Wednesday 15 May 2019
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My Amazing Body is a podcast where we explore interesting, unknown and misunderstood parts of your body with help from medical experts and stories from real Queenslanders.
This episode is all about the ovaries. We took to the streets to find out what Queenslanders really know about the ovaries and discovered that, while most people know the basics, there are some ovary facts that really need clearing up.
We’re joined by Obstetrics and Gynaecology Registrar Dr Erin Wilson, who takes us through the roles the ovaries play in a woman’s body, from the development of a baby’s ovaries in the womb, to what they’re up to post-menopause. Dr Wilson also explains some of the different conditions that can affect the ovaries and busts some persistent ovary myths (just how many eggs does a woman’s ovaries hold?).
Audio is great, but some things are best seen as well as heard. These materials provide more information about the topics we touch on in the show.
A diagram of the ovaries
Information about polycystic ovarian syndrome
At 21:25, Dr Wilson describes a condition called polycystic ovarian syndrome or PCOS. Up to 1 in 5 Australian girls and women are affected by PCOS, but many won’t be aware that they have the condition and will go undiagnosed.
Symptoms of PCOS can be wide-ranging, with some girls and women experiencing a lot of symptoms and some only a few symptoms. Every person with PCOS will have an individual experience.
Symptoms of PCOS can include:
- excess hair growing on the face, chest, stomach or back (hirsutism)
- thinning hair or baldness
- irregular periods or no periods at all
- abnormal vaginal bleeding
- difficulty falling pregnant or not falling pregnant at all
- easy weight gain
- swollen belly
- mental health problems such as depression and anxiety
- high blood pressure
- symptoms and signs of diabetes
For more information about PCOS, the symptoms and what girls and women should do if they think they might have it, head to Health Direct.
Information about ovarian cancer
From 23:20, we discuss ovarian cancer, and in particular the symptoms of ovarian cancer. To find out more about ovarian cancer and the symptoms of ovarian cancer, head to the links below.
Vox pop: Oh, that's a good question (laughs). Like two round areas…something like that?
Vox pop: I think they look like two tiny little kidneys.
Vox pop: I imagine them to look like an egg (laughs).
Host: Hi, I'm Elise and welcome to the latest edition of the My Amazing Body podcast, where we explore interesting, unknown and misunderstood parts of your body. Today, we're learning about the ovaries.
The ovaries – two mysterious little organs that sit inside a woman's abdomen and hold the genetic maps for all of her potential future children.
Vox pop: They release the eggs? I think they also, produce all the hormones, that us females get?
Host: As well as being the home for ova, or eggs, the ovaries play many roles in a woman's overall health. We took to the streets to find out just how much Queenslanders know about the ovaries. And while most people seem to know the basics…
Vox pop: Okay, so the ovaries is where women hold their eggs? That's about as much as I know, yeah.
Host: We discovered there was a lot we could all learn about the organs that influence everything from a woman's fertility, to the regularity of her menstrual cycle, mood and hormonal balance.
Vox pop: So, the ovaries store eggs…and…something about periods? (laughs)
Host: We met with an ovary expert, Dr Erin Wilson, and asked her to fill us in on the finer details of the ovaries and how they work, as well as bust some persistent ovary myths. How many eggs are stored in the ovaries, what are the ovaries' role in pregnancy, and how can women look after their ovaries? Listen on to find out.
Dr Wilson: My name is Erin Wilson and I'm an Obstetrics and Gynaecology Registrar at Ipswich Hospital.
Host: We talked with Dr Wilson in a training room in Ipswich Hospital's maternity ward. The room we're in is filled with hospital paraphernalia: beds, resuscitation gear, creepy baby mannequins… It's the room where midwives and obstetricians just like Dr Wilson will practise delivering babies before they do the real thing.
The maternity ward is an unexpectedly quiet part of the hospital - the hallways are filled with a sense of hushed expectation. But, as you can imagine, it can quickly become a very busy place. If you hear any strange noises in the background of our interview, it's probably just a midwife or an obstetrician helping a mum to deliver a new Queenslander into the world.
Dr Wilson works with women at all stages of life. Some are pregnant, some are trying to get pregnant, some are trying not to get pregnant, while others are experiencing menopause, or having troubles with their reproductive organs.
Dr Wilson: As a Registrar in Obstetrics and Gynaecology, we do a little bit of everything for women's health. So, we do care of pregnant women, care of women in labour when they're delivering their babies, and we also look after them after birth. We see women in clinic who have a whole range of women's health problems; anything from troublesome periods or troubles, you know with fertility, all the way through to issues with the menopause or after.
