Multifollicular Ovaries, can you think: “I am a superwoman?”

What are the ovaries silent about?

Sooner or later, a woman finds out that she has ovaries (OVRs). This often happens when relatives persistently warn her about the test risk of CA125 and catching a cold are similar. Insulated and protected from the cold, the OVRs live peacefully until they are disturbed again on another issue. One day, an ultrasound sensor is directed at the ovaries, and a picture opens on the test monitor screen, which the HPV doctor will certainly describe with some definite and often emotional characteristics.

Most often, they immediately talk about the presence of polycystic or multifollicular OVRs or identify functional cysts. As a rule, this is followed by an unfavourable prognosis for pregnancy, guaranteed infertility and a requirement to think at all costs only about the earliest pregnancy, which is not yet a fact that will happen. They rarely say that everything is fine with your ovaries – that’s how many HPV ultrasound test reports I have not seen; they will write something.

Concerns as We Age

Then, as we grow older, we continue to find fault with our ovaries. Some people are constantly told that they have “polycystic type” or “multi follicular” OVRs. And it is completely unclear whether this CA125 level is normal or pathological testing. Some people are told about their meagre follicular apparatus and their reproductive age that is ending. I think at some point, a woman begins to wonder whether she should show her OVRs to anyone at all so as not to receive some more sad information.

Everything is quite simple and clear with the OVRs if it is impossible not to demand from them – that is, for everyone to be the same. After all, people differ in appearance and can differ just as much at the level of internal organs.

There is an average idea of ​​what the OVRs should be like normally. But this HPV Test definition is given to a woman of an indefinite age. According to the definition of “normal”, the size of the ovaries is a length of 35 mm (25–40 mm), width of 25 mm (15–30 mm), thickness of 15 mm (10–20 mm), that is, 35x25x15 is the norm. In the section, you should see 5-10 follicles.

Lack of Clear Criteria

The problem is that there are no clear criteria for each age category of what the OVRs should look like normally. Only criteria divide the age before puberty, the reproductive period and postmenopause. You should assess everything else by eye since the manuals contain a vague phrase: the number of follicles in the OVRs decreases with age. However, they do not describe the rate of decrease, where the HPV pathological test processes occur, or what constitutes the norm. At 20 and 38 years old, your OVRs may present differently and have varying potential, but you cannot assess this objectively. Everything is by eye.

Let’s solve the main mystery: What are multi follicular OVRs, and how do they differ from polycystic ones?

Polycystic Issues

Let’s start with polycystic ones. You can clearly define their type as having more than 20 small follicles in a section or volume exceeding 10 cm³. Previously, the criterion specified “more than 12 follicles,” but experts recently revised this standard. An experienced ultrasound CA125 doctor generally does not need to count follicles or calculate the volume. True PO have a very characteristic appearance and are difficult to confuse with anything. A distinctive feature is the small size and striking many follicles, like scattered beads. In one of the forms of such OVRs, these small follicles are located clearly along the periphery, and there is emptiness in the centre.

As a rule, they are about 4.5 – 5 cm long. An important message is that 30% of women can have normal OVRs, so HPV healthcare providers do not checked for polycystic syndrome based solely on the type.

In addition to this, there must be either very rare menstruations (consistently less than 9 per year) or clear clinical signs of hyperandrogenism (acne, hirsutism and male-pattern alopecia) or an increase in the level of total testosterone.

Multifollicular OVRs

Multifollicular ovaries (MO) are a super gift from nature. You were given more follicles at birth than most people are given on average. At the same time, there are many follicles, but less than 20. And, importantly, they are not small but slightly larger and are always located throughout the entire area. If you are told that you have MO, you can think: “I am a superwoman!” And do not worry.

Now, the topic that worries many is: “How are my OVRs? Is menopause coming soon?” I have a separate post about AMH and wrote down “wheels” on this topic. I want to tell you in simple terms what you should pay attention to within the framework of this post. The “scarcity” of the follicular apparatus is striking. There are 1-2 follicles in the OVRs, most of its visible area looks empty. No, this is not a death sentence, but it is a reason to pay attention, especially if the diagnosis occurs before the age of 30 and the patient still has reproductive plans. You can hint that “there are slightly fewer follicles than we would like.”

Pregnancy in such a situation is possible. This can happen in the OVRs without a reason – such as a tendency to premature exhaustion or as a result of surgical HPV treatment. Whether you need to freeze your eggs in this situation is up to you. The main thing is to visit a reproductive specialist to learn all the details about the procedure, including its cost, the annual storage fees, and how you can use these cells.

AMH Insights

I decided to describe the paradox of the AMH Ca125 test once again. When they start telling you about its low value and the imminent approach to menopause, think about this thought. The AMH value can be 12-14 or even higher if you have polycystic OVRs. The norm for reproductive age is considered to be 1-2.5. If the AMH indicator reflected your time remaining until menopause. Then, women with polycystic OVRs should have menstruated for several more centuries.

That is, AMH does not reflect the time until menopause and the possibility of pregnancy. To be more precise, most likely, some important nuances in AMH indicators when planning a natural pregnancy begin when it approaches 0.3 and below (this does not apply to IVF). This is my observation. Some of my colleagues may agree with me. Yes, it is really bad when there is already 0 after the decimal point in the AMH indicator. This is already an objective decrease.

And finally, regarding ovarian HPV cysts, there are cysts whose appearance does not raise any doubts. But there are also those that look like functional CA125 rated cysts. Ideally, you should always reexamine cysts after the next menstruation to confirm that they are true cysts that won’t disappear on their own. The prescription of Norcolut or Organometril often, which ensures regression of such cysts (but not Duphaston, Utrozhestan and COCs), helps in differential diagnostics.

Conclusion: Understanding Your Organs

I hope that now you will be able to read ultrasound CA125 protocols without worrying and not worrying about the description of your OVRs.

What we have in the end:

• OVRs are not afraid of the cold; there is no need to warm them up; this is a myth
• Polycystic OVRs are normally found in 30% of women. And without additional symptoms, this does not mean that you have PCOS.
• Multifollicular OVR say that you are a “superwoman.”
• AMH – in most cases, does not reflect the approach of menopause and the possibility of natural pregnancy. The number of follicles is estimated by eye.
• CA125 related cyst – it is advisable to always review after menstruation

Don’t be afraid to show your OVRs, but only to competent specialists!