Polycystic ovary syndrome – or PCO syndrome, PCOS or Stein-Leventhal syndrome – is a hormone disorder that affects only women. It is a so-called symptom complex, as the disease can be associated with a variety of different symptoms. What is behind PCO syndrome and how it is treated, you will learn below.
What is polycystic ovary syndrome (PCO syndrome)?
Despite its high prevalence, there is no precise definition of PCO syndrome, but in general, this female disease can be described as a hormonal disorder or metabolic disorder with various and sometimes far-reaching consequences. Put simply, the body of many affected women produces too many male hormones (androgens) – often the consequences include excessive body hair, an irregular cycle or an unfulfilled desire to have children.
PCOS: diagnosis based on the most important symptoms
According to the so-called Rotterdam criteria, PCOS is present if at least two of the following three criteria are met in a woman:
- Fewer than eight ovulations per year until complete absence of periods (amenorrhea).
- Masculinization due to too many male hormones, for example, testosterone.
- Increased cysts in the ovaries
Thus, contrary to what the name polycystic ovary syndrome suggests, cysts in the ovaries (ovaries) do not necessarily have to be present for the presence of PCO syndrome. Thus, an unremarkable ovarian finding does not preclude a diagnosis of the disease.
Other symptoms of PCO syndrome
As a result of the above symptoms, polycystic ovary syndrome may present with additional signs, but these may be different for each woman:
- Unfulfilled desire to have children
- Male hair pattern or strong body hair (hirsutism), for example a lady’s beard
- Acne
- Hair loss on the scalp
- Deeper voice
- Overweight
- Increased blood sugar
- Increased blood cholesterol
- Increased blood lipid value
Furthermore, there are studies showing that women with PCO syndrome enter menopause an average of four years later.
How to recognize a PCO syndrome?
Because of the wide range and varying severity of symptoms, diagnosing PCOS is not straightforward, but there are blood tests and sonographic (ultrasound) findings that can help make the diagnosis. Thus, when testing the blood, an increase in the so-called lutein-stimulating hormone, estrogens and testosterones, and possibly a decrease in follicle-stimulating hormone (FSH) or progesterone can be found. Ultrasound also allows the gynecologist to detect cysts in the ovaries in many affected women.
How common is PCOS and who is particularly affected?
It is estimated that about 4 to 15 percent of sexually mature women are affected by PCO syndrome, making it the most common hormone disorder in women. Most often, the signs manifest themselves between the ages of 20 and 30. The exact cause is still unclear, but research suggests a hereditary component and insulin resistance as possible causes. The variably estimated prevalence and high incidence of unreported cases result from the wide range of symptoms of PCOS as well as the difficult diagnostic criteria.
Health consequences and risks
Aside from gynecologic symptoms, such as irregular to no menstrual periods or failure to conceive when trying to have children, polycystic ovary syndrome can have other consequences. These include:
- Hormonal disturbances
- Pain in the abdomen
- Excess weight
- Increased sugar and blood fat levels
- Increased blood pressure
Hormonal disturbances as a result of PCO syndrome.
In both men and women, sex hormones, such as estrogen or testosterone, are subject to very complex regulatory circuits controlled by several switching points. They are therefore very susceptible to even the smallest changes, which is why an imbalance has significant consequences for the entire organism. In PCOS, for example, the so-called lutein-stimulating hormone is elevated. Normally, its level in the blood is low, except in the middle of the cycle, when it peaks and thus triggers ovulation.If it is permanently elevated, it stimulates the overproduction of the male sex hormone testosterone – this excess of male hormones is referred to as hyperandrogenemia. The resulting masculinization already mentioned not only causes physical changes, but often also puts a strain on the psyche. Furthermore, follicle-stimulating hormone (FSH) is decreased, which is normally responsible for the maturation of the follicle, i.e. the egg cell, and boosts the formation of estrogens.
Pain and life-threatening complications from cysts
If cysts are present in the ovary of an affected woman, complications may arise. Although a great many women have cysts that usually go unnoticed and are often found as an incidental finding during a medical examination, when such cysts bulge out of the ovary, pressing against other organs in the lower abdomen, it can cause abdominal pain. A rare but dangerous consequence occurs when due to a cyst the ovary rotates on its own axis on its pedicle. This is because many vessels that nourish the ovary run in this pedicle, so the ovary can die due to a pinched artery. In addition, cysts can burst, rupturing their thin wall and spilling fluid into the abdomen. Aside from the high blood loss that can accompany rupture, peritonitis can result.
