Ovaries
Ovaries Funny, when a woman pulls a gutsy move, her chutzpah usually gets attributed to parts of the male anatomy. Rarely, if ever, do you hear, "Boy, she''''s got ovaries."
For whatever reason, the ovaries--the female reproductive glands--have never made it into the popular vernacular as a power symbol the way their male counterparts have.
Yet there they are. These two small structures, situated on either side of a woman''''s uterus, influence practically every aspect of a woman''''s health.
The ovaries churn out hormones that are instrumental in regulating the menstrual cycle. One of those hormones, estrogen, plays a key role in maintaining the health of a woman''''s skin, heart, breasts and bones. It also helps regulate her metabolism and body temperature.
Then there''''s the miraculous process of ovulation. The release of an egg for fertilization is a central ovarian function and key to a woman''''s fertility.
And to think that all that clout springs from two glands about the size and shape of almonds.
| Look for the Signs You may know women who say they know when they''''re ovulating. Is this really possible? Well, yes, there are some ways to tell, doctors say. Aside from estimating when we ovulate--it usually occurs somewhere between 12 and 16 days after the first day of your last period--there are body signals you can look for. The first is a phenomenon doctors call mittelschmerz, which loosely translated means "middle pain." The term refers to the twinge or cramp in the lower abdomen or back that some women feel when an egg is released from the ovary. Second, changes in the quality of your cervical mucus--which is produced by the cells that line the cervical canal--can also indicate if you''''re ovulating. Around the time of ovulation, your cervical mucus tends to become more watery and profuse. A more definite way to tell if you''''re ovulating--it''''s the method used by couples who are having trouble conceiving--is to measure your basal body temperature, or BBT. Over the course of your cycle, your body temperature changes. Prior to ovulation, it''''s lower. (For most people it''''s about 98.6°F, but not exactly--so you need to find out your own basal rate.) Around the time of ovulation, the BBT rises. If your body temperature has remained elevated at least four-tenths of a degree Fahrenheit for up to three days, that indicates that ovulation has occurred. (If your temperature continues to be elevated for more than two weeks, it could be an indication of pregnancy.) Urine tests (similar in design to pregnancy tests) that can help you predict ovulation are available at local drugstores. |
Powerful, but Susceptible
Yet, with all their powerful attributes, the ovaries are susceptible to dysfunction and disease. Most ovarian problems are not preventable, but by understanding what can go wrong, you''''ll be better able to recognize problems early and seek the care you need.
The prime task of the ovaries--ovulation--involves an intricate interplay between hormones. The big players in this hormone interaction are the estrogen released by the ovaries and other hormones released by the brain and the pituitary, a small, pea-size gland located at the base of the brain that regulates the activity of other endocrine glands (the endocrine system) throughout the body.
Located inside each ovary are hundreds of thousands of follicles--tiny clusters of cells that function as storehouses for immature eggs. There are about 1 million follicles present in the ovaries at birth, but their number declines with age, until there are less than half--about 400,000--by the time a woman starts menstruating. For an egg to mature inside a follicle and be released from the ovary, it needs stimulation from certain hormones.
It''''s kind of a tag-team process, where one hormone triggers the release of other hormones, and they in turn promote the growth and release of an egg. The first hormone, a gonadotropin-releasing hormone, is released by the brain, travels down to the ovaries and tickles the pituitary gland located at the base of the brain. The pituitary then releases two more hormones, which go to work on the ovary and its follicles.
When a follicle is stimulated by a gonadotropin-releasing hormone, the cells surrounding the egg begin to grow and release estrogen. This works to start building the lining of the uterus so that it can be ready for implantation if the egg is fertilized.
| Ovarian Cancer: Know the Risks Generally speaking, a 35-year-old woman with no family history of cancer has about a 2 percent chance of developing ovarian cancer sometime during the course of her life. There are some things that can increase that risk. Family history. If you have a mother or sister with ovarian cancer, statistics show that your risk for the disease over the course of your lifetime jumps to about 5 percent, experts say. Your risks are even greater if both your mother and a sister have it, or if two or more sisters have the disease. If your family profile resembles this, it is absolutely imperative for you to receive genetic counseling and advice, because there are steps that you can take to lower your risk, says Susan Harlap, M.D., chief of the epidemiology service at Memorial Sloan Kettering Cancer Center in New York City. No children. Not having had kids increases your risk for ovarian cancer. "Women who have had children are at reduced risk," says Dr. Harlap. "Having the first child reduces their risk by 17 percent. Every subsequent child causes another 13 percent reduction." Women who breastfeed reduce their risk even more. Age. The incidence of ovarian cancer increases with age, says Dr. Harlap. So if you are 30 or 40 years old, your risk for the disease is greater than it was when you were in your twenties. If you have a family history of ovarian cancer and are considered to be at increased risk, you may want to participate in studies about screening and treatment for ovarian cancer, says Dr. Harlap. To find out about ongoing studies in your area, contact the closest major cancer center. |
The entire follicle fills with fluid and swells to reach the surface of the ovary. When it gets a surge of the hormone called the luteinizing hormone, the follicle releases the egg. Once the egg is released from the ovary, the remnants of the follicle become the corpus luteum, which releases the female sex hormone progesterone. This further prepares the uterine lining for the possible reception of an egg.