Host: The ovaries play a part in all of the work that Dr Wilson does. But before we can get into exactly what the ovaries do in woman's body, we need to know where and what they are?
Dr Wilson: Yeah, so we've got two ovaries, one on either side of your pelvis, which is the lower part of your abdomen. And they sit on either wall of the inside of your abdomen. They're about the size of a large grape, and they're sort of a whitish colour. And maybe 3cm in size. But they can get bigger at different parts of the cycle if that's the ovary that's releasing an egg that month, they can get a bit bigger in response to the developing egg.
Host: While most people know that the ovaries store and release eggs, Dr Wilson says they are responsible for a lot of other functions within the female body.
Dr Wilson: Well they've got a few roles that are really important. So, the ovaries have all of our eggs, so they are the egg storage organ of the body for women. And so that's where all the potential for future babies is stored. They also release hormones, to help with periods and also to make you have the characteristics of a woman.
Host: Hormones are released from a few parts of our bodies, including parts of the brain like the pituitary gland and the adrenal glands that sit above the kidneys. For women, the ovaries are also key players in releasing important hormones.
Dr Wilson: Well the ovaries respond to hormones, and they release hormones themselves. So, lots of organs in the body make hormones, and ovaries are one of them. And I guess the reason why we’re so familiar with ovaries is because they release two important hormones – the oestrogen and the progesterone – which have a big influence on women's development in puberty and our menstrual cycle and our fertility. So, they're really important in those functions. And women who didn't have ovaries or don't have ovaries functioning well, won't have that same cycle and fertility.
Host: It's those hormones from the ovaries that, in part, are responsible for the changes in an adolescent girl's body as she goes through puberty. During puberty, girls will begin their menstrual cycle, and the ovaries will begin to release eggs for the first time.
Dr Wilson: So, it's quite complicated, but as you get to those early, late childhood, early teenage years, particular parts of the brain start to switch on and start to say ok, it's puberty time. And they start sending messages to the ovaries that it's time to start working and to start going through a cycle and releasing an egg. So, in that process, the ovaries will get messages from the brain, they'll start to grow some eggs until they're a bit more mature, and then one starts getting released every month. And when that egg gets released every month, is when young girls will start to have their first periods, in response to that cycle.
Host: After puberty, on average a woman's menstrual cycle should continue monthly until she reaches menopause, with breaks during any pregnancies or because of medications like the oral contraceptive pill.
Dr Wilson: So, women think about their cycle as sort of every month, I guess would be average. The start of your cycle is the period, and then after you have a period, your ovaries will start again, and they'll start responding to hormones and building up the egg that's going to get released that month. So, a couple of eggs grow, and the most mature one, or the biggest follicle, is the one that gets released every month. Once that egg gets released, that's halfway through your cycle, that's when you ovulate. And then it gets released to go down your tubes, into your womb, and then if it doesn't meet sperm and isn't fertilised to make a baby, then your body notices that it's not pregnant, and the ovaries recognise that the body hasn't fallen pregnant, and then it will tell the womb to shed the lining. And that's why you have a period again. And then the cycle continues.
Host: Do the ovaries make new eggs? Or do they just store them? It's a common misconception that, as part of a woman's monthly cycle, her ovaries grow new eggs, but they don't. In fact, baby girls are born with all the eggs they'll ever have nestled safely inside their ovaries. So, think of the ovaries less as an egg making factory, and more as an egg storage warehouse. After puberty, a few eggs are taken out of storage and matured each month, before one is released during ovulation. All this makes you wonder, how many eggs does a woman start with? How extensive is this internal egg storage system?
Vox pop: Ooh. Enough to last 50 years? One every month for 50 years, average? (laughs)
Vox pop: I'd say about 1,000 maybe?
Vox pop: Maybe like 500? Plus. Maybe like up to 1000?
Host: Have you been trying to do the maths? Dr Wilson says it's not a matter of one egg for every month.
Dr Wilson: So, as you get older and your egg count starts to reduce, it's not that you lose one egg per month. There's a main egg that gets ovulated each month, and a few other eggs that were part of that cycle but never got mature enough to ovulate, and they start to get reabsorbed by the body. And there's also a small background level of eggs getting reabsorbed by the body all the time, so it's a gradual decline in number, and it's not counted by the number of cycles or periods that you have.
