnic origin. Men and women of the same ethnic group have similar numbers of hair follicles and similar hair patterns. Asians and American Indians generally have less body hair than people of Mediterranean descent. Excessive hair that is due to genetic and ethnic variation is typically located on the arms, hands, legs, and feet, whereas hirsutism typically affects the face, abdomen, chest, inner thighs, and back.
Adults have two types of hair, vellus and terminal Vellus hair is soft, fine, generally colourless, and usually short. In most women, vellus hair covers the face, chest, and back and gives the impression of “hairless” skin. Terminal hair is long, coarse, dark, and sometimes curly and covers the face and body of men. Terminal hair grows on the scalp, pubic, and armpit areas in both men and women. A mixture of vellus and terminal hair covers the lower arms and legs in both men and women.
Hair growth occurs in cycles. While some hair follicles grow, others rest, and still others are shed. Hormonal changes, such as those associated with oral contraceptives (birth control pills) or pregnancy, may synchronize hair growth and make it appear to grow and shed more than usual. However, hair growth patterns usually return to normal within 6 to 12 months.
EFFECTS OF ANDROGENS ON HAIR GROWTH
Terminal hair that covers the face and body of men is usually the result of androgens. In men, androgens are produced primarily by the testes and the adrenal glands. In women, androgens are also produced but at a lower amount by the ovaries and the adrenal glands. Oestrogens, the female hormone reduces the effect of androgens in women. If vellus hair in women are sensitive to androgen then it may change to thick coarse terminal hair which grows faster. Once a vellus hair has changed to a terminal hair, usually it does not change back and is called hirsutism. Androgens increase sebum production, which results in oily skin and acne. Excess androgens in women can cause irregular or absent ovulation and menstruation. Extremely high androgen levels, such as when a tumor is present, may cause male-like balding, deepening of the voice, increased muscle mass, enlargement of the clitoris, and decreased breast size. These effects of excess androgens are called virilisation.
What causes hirsutism?
Excessive production of androgens by the ovaries (polycystic ovary syndrome, tumor)
Excessive sensitivity of hair follicles to androgens (genetic)
Excessive production of androgens by the adrenal glands (non-classical adrenal hyperplasia [NCAH])
Excessive production of cortisol by the adrenal glands (Cushing syndrome)
Polycystic ovary syndrome is the most common cause of hirsutism and it is due to associated hormonal imbalances that cause the ovaries to overproduce androgens.
For unknown reasons, some women have hair follicles that are abnormally sensitive to androgens. Androgen levels are normal and menstrual periods occur regularly in these patients. This tendency to develop hirsutism is clearly genetic, but the exact abnormality is not known.
Ovarian or Adrenal Tumors
On rare occasions, an androgen-producing tumor may develop in the ovaries or adrenal glands. This tumor may produce extremely high androgen levels. Symptoms, such as hirsutism, usually appear suddenly and progress quickly. Very high androgen levels may cause male-like balding, deepening of the voice, and increased muscle mass. Fortunately, most of these tumors are not cancerous.
Around the time of menopause, the ovaries stop producing estrogen but continue to produce androgens. The decreased levels of estrogen may allow the androgens to have a greater impact, leading to an increase in 8 the number of dark terminal hairs, especially on the face. For this reason, many menopausal women complain of new facial hair (moustache and whiskers) and mild balding.
Which drugs may cause hirsutism?
Drugs with characteristics of androgens may cause hirsutism. Anabolic steroids used to increase muscle mass in chronically ill and debilitated people and by some bodybuilders, are chemically related to androgens. Natural supplements such as DHEA may cause hirsutism. Danazol, phenytoin, minoxidil, and diazoxide are other medications associated with increased hair growth.
How Hirsutism is diagnosed?
Physicians trained to treat hirsutism and related problems generally include reproductive and medical endocrinologists. Some gynecologists, dermatologists, and general practitioners also have acquired the necessary expertise. After identifying the causes of hirsutism, physician can recommend appropriate treatment. Any unwanted hair remaining after treatment may be removed by a variety of cosmetic treatments, including laser and electrolysis.
