Polycystic Ovary Syndrome: Causes, Symptoms & Treatment

PCO syndrome (polycystic ovary syndrome) is a disorder of female hormone balance. This disorder leads to an increase in male hormones, called androgens, which can result in infertility in addition to menstrual irregularities. PCO syndrome is also known as Stein-Leventhal syndrome.

What is PCO syndrome?

Polycystic ovary syndrome is one of the most common metabolic disorders in adult women. It is usually caused by increased androgen levels (hyperandrogenism), cycle disorders, and infertility in women. PCO syndrome mostly occurs in woman of reproductive age. Due to the increased production of male hormones (androgens), there are malfunctions in the ovaries. In order for PCO syndrome to be diagnosed, several criteria must be met. Criterion No. 1: So-called polycystic ovaries must be present. This means that cysts are growing in the ovaries. At least 8 cysts must be detectable. Criterion No. 2: Menstrual bleeding occurs only very rarely or not at all. Ovulation occurs very rarely or not at all. Criterion No. 3: The concentration of male hormones is very high. PCO syndrome occurs relatively frequently. About 10 percent of all women between the ages of 15 and 25 suffer from PCO syndrome (polycystic ovary syndrome).

Causes

A primary cause for PCO syndrome has not been found to date. However, it has been possible to delineate various factors that are present in many affected individuals. In many women, a familial disposition is found. It is therefore assumed that there is a hereditary component, although the causative gene has not yet been clearly identified. Furthermore, disorders in the brain are also a possibility. In a PCO syndrome, the pituitary gland produces more of the hormone LH (luteinizing). In contrast, the production of the hormone FSH (follicle-stimulating) is reduced. Due to this imbalance, there is an increased production of male sex hormones in the ovaries. Disorders in the pancreas are also a possible cause. In PCO syndrome, an increased concentration of insulin is found in the blood. The excess insulin stimulates the ovaries to produce more male hormones, which in turn stimulates the pituitary gland to secrete more LG. Other possible causes of polycystic ovary syndrome include puberty, hypothyroidism, stress as well as tumor disease.

Symptoms, complaints, and signs

PCO syndrome is a multifaceted clinical picture that can be accompanied by various complaints. One common symptom is menstrual irregularities. Patients have a prolonged cycle, lasting longer than 35 days, and menstruate less frequently. Menstrual bleeding may also stop completely. In this case, the condition is referred to as amenorrhea. In the course of the cycle, intermenstrual bleeding or even additional bleeding may occur. The cycle disorders lead to reduced fertility or complete infertility. Due to the increased concentration of male sex hormones in the blood, women with polycystic ovary syndrome exhibit a male pattern of hair growth (hirsutism). The hair grows not only in the intimate area, but also on the thighs or on the abdomen, as well as in the area of the upper lip. The patients also suffer from hair loss, oily skin and acne. They also tend to be overweight and have elevated blood sugar levels. True masculinization with a deepening voice and enlargement of the clitoris occurs rather rarely. In principle, not all symptoms are equally pronounced in women with PCO syndrome. However, a large proportion of those affected suffer greatly from the symptoms. In particular, the lack of fertility or complete infertility can lead to severe depressive moods in the case of an unfulfilled desire to have children.

Diagnosis and course

PCO syndrome is diagnosed by the gynecologist. In addition to a general history (medical history), a gynecologic examination is performed. If PCO syndrome is suspected, imaging procedures such as ultrasound and MRI are used to visualize the ovaries. In this way, cysts in the ovaries can be detected. Blood tests are also performed to confirm the diagnosis. In addition to a general blood count, the various hormone levels in the blood are examined.In particular, the hormones LH and FSH are indicative values for a PCO syndrome. If those affected wish to have children, laparoscopies can also be performed. Here, the ovaries in particular are examined in detail. If necessary, biopsies are also performed. In this case, tissue is removed from the ovaries for histological and cytological examination. The course of PCO syndrome depends on when the disease was discovered and how it was treated. Since obesity and elevated insulin levels are often also present in this disease, this poses an additional risk to the patentee, as these symptoms can cause diabetes mellitus and dyslipidemia in addition to cardiovascular disease. With early and adequate treatment, the course of PCO syndrome is good and can be cured without consequences. If treatment is inadequate, late complications such as infertility may occur. If PCO syndrome is diagnosed, it is recommended to consult a specialist for treatment. Only gynecologists with the additional designation of reproductive medicine have the necessary experience to successfully treat PCO syndrome (polycystic ovary syndrome).

