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.

This in­cludes: 

• 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.

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!

as­sisted re­pro­duc­tion

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.

At Fer­tilly, we have made it our mis­sion to ac­com­pany cou­ples (ho­mo­se­xual and he­te­ro­se­xual) and sin­gles on the way to ful­fil­ling their child wish. In doing so, it is im­portant to us to create trans­pa­rency in the area of fer­ti­lity ser­vices, to pro­vide in­for­ma­tion and know­ledge on the to­pics of pregnancy and fer­ti­lity and to help you to find the most sui­table Fer­ti­lity Center. Th­rough co­ope­ra­tion with first-class Fer­ti­lity Cen­tres and cli­nics in Eu­rope, en­qui­ries about Fer­tilly are given pre­fe­ren­tial tre­at­ment. This means that our pa­ti­ents avoid the usually long wai­ting times and get ap­point­ments more quickly.

If you would like more in­for­ma­tion about Fer­ti­lity Cen­ters, suc­cess rates and prices, please contact us using this ques­ti­on­n­aire. We will ad­vise you free of charge and wi­t­hout any ob­li­ga­tion.

Sources:

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