Sunday Tribune

Nigeria

August 10, 2008

IT was during her search for solution to her childless condition that she sought medical help and then realised, better still, attached importance to her irregular menstrual pattern.

When questioned by her doctor on the various changes she had noticed in her body, Denrele, a married woman of three years in her twenties said, she started noticing that abnormality in her menstrual cycle, though it occurs thrice in a year, as against the monthly thing it used to be when she was younger.

Denrele said she did not take it seriously, because she thought it wasn’t a problem since she was not sexually involved with any man before getting married. Aside that, she also noticed she started growing hair on her face, tummy and legs. And that her smooth face now breeds pimples and has become oily.

It was based on the above signs and her inability to achieve pregnancy that Denrele was subjected to a hormonal test, which has Polycystic Ovarian Syndrome as its outcome.

She was afterwards placed on fertility drugs to bring about her monthly ovulation, and in the space of three months, Denrele conceived and is now delivered of a baby girl.

Denrele is one in thousands of women out there, going from pillar to post, not knowing there’s a way out of their condition.

Polycystic Ovarian Syndrome, as explained by Dr. Ayo Arowojolu, a Consultant Obstetrician and Gynecologist, at University College Hospital (UCH), Ibadan, was first found out in the 50s by Stein Leventhal, who gathered some women with irregular menstrual cycle and subjected their ovaries to test. He said, the outcome of the test showed that their ovaries contained a number of small cysts which prevented them from getting pregnant, hence the name poly (many) cystic ovarian syndrome.

According to the gynecologist, Polycystic Ovarian Syndrome (PCOS), is a hormonal problem, which is the commonest cause of infertility due to non-ovulation.This condition affects 21 percent of the women population, resulting in 75-80 per cent of infertility cases due to poor or irregular period.

In PCOS, there are many poorly developed follicles (follicles are sacs within the ovaries that contain eggs) in the ovaries. The eggs in these follicles do not mature and therefore, cannot be released from the ovaries. Instead, they form the cysts in the ovary, thus, causing infertility.

The immature follicles and the inability to release an egg, that is, ovulate are likely caused by low levels of follicle-stimulating hormone (FSH), and higher-than-normal levels of male hormones called androgens produced in such women’s ovaries. This is the reason PCOS is called a congenital condition, that is, inborn.

A woman with polycystic ovarian syndrome is likely to exhibit some features which include, irregular menstrual period, that is, long menstrual cycle, like every 6 months, twice or thrice in a year. And during her menstruation, the flow is usually very heavy, as blood comes out in clots, such that she thinks she had miscarried. There is also an abnormal hair distribution on her face, tummy (up to her navel) and legs. She may also become obese, have pimples, oil face, deepening of the voice like man or baldness.

All these features they exhibit, according to Dr. Arowojolu, are due to excess testosterone (male hormone) in their blood. And they have this excess testosterone because they lack an enzyme that is meant to convert testosterone to oestrogen, aromatase. It is testosterone that makes such women fat and develop muscles like men.

The expert added that recent development made it clear that PCOS, which was initially described as a disease is not, but a syndrome complex that affects other systems in the body of a woman that has it. It can thus give rise to other conditions like diabetes, abnormal liver function, infertility, abnormal thyroid function and excess prolactin (prolactin causes lactation).

Therefore, any doctor managing a woman with PCOS has to investigate her thoroughly by carrying out hormonal test.

In Nigeria, because most unwanted pregnancies are terminated through D & C by quacks, Dr. Arowojolu said most women do not know they are exhibiting the symptoms of PCOS. For instance, because the D & C they had was by quacks, by the time they are having irregular menstrual period, have the impression that they are pregnant and when they have heavy flow, they think they have miscarried and still go to the quacks for evacuation. “So, they end up with pelvic infection and tubal diseases”, he added.

Arowojolu said, it is therefore expedient when managing them, to do hormonal studies, check the potency of the tubes, as well as ascertain the husband’s fertility by doing semen/sperm analysis.

On the management of PCOS, the medical practitioner said, it could be managed medically or surgically. His said, nowadays, most doctors will manage women with PCOS medically with anti-oestrogen, which is a form of fertility drug, but had been abused in Nigeria. You’ll see friends prescribe to themselves this fertility drug and people just purchase drugs off-the-counter without doctor’s prescription, without undergoing medical test to ascertain their health situation.

Apart from the medical management, Dr. Arowojolu said it can also be managed surgically by wedge resection, that is, cutting a big junk of the ovary or both ovaries. The disadvantage of this method of management, according to him, is that, it is often accompanied by scarring of the pelvic organs including the fallopian tubes, resulting in tubal infertility from blockage.

Therefore, the new trend in surgical management is to drill holes in the ovaries through a process called laparoscopy (minimal evasive surgery).

“Good results have been achieved with both surgical and medical management of straight forward PCOS.

“For the complicated cases, such as women with accompanied raised prolactin, thyroid disorder, liver problems and diabetes, they have to be treated first before the use of the described surgical or medical methods. But in some cases, the management methods go concurrently”.

Because pcos is congenital, it has no preventive measures. However, the Doctor said, obese children with irregular menstrual cycle can be placed on sugar-reducing drug in order to prevent the overt symptoms of PCOS later in life.

Also, he said, women willing to get pregnant but are having irregular menstrual cycle should visit their gynaecologists for proper investigation before starting the use of fertility drugs.

He allayed people’s fears in terms of the treatment’s financial implication by saying PCOS in not expensive to treat, only that it need to be investigated thoroughly.

Other forms of management for people who are not bothered about infertility will include, weight reduction and cosmetics, such as hair removal by electrolysis or shaving.

Again, for this set of women, their menstrual cycle can be regulated with combined oral contraceptive pills, which has the ability to reduce their testosterone levels.

Dr. Arowojolu therefore advises quacks, pharmacists to desist from the practice of giving women with infertility problem, drugs off-the-counter without prescription.