Complications

PCO syndrome usually has a very negative impact on the quality of life of the affected woman. In most cases, the concentrations of male hormones are increased with it, so that androgenization of the woman occurs. In most cases, many different psychological complaints develop, and in some cases, depression. Those affected are also often ashamed of the complaints and sometimes suffer from inferiority complexes and a significantly lowered self-esteem. Social discomfort can also occur due to PCO syndrome. Especially at a young age, this syndrome can lead to teasing or bullying. Sufferers continue to suffer from pimples and blemished skin. Obesity and hair loss can also occur as a result of PCO syndrome and have a very negative effect on the aesthetics of those affected. In some cases, patients develop a lady’s beard, and infertility can also be a symptom of the disease. As a rule, the desire to have children cannot be fulfilled. In severe cases, PCO syndrome can also lead to miscarriage. The treatment of PCO syndrome is usually carried out with the help of medication. However, a healthy lifestyle can also have a very positive effect on the disease.

When should you go to the doctor?

PCO syndrome can only be diagnosed in sexually mature and reproductive young and adult women. If those affected have an unfulfilled desire to have children, a follow-up visit to a doctor is recommended. If, despite all efforts and known methods of conception, no offspring could be conceived for several months, a visit to the doctor is advisable. Irregularities of the female menstrual cycle or absence of menstrual bleeding should be presented to a doctor. Intermittent bleeding or a very weak menstrual period often indicate a health impairment. A visit to the doctor is necessary so that an investigation into the cause can be initiated. Overweight or problems with weight despite a low-calorie and balanced diet can be discussed with a doctor. Skin blemishes, acne or very oily skin are signs of a disease for which treatment is needed. If behavioral problems occur or depressive moods develop, a doctor should be consulted. Changes in personality, a deep voice and irregularities in hair growth on the body are complaints that should be clarified by a doctor. It is advisable to seek the advice of a doctor or therapist if there is a persistent or increasing dissatisfaction with one’s life, a decrease in well-being, as well as a lowered quality of life. In many cases, the emotional problems are based on physical inconsistencies that can be treated.

Treatment and therapy

Treatment of PCO syndrome involves several therapeutic goals. Primarily, the acute symptoms are treated. However, the long-term therapeutic goal is to normalize metabolism and prevent possible sequelae such as diabetes mellitus and cardiovascular disease. Since polycystic ovary syndrome is often associated with obesity, it is important to change the diet. Furthermore, sufficient physical exercise in the form of sports is important.Especially in the early stages of PCO syndrome, these two measures can positively influence the menstrual cycle as well as ovulation. When treating PCO syndrome, it is also important to consider whether the affected women wish to have children. In women who do not wish to have children, the hormonal disturbances are often treated with the contraceptive pill. By combining different female hormones such as estrogen and progestin, it is possible to slow down the release of male hormones, so that the secondary symptoms such as increased body hair and skin problems are also reduced. However, this type of therapy is only intended for women who do not wish to have children, as the “pill” has a contraceptive effect. If women with a desire to have children suffer from PCO syndrome, the previously mentioned therapy is not recommended. In these cases, low-dose cortisone preparations are often used. These act on the adrenal glands, where the male hormones are produced. If ovulation does not occur despite treatment, ovulation-inducing drugs can be administered. If the cause is diagnosed as high insulin levels, the first priority is to lower them. The hormone FSH is often injected as the drug of choice. However, it must be pointed out to the patient that this form of therapy is followed by a very high probability of a multiple pregnancy. In exceptional cases – especially in women who wish to have children – it may be indicated that the PCO syndrome must be treated by means of a surgical intervention. In this case, the cysts in the ovaries are destroyed with a laser during a laparoscopy (laparoscopy).

