PCO syndrome (PCOS): What is behind it?

PCO syndrome (PCOS): What is behind it?

Polycystic ovary syndrome – also known as PCO syndrome, PCOS or Stein-Leventhal syndrome – is a hormone disease that only affects women. It is a so-called symptom complex since many symptoms can accompany the disease. Below, you can find out what is behind PCO syndrome and how it is treated.

What is Polycystic Ovary Syndrome (PCO Syndrome)?

Despite its widespread occurrence, there is no precise definition of PCO syndrome, but in general, this women’s disease can be described as a hormonal disease or metabolic disorder with various and sometimes far-reaching consequences. 

To put it simply, the bodies of many affected women produce too many male hormones (androgens) – the consequences often include excessive body hair, an irregular menstrual cycle or an unfulfilled desire to have children. 


PCOS: Diagnosis based on the most critical symptoms

According to the so-called Rotterdam criteria, a woman has PCOS if at least two of the following three criteria are met:

  1. fewer than eight ovulations per year until no period at all ( amenorrhea )
  2. Masculinization is caused by too many male hormones, such as testosterone
  3. increased cysts in the ovaries

Contrary to what the name polycystic ovarian syndrome might suggest, the presence of PCO syndrome does not necessarily mean that cysts are present in the ovaries (ovaries). Thus, an unremarkable finding of the ovaries does not rule out a disease diagnosis.

Other symptoms of PCO syndrome

As a result of the above symptoms, there may be other signs of polycystic ovary syndrome, but they can be different for every woman:

  • unfulfilled desire to have children
  • Male hair pattern or excessive body hair ( hirsutism ), for example, a lady’s beard
  • Acne
  • hair loss on the scalp
  • deeper voice
  • overweight
  • increased blood sugar
  • increased blood cholesterol level
  • increased blood fat level

Some studies show that women with PCO syndrome start menopause four years later on average. 1


How do you recognize PCO syndrome?

Due to the wide range of symptoms and their severity, diagnosing PCOS is not easy, but there are blood values ​​and sonographic findings (ultrasound) that make it easier to diagnose.

A blood test shows an increase in the so-called lutein-stimulating hormone, estrogen and testosterone and possibly a reduction in the follicle-stimulating hormone (FSH) or progesterone.

With the ultrasound, the gynaecologist can also detect cysts in the ovaries of many affected women.

How common is PCOS, and who is affected most often?

It is estimated that around 4 to 15 per cent of sexually mature women are affected by PCO syndrome, making it the most common hormonal disorder in women. The signs usually appear between the ages of 20 and 30. 

The exact cause is still unclear, but research suggests a hereditary component and insulin resistance as possible causes. 2

The differently estimated spread and the high number of unreported cases result from the wide range of symptoms of PCOS and the complex diagnostic criteria.

Health consequences and risks

Aside from the gynaecological symptoms, such as irregular or no menstrual periods or failure to get pregnant if you want to have children, polycystic ovarian syndrome can have other consequences. This includes:

  • hormonal disorders
  • abdominal pain
  • overweight
  • increased sugar and blood fat levels
  • increased blood pressure 


Hormonal disorders as a result of PCO syndrome

In both men and women, sex hormones, such as estrogen or testosterone, are subject to very complex regulatory circuits that are controlled by several control points. They are, therefore, very susceptible to the most minor changes, which is why an imbalance has significant consequences for the entire organism. 

In PCOS, the so-called lutein-stimulating hormone is increased. Usually, its level in the blood is low, except in the middle of the cycle, when it peaks, thus triggering ovulation. If it is permanently increased, it stimulates the overproduction of the male sex hormone testosterone  – this excess of male hormones is referred to as hyperandrogenemia. The resulting masculinization already mentioned not only causes physical changes but often also represents a burden on the psyche.

Furthermore, the follicle-stimulating hormone (FSH), which is usually responsible for the maturation of the follicle, i.e., the egg cell, is reduced and stimulates the formation of estrogens.

Pain and life-threatening complications from cysts

If the affected woman has cysts in her ovaries, complications can occur. While many women have cysts, which usually go unnoticed and are often found as an incidental finding during a physical exam, when such cysts protrude from the ovary and press against other organs in the lower abdomen, it can cause abdominal pain.

A rare but dangerous consequence occurs when a cyst causes the ovary to rotate on its axis on its pedicle. This is because many of the vessels that feed the ovary run through this pedicle so that the ovary can die due to a pinched artery.

