PCO syndrome: causes, symptoms and treatment
Polycystic ovary syndrome (abbreviated to PCOS or PCO syndrome) is a hormonal disorder that affects about 5–10% of all sexually mature women worldwide and can lead to childlessness. In this article we look at the symptoms and treatment options for PCOS.
PCOS: cause, symptoms, treatment
Typical symptoms of PCO syndrome:
PCOS appear very differently from woman to woman, so treatment is also individualized on a case-by-case basis.
The most common symptoms of polycystic ovary syndrome include:
- Irregular menstruation
- Increased body hair
- Hair loss on the head
- Oily skin and acne
- Unwanted weight gain
- Insulin resistance and therefore an increased risk of type 2 diabetes
- Abdominal pain
- High blood pressure
- Multiple ovarian cysts
- Elevated anti-mullerian hormone levels
Women who suffer from PCOS and the associated irregular menstrual cycle usually find it difficult to fulfill their desire to have children.
This condition is a symptom complex: several possible symptoms occur, but they might not all appear at the same time. For this reason, in some cases it takes several years before PCO syndrome is noticed and diagnosed.
Polycystic ovary syndrome is a complex hormone disorder that is only confirmed after other diseases have been ruled out. In order to be able to make an accurate judgement, the attending physician must first find out the entire course of the patient’s disease.
- Questions about previous illnesses, cycle and family history.
- Physical examinations such as hair pattern, blood pressure, skin examination, BMI and fat distribution pattern.
- Glucose tolerance test
- Examination of thyroid function
To facilitate diagnosis, three main symptoms, known as the Rotterdam criteria, have been defined. If other causes have been ruled out and two of these features occur, it is called polycystic ovary syndrome:
- Cycle disturbances and lack of ovulation
- The cycle lasts longer than 35 days for at least 3 months a year (oligomenorrhoea)
- Menstrual bleeding is absent for more than 3 months a year (amenorrhoea).
- Increased levels of male sex hormones
As a result, increased body hair, hair loss on the head (baldness) and/or acne are known.
The hormonal balance of the woman is examined by taking blood samples. Among other things, oestrogens, androgens, LH, FSH, the LH/FSH ratio and TSH (Laboraktuell, 2016) are checked.
Multiple ovarian cysts — the so-called polycystic ovaries.
These are small fluid-filled blisters that occur in both ovaries at the same time. Although this feature gives the condition its name, it occurs in — only — 78% of all PCOS diagnoses.
This symptom is examined using a transvaginal ultrasound. It is quite easy for specialists to recognise, because the ovaries of PCOS sufferers are outwardly different from those of a healthy woman.
PCO syndrome: Causes
Even though the disease was first described in 1721, the exact causes of PCO syndrome are still not known. Rather, individual connections between the disease, genetic factors and environmental influences have been established.
On the one hand, it is claimed that PCOS is genetically hereditary. Studies have shown that in some families several family members suffer from this hormonal disorder. But male members of the family can also show PCO-like signs: Premature baldness is for example one of them. To date however, no single PCOS gene has been identified.
The insulin resistance found in 71% of cases is strongly related to the hormone balance of those affected being out of balance:
- Increased concentration of male sex hormones (androgens).
- Resulting increased production of female sex hormones (oestrogens)
- Increased secretion of the LH hormone, which together with the follicle-stimulating hormone FSH is responsible for the functional processes in the ovaries.
On the one hand, the shifted ratio of both hormones leads to impaired follicle maturation and thus to problems with ovulation. On the other hand, the increased release of LH in turn drives the increase in hormone production in the ovaries.
But external influences also play an important role in the development of PCO syndrome. The level of calorie intake and the right composition of food play a role here. In addition, physical inactivity and obesity can aggravate the symptoms of the disease.
Even though an absolute cure for PCO syndrome is not yet possible, there are ways to alleviate the symptoms. However, each woman has to be considered individually, as well as the respective intensity of the symptoms that occur.
Reducing excess weight
Weight reduction is the first thing women who are overweight and have PCO syndrome should focus on. Sufficient exercise and avoiding foods high in fat and sugar help enormously.
In comparison to slim patients, whose carbohydrate content may be around 50–55%, it should be a maximum of 40% in obese insulin-resistant women.
This treatment step alone can lead to a more regular cycle with ovulation — for patients with an unfulfilled child wish, this is a particularly motivating factor.
In addition, weight reduction reduces the risk of type 2 diabetes and cardiovascular disease.
Drug and hormonal treatment
Oral contraceptive therapy, also known as the birth control pill, is used to combat the external clinical signs. It reduces the amount of male hormones in the blood, stabilizes the menstrual cycle and clears up the woman’s skin. Thus, strong body hair as well as acne can be counteracted.