Outlook and prognosis

The prognosis in the presence of PCO syndrome, also known as polycystic ovary syndrome, is not very good. In addition to physical symptoms that are distressing, female fertility is also limited. Both can lead to emotional distress and social withdrawal. Therefore, polycystic ovary syndrome not only leads to increased miscarriages, but also to emotional distress or depression that requires treatment. THE PCO syndrome can lead to increased body hair, absence of menstruation and infertility. Although in principle it is still possible to have children, this is made much more difficult. Pregnancies in women with PCO syndrome are subject to higher risks. Those affected are burdened more by gestational diabetes, miscarriages or multiple pregnancies. In addition, complications during pregnancy occur more frequently. As a result, women with PCO syndrome develop increased risks of suffering from cardiovascular diseases. Drug treatments and dietary changes can increase the prospects for better quality of life. Regular gynecological examinations are advised. During menopause, PCO symptoms may improve. But they can also get worse. Why this is so is still being researched. The existing symptomatic treatment approaches are insufficient. If there is no desire to have children, the increasing masculinization or accompanying acne can be counteracted with ovulation inhibitors. The prognosis is worse if there is a desire to have children. The PCO syndrome that hits especially young women hard.

Prevention

To date, no direct preventive measures against polycystic ovary syndrome are known. Since obesity is an important factor in PCO syndrome, diet should be changed and sufficient exercise should be taken. Furthermore, the annual gynecological screening should be taken advantage of. If PCO syndrome has been diagnosed, adequate therapy should be started as early as possible. Because only in this way can the course be positively influenced and late consequences avoided.

Follow-up care

In most cases, follow-up care for PCO syndrome proves to be relatively difficult, so that the measures of direct follow-up care for this disease are relatively limited. Affected individuals should seek medical attention early on for this reason, so that other complications or complaints do not arise in the further course of the disease, which can limit the quality of life of the affected individual. PCO syndrome cannot heal itself, so the patient is always dependent on treatment by a doctor. First and foremost, medications that promote the symptoms must be discontinued. However, the discontinuation of medication should only take place with a doctor’s approval.Likewise, regular checks by a doctor during treatment are very important in order to detect and treat further damage to the body at an early stage. However, most of those affected also require surgical intervention. Afterwards, strict bed rest should be observed, and the affected person should rest and take it easy. In this regard, the support and care of one’s family or partner is also very important, as this can also prevent depression and other psychological upsets.

This is what you can do yourself

In addition to drug treatment, those affected can additionally take active steps themselves to combat the symptoms of PCO syndrome. In most cases, a change in lifestyle is necessary. In patients who are overweight, a reduction in body weight and a change in diet usually bring about a significant improvement. Abdominal fat in particular should be reduced. Sports activities such as light abdominal exercises, jogging or Nordic walking can help. Regardless of the body weight of those affected, high-calorie foods should generally be avoided. The consumption of sugary foods and white flour products should be avoided. Instead, it is recommended to eat plenty of vegetables, satiating protein, whole grains and oils with omega-3 fatty acids. Excessive alcohol consumption and smoking should be avoided. During pregnancy, increased attention should be paid to a healthy lifestyle and diet, as there are certain risks such as miscarriage or gestational diabetes if PCO syndrome is present. In case of severe body hair, professional permanent hair removal can help. If affected women suffer from severe acne, laser treatment is possible. For many sufferers, the condition is primarily a psychological burden. In these cases, psychotherapeutic help can also be sought. In addition, there are a number of self-help groups as well as Internet forums where sufferers can exchange information with each other.