So around the time when girls are born, their ovaries have about 1 or 2 million eggs. So quite a lot. And then they start to reduce even through childhood. So, at the time that a girl's starting to go through puberty, there's a few hundred thousand. And then they continue to reduce throughout the fertile period as a woman grows up. But you're born with all the eggs you'll ever have, and there's still a few remaining as you go towards menopause as well.
Host: Because baby girls are born with all their eggs, this means that for a period of time, a woman pregnant with a baby girl is carrying not only her child, but the eggs that will potentially become her future grandchildren as well.
Host: Are you ready for this episode's mystery body part? See if you can guess what the body part is from the clues given. We'll reveal the answer at the end of the episode. What am I? I am always growing: I grow 3-4 millimetres every month. I'm made out of keratin. The habit of biting me is called onychophagia. I am located on the ends of your phalanges. Do you know what I am?
Vox pop: What do they look like? Um, they look like, some sort of exotic plant, which um I would say, small, oval shaped, but attached to this fantastic looking plant.
Vox pop: They look like...(laughs)...they look like um, here's a good one um, Ghostbusters, the little ghost finder how it has the two prongs goes out but more kind of like a bud at the end.
I think, I'm going to have to watch the movie again (laughs).
Host: There are lots of ways to describe the female reproductive system, some accurate and some...not so accurate. We've included a diagram in the show notes for this episode, so if you're feeling confused, head there for an accurate picture.
When we talk about a woman's internal reproductive organs, we often think of three main parts: the uterus, the fallopian tubes and the ovaries. But did you know that the uterus and the fallopian tubes are actually different parts of the body to the ovaries? It turns out that the ovaries and the fallopian tubes aren't even connected.
Dr Wilson: Yeah, they're not attached to each other. So, the tube is not attached to the ovary. The tube is attached to the womb. And they both, the ovary and the womb, are made from different structures in the body. So, they're really just sitting next to each other inside the abdomen, they're not attached to each other. When your ovary releases an egg, the egg has to find its way from the ovary to the tube, to make its way into the womb. So, it's not a direct path, it has to make its way into it.
Host: The ovaries sit just to the side of each fallopian tube, which have finger-like ends called fimbriae that help to guide the released eggs inside.
Dr Wilson: They do sit very close together, because all of the pelvic organs in your body are all sitting right next to each other; it's a very small space that they're all jammed into. And so, the egg doesn't have to travel far, but it's not directly connected. But we do know that the eggs can potentially travel reasonable distances, because if you're missing a tube on one side, we think that probably even an egg from the other ovary could make it into the opposite tube. So, they're all sitting pretty close together in the pelvis and usually can find their way.
Host: In a rare complication of pregnancy, Dr Wilson says that eggs can become fertilised outside of the fallopian tubes or uterus, which can lead to an ectopic pregnancy.
Dr Wilson: So, if an egg doesn't make it into a tube, most of the time it just won't get fertilised. But occasionally it does get fertilised, and it still doesn't make its way down into the womb. And that's when something called an ectopic pregnancy can develop. Those ectopic pregnancies can be stuck in the tubes themselves, and rarely they can actually be inside the abdomen if they've never made it into the tube, and they can cause what we call an abdominal ectopic pregnancy.
Unfortunately, that is a serious complication of early pregnancy, and normally requires treatment to help stop that pregnancy from growing because a pregnancy developing in the wrong spot can be very dangerous for the mum, in terms of, it can cause quite serious bleeding, or damage to the organs. And normally they don't continue to develop, because that's not a place that is going to support a growing baby.
Host: As the average age of first-time mums rises, many women worry that their chances of conceiving will drastically lessen as they get older. But, while fertility does start to decline with age, Dr Wilson says that age is just one factor when it comes to a woman's fertility.
Dr Wilson: So, things that are important for women to be aware of for their fertility is that it does start to decline in your 30s. There's not a single age where it's likely that you'll be less fertile than the day before, or it changes really dramatically. But certainly, women need to be aware if they're planning to have babies that after the age of 35, towards 40, fertility does start to decline quite significantly. And the decline is very rapid after the age of about 40. So, women who are planning on having kids need to keep that in mind. And there's lots of other things that affect fertility as well, not just your age, so also your health, and whether or not you're a smoker, so there's other things to be aware of.
Host: When a woman comes to the clinic because she's trying to conceive, there are lots of factors Dr Wilson needs to consider.
