Polycystic ovary syndrome (PCOS) (synonyms: polycystic ovary syndrome; polycystic ovary syndrome; polycystic ovary syndrome; polycystic ovary syndrome; polycystic ovaries; polycystic ovary disease; polycystic ovary syndrome (PCO syndrome); polycystic ovary syndrome; Stein-Leventhal syndrome; ICD-10 E28. 2: Polycystic ovary syndrome) refers to a symptom complex characterized by hormonal dysfunction of the ovaries.
Definition of PCO syndrome
According to the 2003 Rotterdam Consensus Workshop (“Rotterdam criteria”), PCO syndrome is present when two of the following criteria are met:
- Cycle disturbances – oligomenorrhea to oligo-amenorrhea (definition: see below).
- Clinical hyperandrogenism and/or hyperandrogenemia.
- Clinical features of hyperandrogenism such as hirsutism (increased hair according to the male distribution pattern), acne (e.g., acne vulgaris), seborrhea (oily skin), and/or
- Hyperandrogenemia (increased formation of androgens/sex hormones that serve to develop and maintain male characteristics); total testosterone level > 2.08 nmol/l or as serum dehydroepiandrostenedione sulfate (DHEA-S) level > 6.6 mol/l; and/or
- Polycystic ovaries – when at least one ovary (ovary) has a volume of at least 10 ml and/or 12 follicles of two to nine millimeters each are present.
In a cluster analysis, the symptoms of PCO patients could be assigned to different courses: a reproductive subtype (affecting reproduction) and a metabolic subtype (affecting metabolism). (see Causes/Pathogenesis).
Peak incidence: Polycystic ovary syndrome usually presents from the 2nd or 3rd decade of life.
The prevalence (disease incidence) is up to 20% of all women. Polycystic ovary syndrome is the most common endocrinopathy (disease caused by disturbed function of the endocrine glands or the defective action of hormones) in women of fertile age. It affects ca:
- 25% of all women with secondary amenorrhea (no menstrual bleeding for > 90 days with an already established cycle).
- 50% of all women with oligomenorrhea (interval between bleeding is > 35 days and ≤ 90 days, bleeding occurs too infrequently)
- 50% of all women with hirsutism (increased terminal hair (long hair) in women, according to the male distribution pattern (androgen-dependent)).
Course and prognosis: a cure for polycystic ovary syndrome is currently not possible. Treatment should be early and adequate, because untreated, the disease is associated with an increased risk of coronary disease (cardiovascular disease), hyperlipidemia (lipid metabolism disorders) and diabetes mellitus type 2.The symptoms can be well treated. In addition to pharmacotherapy (drug therapy) and hormonal treatment, lifestyle modification measures such as weight reduction are also part of the therapy concept.
Comorbidities (concomitant diseases): In the group of subfertile PCOS women, about 90 % are overweight or obese. Other associated conditions include metabolic syndrome, fatty liver (steatosis hepatis), infertility, pregnancy complications (gestational diabetes, preeclampsia, preterm birth), mental illness (depression, anxiety disorders), and obstructive sleep apnea syndrome (favored by overweight or obesity present).Three out of four women with PCO syndrome also have insulin resistance (decreased or abolished effect of the hormone insulin).
