Synonyms
PCO Syndrome, PCOS Stein-Leventhal SyndromePolycystic ovarian syndrome is a complex of symptoms consisting of menstruation failure (amenorrhea) or prolonged menstrual pauses (oligomenorrhea), increased body hair (hirsutism) and overweight (obesity) and is due to hormonal dysfunction of the female ovaries. The symptom complex was described by Stein-Leventhal in 1935.
EpidemiologyPopulation incidence
Polycystic ovarian syndrome is more frequently found in women between the ages of 20 and 30. However, the actual onset of the disease is suspected as early as puberty and is either diagnosed during routine examinations or only when the disease becomes symptomatic. Approximately 5% of women capable of giving birth have polycystic ovarian syndrome.
The cause of polycystic ovarian syndrome, which is manifested by various symptoms, but can also be recognized in ultrasound in the form of many cysts distributed in the ovary, is largely unknown. It is assumed that there is a faulty interaction between the hormones FSH and LH, the cause of which is not yet known. In the so-called hypothalamus in the brain, which is responsible for the production of many hormonal precursors, the so-called gonatotropin-releasing hormone (GnRH) is released.
This then acts on the pituitary glands (hypophysis), also in the brain, releasing the two hormones follicle-stimulating hormone (FSH) and luteinizing hormone (LH), both of which act on the ovaries (ovaries) and the menstrual cycle. GnRH is released from the hypothalamus in a specific temporal pattern. FSH and LH are then stimulated.
At a certain point, both hormones drop briefly, which initiates ovulation. Shortly afterwards, the two hormones increase again. In women, FSH affects both the menstrual cycle and the development of the gonads.
The release of FSH promotes granulosa cell growth in the ovaries. The luteinizing hormone (LH) triggers follicle maturation and finally ovulation. It also causes the development of the so-called corpus luteum, which produces the hormones estrogen and progesterone.
In Stein-Leventhal syndrome, there is probably a lack of activity of certain enzymes (aromatases) in the granulose layer in the ovary mentioned above. In healthy women, this layer is stimulated by FSH. In the diseased patient, a hyaline layer probably covers the granulosa and thus does not allow FSH to act properly there.
As a result, the granulosa cells begin to regress slightly. However, LH is still produced and secreted, which leads to increased production of steroids in the ovary and increased production of androgens (male sex hormones). It is these androgens that finally cause a further hyaline thickening of the ovary and the typical cystic image in the ultrasound scan.
In addition, the male sex hormones lead to the often observed increased body hair (hirsutism) and the increased steroid quantity to overweight (obesity). The altered menstrual cycle is attributed on the one hand to the cystic changes and on the other hand also to the disordered FSH/LH secretion. The initial discussion between the doctor and the patient about the patient’s medical history (anamnesis) gives the doctor first indications of the type of disease.
The timing and progression of the symptoms can often lead to the suspicion of polycystic ovarian syndrome. In any case, if not already done, further treatment and examination should be continued by a specialist in gynecology, who can then usually identify the typical cystic changes in the ovaries (ovaries) by means of an ultrasound examination. The image ranges from completely inconspicuous ovaries to pearl-chain-like arranged cystic structures. Due to the increase in tissue, the ovary often appears enlarged in the ultrasound.
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