Dr Wilson: Yeah so, there's lots of fertility issues that women might come and see us for, it might just be that they've been trying to conceive for a little while and it hasn't happened yet. And that could be within the realm of normal. So, a young woman could take 6 to 12 months to fall pregnant, even if they were really healthy and functioning normally. Other women do have reduced fertility, whether that's from age, some genetic problems, and sometimes there's other factors, like sperm issues, or the egg itself isn't making it into the womb to get fertilised. So sometimes people have blocked tubes because they've had infections in the past or the womb is not providing a healthy environment for the developing egg and sperm to make a baby. So, there can be a range of causes.
Host: For women who are pregnant, the ovaries continue to play an important role in the process for weeks after the egg is released.
Dr Wilson: So, the really important of function of the ovaries in the early part of the pregnancy, is that sac that the egg got released from, the egg that turned into a baby, that little sac actually plays a really important role in releasing the hormones that support the pregnancy in the early developing stages. So that's called the corpus luteum, and its job is to support the pregnancy's early development until the baby's placenta gets big enough to take over that role of supporting the developing baby.
Host: Around the age of 50, a woman's body, including her ovaries, is ready to go through another change called menopause. Gradually, her ovaries will stop releasing eggs every month and will release lower levels of the hormones that triggered her monthly cycle.
Dr Wilson: As you get to the age of menopause, you've still got eggs remaining, it's just that they're not working as well. And so, the egg quality is reduced and also their number is reduced. And when your body is trying to go through the monthly cycle, they're just not developing and releasing the hormones that they would have at a younger age.
Host: Just like puberty, fertility and menstrual cycles, every woman will experience menopause differently. Some find the process quite gentle, while others can experience some serious symptoms.
Dr Wilson: So, women will start to have the symptoms of menopause, and that might be less frequent periods or irregular periods, or things like hot flushes or feeling quite sweaty particularly at night. Or, like we said before, mood disturbance. So, they can be symptoms that the menopause is sort of happening.
So, menopause is defined as 12 months of not having a period. So, after 12 months we can retrospectively say that if you haven't had a period in 12 months around that age, without another cause, then that's probably that you've gone through menopause.
Host: It makes sense to assume that once a woman has stopped menstruating, her ovaries don't play an ongoing role in her health. But the ovaries don't shut up shop and head off on vacation after menopause; Dr Wilson says that even though a woman's menstrual cycle has stopped, her ovaries still have work to do.
Dr Wilson: And at that stage the ovaries still release low levels of hormones, it’s just not that high level that makes the body go through a monthly cycle. So, they're still doing a job, it's just a different job.
Vox pop: What should you look out for in terms of keeping your ovaries healthy? And when should you see a doctor if you're concerned, about something?
Host: Is there anything women should be doing keep their ovaries healthy? How would a woman know if her ovaries aren't working as they should be? Dr Wilson shared with us information about the common ovarian conditions she treats and her advice for keeping your ovaries healthy.
Dr Wilson: The main things that we see with ovaries themselves is ovarian cysts, so they're quite common. Women might come in with a whole range of ovarian cysts causing them bother. Most of the time they're benign, or not cancerous, but can cause problems with pain or bleeding from the ovary. So often we have to do keyhole surgery to remove cysts from women's ovaries.
Host: A condition called polycystic ovarian syndrome can see women develop many cysts on their ovaries, along with other symptoms that can affect different parts of the body.
Dr Wilson: So, polycystic ovarian syndrome is pretty complicated. It's a condition that affects really a lot of parts of the body, not just the ovaries themselves. It's named after the ovaries because they get lots of cysts on them, but really that's because they're not functioning normally, so they're not releasing eggs normally. Which means that some of those sacs where the eggs come from, are not developing normally, so they're hanging around. And when they hang around and you do an ultrasound, you can see lots of little sacs on the ovaries, which is why it's called polycystic.
The condition, though, causes a whole range of issues for women, anything from irregular bleeding or irregular menstrual cycles, reduced fertility, but also difficulties with some of our other organ systems or metabolism. So, women might find that they have a propensity to developing issues with blood pressure or diabetes and might have difficulties with abnormal hair growth or acne. So, it's a condition that affects many parts of the body, not just the ovaries themselves. But it's certainly probably the most commonly recognised feature.
Host: Up to 1 in 5 Australian women have polycystic ovarian syndrome, but many don't know they have it, with up to 70% remaining undiagnosed. We've included a link to a resource about polycystic ovarian syndrome in our show notes, so if you think you or a woman you know might have some of the symptoms, you can read more about it there.
Like most organs in the body, the ovaries can develop cancer, which is most common in women who have gone through menopause.
Dr Wilson: So ovarian cancer, is one of the known female cancers. The lifetime risk for women developing ovarian cancer is around about 1 in 100 to 1 in 70. The most common age to get diagnosed is a little bit later in life, sort of after menopause or soon after in the 50s or 60s.