Consequences of PCO syndrome for metabolism.
A symptom exhibited by many women suffering from PCOS is the so-called metabolic syndrome. This refers to a complex of factors that originate in metabolism. These factors are:
- Obesity
- Increased blood pressure
- Increased value of triglycerides (blood fats)
- Lowered HDL cholesterol
- Increased blood glucose
Metabolic syndrome factors are considered risk factors for diseases of the cardiovascular system or cancer. Therefore, just like other metabolic syndrome sufferers, women with PCO syndrome are at high risk for developing such diseases.
Insulin resistance in PCO syndrome.
Above all, the increase in blood glucose levels is of central importance in PCO syndrome, since a disturbed insulin metabolism (in the sense of insulin resistance) is thought to be a possible cause of the disease. Such insulin resistance means that the cells do not absorb sugar from the blood properly and blood sugar levels are elevated: women with PCOS are therefore at increased risk of diabetes mellitus. However, insulin resistance has other consequences: In response, the body produces even more insulin, so that its level in the blood is actually increased. On the one hand, insulin is a so-called lipogenic hormone, which means that it promotes the build-up of fat by activating various enzymes and thus promotes obesity. On the other hand, it stimulates testosterone production in the ovaries and thus promotes masculinization.
What are the treatments for PCOS?
Depending on the symptoms and pre-existing conditions of the affected woman and whether or not there is a desire to have children, different treatment methods for PCO syndrome are offered in each case. This is because, as explained above, our hormonal system is very complex and sensitive to changes. Therefore, therapy can be thought of as a balance, with the focus either on normalizing the ovaries or on correcting the masculinization symptoms. Although PCO syndrome cannot usually be cured, it is at least possible to alleviate the symptoms with appropriate treatment. What can be treated in all cases is the elevated blood sugar level. For this purpose, therapy with metformin is recommended, although increased success has also been achieved with myo-inositol.
PCOS therapy in affected individuals who do not wish to have children.
If there is no desire to have children, the recommended drug treatment is usually the use of the pill with dienogest or cyproteronacetet and glucocorticoids such as cortisol, since these have an antiandrogenic, i.e., testosterone-blocking, effect and thus counteract masculinization. However, if obesity and nicotine use are present, the risk of thrombosis (blood clots) should be weighed here, as dienogest is suspected of increasing the risk of such.
What to do if you have PCO syndrome and want to have children?
In the case of a desire to have children, treatment is often more difficult because, although the function of the ovary itself is not disturbed, the regulatory cycle of the menstrual cycle is, which is closely interwoven with the possibility of pregnancy. Whether a woman with PCOS can become pregnant, and if so, what the likelihood of this is, cannot be answered in a generalized way, since her fertility (fertility) depends not only on the severity of her disease, but also on many other factors. However, it can generally be said that the success rate of fertility treatment in patients with PCOS is comparatively high. For example, the follicle-stimulating drug clomiphene can help several eggs to mature, making pregnancy more likely. In addition, artificial insemination may be considered: Pregnancy rates after in vitro fertilization are 25 percent per cycle. However, taking clomiphene also increases the risk of ovarian hyperstimulation syndrome (a symptom complex that can result from ovarian hyperstimulation) and multiple births.
PCO syndrome: treatment without medication
Because the cycles of fat metabolism and sex hormones are closely related, dietary changes and adequate physical activity are recommended. In some cases, these two measures alone can already lead to a normalization of the cycle and even to pregnancy. If obesity is present, it is advisable to lose weight and avoid high-fat, high-sugar and high-calorie foods in the diet. Instead, dairy and whole-grain products as well as lean meat, fish, fresh fruit, vegetables and nuts are recommended. In any case, a permanent change in diet is preferable to a short diet for successful weight loss.
Monk’s pepper for PCOS
In phytotherapy (herbal medicine), success has been achieved with the use of monk’s pepper (Vixex agnus-castus). Because of its progesterone-deficiency-correcting effect, it normalizes the menstrual cycle and promotes ovulation. In a three-month study of 45 women suffering from hormone-related fertility disorders who took monk’s pepper, seven women became pregnant, 25 developed normal hormone levels, and the rest improved. This suggests that monk’s pepper as a tea-especially for women who want to have children-can help treat PCO syndrome naturally and help them get pregnant despite PCO.