In addition, cysts can rupture, tearing their thin wall and spilling fluid into the abdomen. Aside from the high blood loss that can accompany the rupture, peritonitis can result.

Consequences of the PCO syndrome on the metabolism

A symptom that many women who suffer from PCOS exhibit is what is known as metabolic syndrome. This is a complex of factors that have their origin in metabolism. These factors are:

  • overweight
  • increased blood pressure
  • increased level of triglycerides (blood fats)
  • decreased HDL cholesterol 
  • increased blood sugar level

The factors of metabolic syndrome are considered risk factors for diseases of the cardiovascular system or cancer. Just like other sufferers of the metabolic syndrome, women with PCO syndrome are therefore at high risk of developing such diseases.


Insulin resistance in PCO syndrome

Above all, the increase in the blood sugar level is of central importance in PCO syndrome, as a possible cause of the disease is suspected to be a disrupted insulin metabolism (in the sense of insulin resistance). Such insulin resistance means that the cells do not absorb sugar from the blood properly, and the blood sugar level is increased: women with PCOS are, therefore, at an increased risk of diabetes mellitus.

However, insulin resistance has other consequences: In response, the body produces even more insulin so that its level in the blood is even higher. On the one hand, insulin is a so-called lipogenic hormone, which promotes fat accumulation by activating various enzymes and thus promotes obesity. On the other hand, it stimulates testosterone production in the ovaries, thus promoting masculinization.

What treatments are there for PCOS?

Depending on the symptoms and previous illnesses the affected woman has and whether or not she wants to have children, there are different treatment methods for PCO syndrome. 

As explained above, our hormone system is complex and sensitive to changes. The therapy can, therefore, be thought of as a scale, with the focus either on normalizing the ovaries or on correcting the signs of masculinization. Although PCO syndrome cannot usually be cured,  the symptoms can at least be alleviated with appropriate treatment.

What can be treated in all cases is the elevated blood sugar level. For this purpose, therapy with metformin is recommended, although increasing success has also been achieved with myo-inositol.

PCOS therapy for those affected who do not wish to have children

Suppose there is no desire to have children. In that case, it is usually recommended to take the pill with dienogest or cyproterone acetate as well as glucocorticoids such as cortisol for drug treatment, as these have an antiandrogenic, i.e. testosterone-blocking effect and thus counteract masculinization. 

However, if obesity and nicotine consumption are present, the risk of thrombosis (blood clots) should be weighed here since dienogest is suspected of increasing the risk of such.


What to do if you have PCO syndrome and want to have children?

If you want to have children, the treatment is often more difficult since the function of the ovaries is not disturbed. Still, the control cycle of the menstrual cycle, which is closely interwoven with the possibility of pregnancy, is. 

There is no general answer as to whether a woman with PCOS can become pregnant and, if so, how high the probability is since her fertility not only depends on the severity of her disease but also on many other factors. 

In general, however, the success rate of fertility treatment in patients with PCOS is comparatively high. For example, the follicle-stimulating drug clomiphene can help mature multiple eggs, making pregnancy more likely. In addition, artificial insemination can be considered: the pregnancy rate after in vitro fertilization is 25 per cent per cycle. 

However, taking clomiphene also increases the risk of ovarian hyperstimulation syndrome (a symptom complex that can result from overstimulation of the ovaries) and multiple births. 

PCO syndrome: treatment without medication

Since the cycles of fat metabolism and sex hormones are closely related, a change in diet and sufficient physical exercise are recommended. In some cases, these two measures alone can lead to a normalization of the menstrual cycle and even to a pregnancy. 

If you are obese, it is advisable to lose weight and avoid high-fat, high-sugar and high-calorie foods. Instead, dairy and whole grains are recommended, along with lean meat, fish, fresh fruit, vegetables, and nuts . A permanent change in diet is always preferable to a short diet for successful weight loss.

Chaste tree for PCOS

In phytotherapy (herbal medicine), successes have been achieved using monk‘s pepper (Vitex agnus-castus). Due to its progesterone deficiency-correcting effect, it normalizes the menstrual cycle and promotes ovulation. 

In a three-month study of 45 women with hormone-related fertility problems who took chaste trees, seven women became pregnant, 25 developed normal hormone levels, and the remainder improved. 3 This suggests that chaste tree tea – especially for women trying to conceive – may help treat PCO syndrome naturally and get pregnant despite having PCO.

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