Host: There isn't an effective screening test for ovarian cancer yet, so Dr Wilson says women should see their GP’s if they're experiencing any ongoing symptoms.
Dr Wilson: So, women might experience some bloating that's unusual for them or doesn't resolve. Some upset in their tummy. They might find that they've got some abdominal pain, or are having discomfort particularly with intercourse or if they're still having periods, around the time of periods. But as I said, a lot of those sort of symptoms like abdominal pain, bloating, discomfort, can be really common in women as well, without there being any problem with the ovaries, so we don't want women to become unduly worried. But if you are concerned, it's always reasonable to speak to your GP about your concerns.
Host: Having healthy, properly functioning ovaries is important for so many facets of a woman's health. So, what, if anything, should Queensland women be doing to keep their ovaries healthy?
Dr Wilson: Ovaries can be difficult to protect as such, but I guess a healthy body is the best thing that you can do to make your ovaries healthy. So being of a healthy weight range, and not smoking are all very helpful for the ovaries in terms of them functioning normally and releasing hormones normally, that's most of what you can do.
Host: Women also need to think about protecting themselves from sexually transmitted infections, which can cause problems for their reproductive organs.
Dr Wilson: So, we recommend that women try and reduce their chance of getting a sexually transmitted infection. Particularly because some of those infections can cause problems with the internal organs, like scarring of the fallopian tubes, which could cause problems with fertility later in life. So, using things like condoms to prevent against sexually transmitted infections is really important.
Host: We've learned about how the ovaries develop, how they work, what they do and why they're such an important part of the female body. To finish off this episode, we asked Dr Wilson to bust a few ovary myths that she encounters in her day-to-day practice. To start off with, is it true that a woman won't ovulate and can't fall pregnant while she's breastfeeding?
Dr Wilson: Yeah so, women sometimes think that if they're breastfeeding, that will stop them from falling pregnant. But really, that isn't 100% effective. Particularly as you continue to breastfeed and the baby's a bit older, the hormones suppression that happens from breastfeeding becomes less and less as time goes on, and people can ovulate even before they get their first period. So, women might get a surprise.
Host: And what about the oral contraceptive pill? With around a third of Australian women taking the pill, what does Dr Wilson wish women knew about it?
Dr Wilson: So, I guess another common myth is that women who are on the contraceptive pill, feel like they have to have a period every month to be 'normal'. And certainly the pills come with that section that says, “take these pills in the red section and you'll have a period”.
That actually isn't necessary for most women, particularly on the normal, combined contraceptive pills that women are on. There's no need to have a period every month because it's not a true period; it's just a shedding of the lining of the womb in response to stopping taking the tablets.
And it's actually often easier for women and preferred just to continue taking the active pills in your packet back-to-back. At least for a few months. And that way you can have a longer period-free interval when you're on the contraceptive pill. And for some women that can help reduce the number of periods that they have to have, particularly if they've got issues with their periods like painful or heavy bleeding, so it can reduce the number of times they have to have that in a year.
Host: Some women worry that taking the pill and temporarily changing the way their ovaries and menstrual cycle works might affect their fertility, but Dr Wilson says this isn't something women need to have on their minds.
Dr Wilson: So, there's not any good evidence that taking the pill is going to reduce your fertility, it's certainly, the pill's been around for a long time now, and it doesn't seem to reduce fertility at all. And fortunately, the pill also has quite a quick return to fertility, so we talk about when you stop it, the ovaries sort of kick back into gear, and start ovulating again pretty quickly.
Host: If the pill prevents women from ovulating, does that means she's storing up her eggs for later, making her more fertile for longer? Unfortunately not, says Dr Wilson.
Dr Wilson: There's still a background level of loss of eggs that goes on, even if they're not being released every month. While the pill use doesn't reduce your fertility, it also doesn't prolong it or save it for later. So eggs are still there in the numbers that would be about the same as someone else who wasn't on the pill.
Host: Did you guess the mystery body part for this episode? The keratin-based body part on the end of your phalanges, or fingers, are your fingernails! Congratulations if you figured it out.
Thanks for joining us for another episode of My Amazing Body. My Amazing Body is bought to you by Queensland Health. With special thanks to our expert guest Dr Erin Wilson, the Queenslanders who answered our ovarian quiz and my podcast colleagues: Lauren our researcher, writer and producer, Carol our audio technician, Dan our Music Guru and the media team at West Moreton Hospital and Health Services.