While many women will always have healthy ovaries, sometimes things can go awry. Among the problems women may encounter are unusual cyst formation, polycystic ovaries, ovarian failure, benign ovarian tumors, obstruction by endometriosis (a disease of the uterine lining), inflammation and cancer.
When a Cyst Is the Matter
Ovarian cysts are fluid-filled sacs that form inside the ovary. Not all ovarian cysts are problematic, says Daniel Cramer, M.D., Sc.D., associate professor of obstetrics and gynecology at Brigham and Women''''s Hospital in Boston.
A cyst, called a follicular cyst, generally forms every month during a normal cycle. After ovulation this cyst is converted into a corpus luteum cyst. If no pregnancy occurs, the corpus luteum cyst disappears.
But if an egg is not released and stays inside the ovary and continues to enlarge, that may become a problem. A doctor is likely to advise you to have the cyst removed if it grows to be larger than ten centimeters (about four inches) or if it turns into a complex cyst, which is a fluid-filled sac with growths inside.
Your doctor can usually feel an oversized cyst during a pelvic exam and tell just how big it is by doing an ultrasound exam. The ultrasound will also reveal whether or not the cyst is a complex one, because the test allows your doctor to see its contents.
Some women suffer from polycystic ovarian syndrome, a condition in which follicles do not get released from the ovaries and multiple cysts form instead. The syndrome can cause irregular menstrual periods, excessive hair growth and infertility.
The heart of the problem is hormone imbalance. While the follicles produce sufficient estrogen, they do not produce enough of the second kind of hormone that''''s needed to complete the egg release and fertilization process--progesterone.
Progesterone is key in helping the uterine lining shed, so without enough of it, the lining may stay in place and a woman may skip her period for several months at time. When the uterine lining (endometrium) doesn''''t shed, a woman''''s risk of endometrial cancer increases. In addition to not producing enough progesterone women with polycystic ovarian syndrome produce excessive amounts of the male hormone testosterone, and this can lead to excessive hair growth on the face and chest.
Other problems can also interfere with ovulation, including defects in the ovary itself, diseases that compromise the immune system and exposure to radiation or chemotherapy. Not ovulating is one of several problems that can result in infertility.
Beyond the category of ovarian cysts are benign ovarian tumors, says Dr. Cramer. The most common form of benign tumors are called dermoid tumors, which arise from the growth cells in the ovary. There''''s also a collection of tumors that arise from the epithelium, another layer of cells in the ovary.
Endometriosis and Inflammation
Endometriosis--a disease in which the endometrial lining of the uterus grows outside the uterus where it doesn''''t belong--can also interfere with ovulation. Sometimes endometriosis implants adhere to the ovaries. While the disease starts off as small spots of tissue, it can grow into large clumps. If it covers the surface of the ovary through which an egg is to be released, then ovulation can be blocked, says Edmond Confino, M.D., associate professor and director of the In Vitro Fertilization Program at Northwestern University in Evanston, Illinois. It can also spread and attach to other organs such as the fallopian tubes or bowels.
The ovaries are also susceptible to a condition called oophoritis, which is basically swelling and inflammation of the ovary itself. Pelvic inflammatory disease, an infection of the upper reproductive tract, can cause it, as can the mumps virus.
The Silent Cancer
Finally, the ovaries are susceptible to cancer. Researchers don''''t know exactly what causes ovarian cancer, but they theorize that there may be some link between incessant ovulation and ovarian cancer. That is, women who ovulate repeatedly year after year without a break--that is, they haven''''t gotten pregnant or haven''''t been on the Pill--appear to be at increased risk.
