Ovaries

Today, I tackle a body part upon which I consider myself to be somewhat of an expert. Had my left ovary behaved years ago, I would not be typing this today–and I would still have both ovaries. Speaking with other women, it becomes obvious very quickly that we tend to know very little about our ovaries.  Hopefully, I will shed some light on this for you today!

Where are the ovaries?  It’s safe to say we know they’re in our pelvis, but where exactly?  A good estimate is to make a triangle with with your index fingers and thumbs and place that over your pelvis with the index fingers pointing downward.  In the upper corners is about where your ovaries are.  (They tend to be a bit lower and more centralized than most assume they are.)  The ovaries are held in place by a network of ligaments which also attach to the uterus and Fallopian tubes.  The ovaries are not connected directly to the Fallopian tubes.  Many diagrams shows the fimbriae (the leafy looking parts on the far left and right below) of the Fallopian tubes as been directly adjacent to the ovaries, which leads many to believe that the ovaries are directly attached to them.  They are not.  (Read more about the relationship between the ovaries and the Fallopian tubes in the section about Fallopian tubes.)


The ovaries are, ironically, shaped like eggs but are smaller than the chicken eggs that one typically purchases at the grocery.  The ovaries are about the size of a walnut, are slightly pearl colored, and have bumpy, soft surfaces.  The ovaries are responsible for producing a variety of sex hormones.  At birth, the ovaries of a healthy baby girl contain between one and two million eggs.  By the time puberty begins, most of these have wasted away leaving about 300,000 eggs–plenty for the reproductive lifespan.  Thus, a woman has a finite number of eggs, but men have a different mechanism that continually makes sperm.  This is why women have “childbearing” years, but men can father children throughout their adult lives.

The eggs have a complicated lifespan before they are even released for potential fertilization.  The term “egg” is generic and refers to a single cell’s journey through maturation.  Before maturation, the egg is referred to as an oocyte.  Once it finishes maturing (see diagram below), it becomes an ovum and three polar bodies.  The polar bodies are actually inside of the ovum and serve to “fuel” the egg once it is fertilized continuing cell division and replication before it implants in the uterine lining (where it forms a network of blood vessels that forms the placenta and umbilical cord).

Each month, the ovaries usually release one mature egg (not one from each).  The ovaries are covered in cells called follicles and within each follicle is a single egg.  Once an egg is matured, the process of ovulation can begin.  During this time, the follicle that houses the mature egg expands and eventually ruptures forcing the egg outward.  This rupturing is completely normal–it would be abnormal for ovarian follicles to never rupture, and in fact some women can actually feel a quick pain when the rupture occurs.  The diagram below is an illustration of the ovulation process, beginning in the upper-left hand corner and going clockwise.


Following a woman’s “childbearing” years, the ovaries continue to play an important role.  For years, many doctors prescribed a surgery called a hysterectomy to remove the ovaries (as well as the uterus and Fallopian tubes) once a woman was finished having children.  This was performed to prevent cancer from developing.  However, we now know that ovarian cancer can actually develop anyway after the ovaries have been removed.  This is because the ovaries share tissue with the internal cavity that remains following a hysterectomy.  Leaving the ovaries intact provides a number of hormonal benefits throughout menopause that are difficult to replace.  Thus, the benefits of leaving the ovaries intact often outweigh the drawbacks.  (This is something that should be discussed with a physician, because each individual has a different medical history that will affect any such decision.)

There is a lot more that could be said about ovaries, but let’s save that for another day.  Hopefully this gives you a better understanding of how the ovaries work!

Endometriosis

In the past two weeks, I cannot tell you how many times I have heard someone mention in conversation “endometriosis.” I have several friends and family members who have endometriosis, so it is not an altogether unfamiliar subject to me. However, I have never given much thought to endometriosis.   So, in writing this blog entry I hope to educate both myself and my readers a bit.

To start with the root, the word endometriosis comes from the Greek words meaning “inside” and “womb.”  Remember that the endometrium is the layer lining the uterus.  Here is a diagram:

The endometrium is where the embryo implants after it has been fertilized, so it is an integral part of reproducing.  Without a healthy endometrium, an embryo is not likely to implant successfully.

Interestingly, too many endometrial cells are a bad thing, and this is what endometriosis is:  the proliferation (spread) of endometrial cells outside of the uterus, especially common on the ovaries.  These cells respond as the endometrium does to hormonal changes over the course of a menstrual cycle.  So, imagine that you have endometrial cells throughout your pelvis and not just in your uterus.  Menstrual cramps would be amplified–the pain difficult to bear.  So, if you have particularly unmanageable menstrual pain during your period, please visit your doctor.  You may have a disorder such as endometriosis.  Only investigation by a medical professional can determine the source of the pain.

It is estimated that between 5-10 percent of women are affected by endometriosis.  Its effects generally do not manifest until menarche (first menstrual cycle) and usually diminish following menopause, though not always.  A large number of women who are infertile are infertile because of endometriosis (about 20-50%).  The proportion of women with chronic pelvic pain who suffer from endometriosis is much higher (about 80%).  There seems to be an increase in incidence of endometriosis in families that affected by it.  Women with an immediate relative with endometriosis has a higher risk of having endometriosis.  There is some association between endometriosis and certain types of cancer (especially ovarian), so it is important to know if you have endometriosis or if you have another malady with similar symptoms.

Endometriosis usually appears in patches within the pelvis that are often visible to the human eye during surgery because they can appear as darkened bluish-black spots.  Here is a diagram example of endometriosis:

Not all endometriosis appears as darkened spots, so it is necessary sometime to perform biopsies to be certain.  Endometriosis causes an inflammatory response that often causes scar tissue.  This scar tissue is frequently problematic in a variety of ways, including being the cause of infertility.  The cause of endometriosis is, so far, unknown but it is believed that there is more than one possible cause.  Hopefully, further research will uncover causes that can help in management and treatment of the disease.  Symptoms, too, can vary widely across endometriosis sufferers.  Abdominal pain being the most common symptom, others include:

  • nausea, vomiting, fainting, dizzy spells
  • frequent or constant menstrual flow
  • chronic fatigue
  • heavy or long uncontrollable menstrual periods with small or large blood clots
  • mood swings
  • pain in legs and thighs
  • back pain
  • mild to extreme pain during intercourse
  • mild to severe fever
  • headaches
  • depression
  • Again, it is important to remember that other disorders can have similar symptoms to endometriosis.  It is crucial to consult a doctor if you are experiencing problems in order to accurately determine what you have.  Never rely on an “Internet diagnosis.”  This article is just scratching the surface of this topic (maybe I will write “Endometriosis:  Part 2”), so please feel free to leave comments and questions!