Metformin is prescribed to reduce blood sugar levels and improve metabolism: a drug used to treat diabetes. As a result, insulin resistance is combated and the lowering of male hormones in the blood is promoted.
This is to achieve a stable menstrual cycle. This therapeutic approach is relevant for PCOS patients who wish to have children.
If the desire to have children is the main focus of the treatment, the anti-oestrogen clomiphene can also be administered.
This drug is used to promote ovulation and thus increases the woman’s chances of pregnancy. Treatments with clomiphene may be given for a maximum of six cycles and is replaced by a drug FSH preparation if necessary. The known risks of this method include multiple pregnancies as well as hormonal overstimulation.
To prevent further health problems, any of these PCOS therapies may only be carried out under strict medical observation!
In polycystic ovary syndrome, pregnancy by means of assisted reproduction is only considered when hormonal methods have failed.
Surgery on the ovaries
If chlomiphene stimulation does not work and the child wish remains unfulfilled, a woman with PCO syndrome can be helped by means of ovarian stitching.
This is a surgical procedure in which several small punctures are made in the ovaries with a special needle.
Advantages of the procedure:
- Higher likelihood of pregnancy: within one to two years after treatment, 50–70% of patients with PCO syndrome become pregnant. (Ott J, Kurz C., 2015)
- Low rate of multiple pregnancies.
- Reduced risk of hyperstimulation syndrome
Disadvantages of the procedure:
- Like any surgical procedure under general anaesthesia, ovarian stitching can lead to complications.
PCO syndrome: Emotional distress
Polycystic ovary syndrome is not just a health problem. The dissatisfaction with the external appearance or also the unfulfilled child wish can be emotionally very stressful. This can severely limit the quality of life of the affected woman and have psychological consequences.
A visit to a psychotherapist can be very helpful and liberating in dealing with the emotional and psychological aspects of this condition.
To learn more about the connection between fertility and psychological factors, click here.
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1. Stammer, H., Wischmann, T., Verres, R. (2004): Paarberatung und — therapie bei unerfülltem Kinderwunsch. Hogrefe, Göttingen.
2. Wischmann, T., Stammer, H. (2010): Der Traum vom eigenen Kind. Psychologische Hilfen bei unerfülltem Kinderwunsch. Kohlhammer, Stuttgart.
3. Kentenich, H., Wischmann, T., Stöbel-Richter, Y. (2013): Fertilitätsstörungen — Psychosomatisch orientierte Diagnostik und Therapie. Leitlinie und Quellentext — 1.Revision. Psychosozial Verlag, Göttingen.
4. Rohde (2001). Zur psychischen Situation ungewollt kinderloser Paare. In W. Fthenatkis & M. Textor (Hrsg.), Online-Familienhandbuch. München: Staatsinstitut für Frühpädagogik.
5. Wischmann T., (1998): Heidelberger Kinderwunsch-Sprechstunde. Eine Studie zu psychosozialen Aspekten ungewollter Kinderlosigkeit. Verlag Peter Lang, Frankfurt/Main.
6. Mutsaerts MA, Groen H, Huiting HG, Kuchenbecker WK, Sauer PJ, Land JA, Stolk RP, Hoek A. The influence of maternal and paternal factors on time to pregnancy–a dutch population-based birth-cohort study: the GECKO drenthe study. Hum Reprod. 2012;27:583–593. doi: 10.1093/humrep/der429.
7. Li Y, Lin H, Li Y, Cao J. Association between socio-psycho-behavioral factors and male semen quality: Systematic review and meta-analyses. Fertil Steril. 2011;95:116–123. doi: 10.1016/j.fertnstert.2010.06.031.
8. Lynch, C.D., Sundaram, R., Maisog, J.M., Sweenez, A.M., Buck Louis, G.M. (2014): Preconception stress increases the risk of infertility: Results from a couple-based prospective cohort study-the LIFE study. Human Reproduction, Vol.29, No.5 pp. 1067– 1075, 2014.
9. Institut für Demoskopie Allensbach (2007): Allensbacher Bericht 11/2007 Unfreiwillige Kinderlosigkeit Pook, M./Tuschen-Caffier B./Krause et al. (2000): Psychische Gesundheit und Partnerschaftsqualität idiopathischer infertiler Paare. In: Brähler, E./Felder, H./Strauß, B. (Hrsg.): Fruchtbarkeitsstörungen. Jahrbuch der Medizinischen Psychologie 17: 262–271.
10. Lorenz TK, Heiman JR, Demas GE. Interaction of menstrual cycle phase and sexual activity predicts mucosal and systemic humoral immunity in healthy women. Physiol Behav. 2015;152(Part A):92–98.