Polycystic Ovarian Syndrome and Pelvic Pain
Frederick R. Jelovsek, MD
\"Last month I had a vaginal hysterectomy due to PCOS (polycystic ovarian syndrome), but the Dr. refused to take out the cysts in my ovaries and didn\'t take out the ovaries either. The pain is still present and feels like someone is squeezing the ovary really hard. I can\'t stand it and it affects both ovaries. Birth control pills didn\'t work. Any suggestions as to what I can do? The Dr. is no help. I\'m 36 years old and in pretty good health.\" KE
Actually you may be quite surprised to hear that polycystic ovarian syndrome (PCOS) is not thought by most physicians to cause any pain at all. In fact insurance companies will not authorize payment for hysterectomy for PCOS. They will authorize it for pelvic pain and I suspect that is what your physician put down on the forms as a diagnosis. This does not mean that women with PCOS do not have pelvic pain, but it questions whether the cause of the pelvic pain is something other than the ovaries.
PCOS affects about 4-7% of women (1) although the incidence can vary by the definition used. Be sure to see our disease profile about polycystic ovarian syndrome and what is usually considered to be part of the syndrome. Pain is not included as part of the definition.
I thought that any type of ovarian cysts cause pain.
There is a difference between periodic or chronically recurring ovarian cysts that cause pelvic pain and PCOS that is an endocrine syndrome which happens to have small immature follicle cysts in the ovary. All functional ovarian cysts that are the result of arrested development of an egg are a result of anovulation. These cysts accumulate and persist in the ovary and will show up on ultrasound as multiple cystic areas in the ovary. One proposed classification divides this follicular ovarian disease into two groups (2):
- polycystic ovarian syndrome (small follicles usually less than 2.0 cm)
- multi follicle ovaries (larger follicles)
- macro polycystic ovaries (multiple cysts larger than the usual polycystic ovarian cysts)
- functional cysts (one to several larger, simple cysts)
- luteinized unruptured follicle syndrome (i.e., and egg that did not ovulate but the cystic area went on to form a corpus luteum gland for support of possible pregnancy as if an egg did ovulate)
Thus if a diagnosis of polycystic ovarian syndrome was made on the basis of an ultrasound rather than an endocrinological basis, you may have one of the other conditions of multicystic ovaries which are associated with pain.