One possible explanation is that because ovulation causes a cycle of rapid growth of the ovarian cells immediately followed by cell division, the cells of the ovary may be most vulnerable during ovulation. Therefore, incessant ovulation increases the opportunities for mutation to occur, says Susan Harlap, M.D., chief of the epidemiology service at Memorial Sloan Kettering Cancer Center in New York City. The more often ovulation occurs, then, the more susceptible a woman may be.
Another factor that can contribute to ovarian cancer is having a family history of the disease.
The frustrating thing about ovarian cancer is that the disease is virtually a silent one--that is, women don''''t feel any pain from it. In fact, with ovarian cancer there are usually no signs until very late in the disease. The symptoms that do finally appear include abdominal discomfort and swelling.
Mind Ovary Matters
There''''s no self-exam that can help you detect ovarian cancer, but here are some general guidelines, recommended by experts, to help you protect your ovaries.
Consider the Pill. The Pill is the most beneficial thing we know of in terms of preventing ovarian cancer, says Dr. Harlap. "The longer a woman has used the Pill, the greater the protection," she says.
Most studies indicate that at least four years of Pill use is required before it reduces your risk for ovarian cancer. According to other studies, however, some protection has been seen with even shorter periods of use. In addition, the Pill can help prevent ovarian cysts and benign growths, says Dr. Harlap.
While use of the Pill is beneficial for ovarian cancer protection, "women need to be aware that there are some risks associated with it," says Mary Daley, M.D., director of the Margaret Dyson Family Risk Assessment Program at Fox Chase Cancer Center in Philadelphia. If you are particularly prone to blood clots, for example, the Pill may not be for you. Ask your doctor if you have any risk factors that preclude you from taking the Pill, she says.
Have an annual exam. During an annual pelvic exam, your doctor can palpate your ovaries by pressing up from your vagina and down on your abdomen. The size of your ovaries and any pain you feel when she does this exam can help detect ovarian cysts, benign ovarian tumors or enlargement of the ovaries from cancer. So schedule a pelvic exam annually, experts say.
Ban the butts and munch the crunchies. Chances are that the causes of ovarian cancer aren''''t very different from the causes of other cancers, says Dr. Harlap. So follow the general cancer prevention practices. Get regular exercise, quit smoking and follow a healthful diet that includes five to eight portions of fruits and vegetables every day.
Don''''t powder up. One theory about ovarian cancer is that certain substances may trigger cell mutation. Doctors suspect that talcum powder may be one culprit. So avoid the use of talcum powder in the genital area, says Dr. Cramer.
Interview Grandma. It''''s important for women to be aware of their family history, not only of ovarian cancer but of breast cancer, says Dr. Daley. "The two are related."
You can start the process of learning your history by asking family members if anyone has ever had ovarian cancer, Dr. Daley says. It is particularly important to do this on your paternal side as well as on your maternal side, as you would still have a high risk of ovarian cancer if your father''''s mother or grandmother had the disease.
Get guidance. If a woman finds she has a family history of cancer, the next step is to confirm the diagnosis of the relative by obtaining her medical records. This can be a complicated process right from the start, since often the relative is deceased and the medical records are stored at the hospital. Try requesting the records on your own, but if you have a hard time tracking them down, you may want to enlist professional guidance from a major cancer center, says Dr. Daley.
Cancer centers often have counselors who are familiar with hospital systems and know some of the ins and outs of finding records.
Hire an interpreter. Once you have the records, you have to make sense of them--so you may want to see a genetic counselor. Some cancer centers, such as Memorial Sloan Kettering in New York City, have genetic counselors available who can read the records, help interpret your family history of cancer, assess your own personal risk and determine a prevention plan for you, says Dr. Harlap.
The cancer center you contact may have a genetic counselor on staff who can help you, but be sure to ask the cost. If you''''re not near a cancer center, call the teaching hospital nearest you or a branch of the American Cancer Society.
Ask for authorities. The gurus of cancer detection are those who study it all the time. If you or your doctor suspects ovarian cancer, go to a gynecologic oncologist for your treatment, experts say. While gynecologists are trained to diagnose cancers, gynecologic oncologists have several years of additional training on how to treat the disease. For help in finding one, contact the closest major cancer center, recommends William Hoskins, M.D., chief of gynecology service at the Memorial Sloan Kettering Cancer Center in New York City. Or call the Society of Gynecologic Oncologists in Chicago at 1-800-444-4441. The Society will provide a list of gynecologic oncologists in your geographic area through either voicemail or fax.
See also Birth Control, Endocrine System, Fertility, Gynecological Exam, Hormones, Menstrual Cycle, Reproductive System
