Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects approximately 5-10% of women of reproductive age. The name refers to the multiple cysts that develop in the ovaries due to an excess of male hormones (androgens).
While PCOS often only affects one ovary, some women have a bilateral presentation where both ovaries are involved. This article will provide an in-depth look at bilateral PCOS – the causes, symptoms, diagnosis, and treatments options available.
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What is Bilateral PCOD?
PCOS occurs when there is an imbalance of reproductive hormones in the body. This leads to problems in the ovulation process and the development of ovarian cysts. In bilateral PCOS, cysts form on both ovaries instead of just one.
The exact cause is unknown but likely involves a combination of genetic and environmental factors. Risk factors include obesity, insulin resistance, inflammation, and high androgen levels.
Like regular PCOS, the bilateral form leads to irregular menstrual cycles, infertility, and signs of androgen excess like acne and excess hair growth. There may also be multiple cysts present on ultrasound. The symptoms are generally similar to regular PCOS but may be more exaggerated with both ovaries involved.
What Causes Bilateral PCOD?
The exact mechanisms behind bilateral PCOS are unclear, but excess androgen production appears to play a major role. Possible causes include:
- Genetics – Bilateral PCOS runs in families, indicating a genetic component. Certain gene variants passed down from parents may predispose women to hormonal imbalances.
- Insulin Resistance – Insulin helps regulate reproduction and metabolism. Women with PCOS often have insulin resistance, leading to higher insulin and androgen levels.
- Low-grade Inflammation – Chronic inflammation may contribute to elevated androgens and other PCOS symptoms. Obesity can trigger inflammation.
- Ovarian Hyperthecosis – Rarely, small benign tumors in the ovaries called theca lutein cysts secrete excess testosterone and lead to bilateral PCOS.
- Congenital Adrenal Hyperplasia – A genetic disorder affecting cortisol production that can result in elevated androgens.
The interaction of these potential factors influences the development of PCOS in both ovaries. Obesity, genetics, and insulin resistance play a particularly strong role.
What are the Symptoms of Bilateral PCOD?
Signs and symptoms of bilateral PCOS often appear after puberty and may include:
- Irregular periods – Menstrual cycles become infrequent, rare, or absent due to lack of ovulation. This can lead to infertility.
- Excess androgens – High testosterone levels cause symptoms like facial hair growth, scalp hair loss, severe acne, and deepening voice.
- Multiple ovarian cysts – Fluid-filled sacs surround the eggs in the ovaries. They are identified on pelvic ultrasounds.
- Obesity – Up to 80% of women with PCOS are overweight or obese, especially around the waist.
- Darkening skin – Dark patches may appear on the neck creases, groin, and underneath breasts.
- Pelvic pain – Some women experience a dull ache or stabbing pain from large ovarian cysts.
- Depression/mood changes – Hormone imbalances and infertility challenges may trigger mood disorders.
The severity can vary significantly from case to case. See a doctor if you notice a combination of menstrual dysfunction and androgen excess symptoms.
How is Bilateral PCOD Diagnosed?
Diagnosing bilateral PCOS requires a combination of:
- Medical history – Doctors will ask about your menstrual cycles, hormones, and family history of PCOS.
- Physical exam – Signs of androgen excess like excess facial hair are noted. Pelvic exams check for enlarged ovaries.
- Blood tests – Levels of hormones like testosterone, progesterone, and prolactin may be measured.
- Pelvic ultrasound – Used to visualize ovarian cysts and examine the uterus and ovaries.
- Rarely, genetic testing – This can detect gene mutations or congenital adrenal hyperplasia.
There is no single test for PCOS. Your doctor will look for at least two of the following criteria:
- Irregular ovulation/no periods for months.
- Excess androgen levels and/or symptoms.
- Polycystic ovaries on ultrasound.
These diagnostic criteria apply to both typical PCOS cases and bilateral PCOS.
What Treatments are Available for Bilateral PCOD?
While there is no cure for PCOS, various treatments can help manage symptoms. Treatment options for bilateral PCOS include:
- Birth control pills – Oral contraceptives containing estrogen and progestin can regulate menstrual cycles and reduce androgen levels. They don’t treat the underlying cause but do improve symptoms.
- Anti-androgens – Medications like spironolactone block androgen receptors, lowering testosterone effects. Used for excess hair growth and acne.
- Metformin – The diabetes drug Metformin improves insulin sensitivity and may restore ovulation, treat infertility, and stabilize testosterone.
- Weight loss – Losing at least 5% of body weight can significantly improve PCOS symptoms related to obesity.
- Surgery – Laparoscopic ovarian drilling reduces male hormones by destroying tissue in the ovaries. Done for infertility.
- Fertility treatments – Medications like Clomid or injectables can stimulate ovulation for pregnancy. In vitro fertilization is also an option.
- Lifestyle changes – Diet, exercise, and stress reduction techniques also benefit hormone balance and fertility.
Treatment is catered to each woman based on symptoms, fertility goals, and other health conditions. Combining lifestyle changes with medical therapies works best for managing this chronic condition.
Frequently Asked Questions about Bilateral PCOD
- Can you get pregnant with Bilateral PCOD?
Yes, pregnancy is possible with bilateral PCOS through ovulation induction treatments, but it can be more challenging to conceive. The risk of miscarriage may also be higher.
- Does bilateral PCOS go away?
No, currently there is no cure for PCOS. But symptoms are manageable long-term with lifestyle interventions and medications based on each woman’s goals.
- Can you still get a period with bilateral PCOS?
Periods typically become very irregular or stop altogether with bilateral PCOS. But ovulation and menstruation can be induced with medications to achieve pregnancy or for health reasons.
- Is bilateral PCOS genetic?
Research shows genes play a role. Daughters of women with PCOS have an elevated risk. Certain genetic variants affect androgen levels and ovarian function. Talk to your doctor about genetic testing.
- Can losing weight help bilateral PCOS?
Yes, losing at least 5-10% of body weight through diet and exercise may significantly improve hormonal balance, menstrual cycles, fertility, and related health risks.
Bilateral PCOS is a challenging condition, but the variety of medical and lifestyle treatment options available can help manage symptoms for the long run.
Work with your healthcare providers to find the right plan for regulating cycles, hormones, and fertility goals. Consistent follow-up care is essential as well. With proper treatment, bilateral PCOS can be controlled to optimize health and well-being.