Doctors might recommend an ultrasound or a CT scan to check ovaries and adrenal glands for tumours or cysts. Tests that measure the amount of certain hormones in blood, including testosterone or other testosterone-like hormones, might help determine whether elevated androgen levels are causing hirsutism.
What laboratory tests should be ordered for a patient with hirsutism?
Laboratory testing depends on the symptoms expressed by patients. Cases of mild hirsutism may be left alone without any investigations. However, serum levels of total and free testosterone, DHEAS, and 17-OHP can be useful tests, depending on the individual patient. Patients with signs or symptoms of hypothyroidism,
hyperprolactinemia, acromegaly, or Cushing syndrome also should be evaluated with serum thyroid-stimulating hormone (TSH), prolactin, IGF-I, or 24-hour urine cortisol testing, respectively.
How is hirsutism treated?
Treatment of hirsutism is usually with a combination of oral contraceptive pills, spironolactone, other drugs like eflorinithine and cosmetic measures; however, other antiandrogens and gonadotropin-releasing hormone agonists can be used.
Patients with polycystic ovary syndrome may have improvement of symptoms if they are treated with insulin sensitizers.
Treatment of virilization is surgical removal of the tumor or steroid treatment for congenital adrenal hyperplasia.
How do you choose the appropriate therapy for hirsutism?
Most patients are given a trial of OCPs, with or without spironolactone, and are advised to use cosmetic measures while waiting for the medications to work. The topical cream eflornithine HCl may be used alone or in combination with other measures. Because of their more serious side effects and higher cost, the other medications are reserved for the most severe cases in which OCPs and spironolactone fail.
Whatever therapy may be chosen, the results do not last for more than 3 to 6 months. Although many medications and combinations have been used, only topical eflornithine HCl is currently approved by the Food and Drug Administration for treatment of hirsutism. Unfortunately, most patients have a relapse of hirsutism approximately 12 months after discontinuation of medical therapy.
What cosmetic measures can be used for the treatment of hirsutism?
Bleaching, shaving, plucking, waxing, depilating, and electrolysis are effective measures that can be used alone or in combination with medications. By these procedures terminal hair that is already present is removed. Simultaneous use of medications decrease new growth and rate of transformation to terminal hair. Laser-assisted hair removal is a commonly used method of treatment for hirsutism. It is done on outpatient basis using intense pulsed light therapy which cause thermal injury to the hair follicle. At least three to six treatments about 2 to 2.5 months apart are required. The techniques result in removal of hair, and a period of 2 to 6 months before the regrowth of hair, which is thinner and lighter. Patients with light skin and dark hair have the best results with the fewest side effects. The side effects include minimal discomfort, local swelling and redness lasting 24 to 48 hours.
[su_quote style=”default” cite=”” url=”” class=””]IVF is used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult or due to problems in the partner like decreased sperm quality and quantity.[/su_quote]
IVF is used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult or due to problems in the partner like decreased sperm quality and quantity. For IVF to be successful it typically requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Due to the costs of the procedure, IVF is generally attempted only after less expensive options have failed. Pregnancy is a complex phenomenon and many things can change in due course of time. People who had a baby with IVF can get pregnant naturally later. Here are a few theories on what can impact natural success in pregnancies after IVF.
Endometriosis can subside after pregnancy
Sometimes, when a woman with endometriosis becomes pregnant through IVF, her body has time to recover from endometriosis, even if she doesn’t know she has it.
The disease is suppressed allowing the female environment to potentially be more favourable for subsequent pregnancies to occur during 9 months of childbearing.
Release of stress resolves the hormonal environment
For some women, after having their first child through IVF, the pressure of becoming pregnant significantly subsides and with decreased stress and lack of contraception, natural pregnancies may occur. Similarly, at many instances it is seen that women who have adopted a baby conceive naturally later.
Unexplained infertility may get better
About 20 percent of people who had a baby with IVF can get pregnant naturally later and this is more likely to happen if the cause of infertility was unexplained.
PCOS resolves with increasing age
PCOS patients often have regular cycles after a pregnancy, with increasing age the symptoms of PCOS reduce and the hormonal environment slowly returns to normal. This usually corrects defects in ovulation and improves quality of eggs and hence prepares the women for natural conception.