What is Behind the Abbreviation?
The abbreviation PCO syndrome (also abbreviated as PCOS) stands for Polycystic Ovary Syndrome (formerly Stein-Leventhal syndrome). It is a hormonally caused disease, which is the most common cause of menstrual disorders, increased androgen levels (male sex hormones) and infertility in mature women. It occurs in 5 to 12% of all women of childbearing age.1 Compared to its frequency, it is relatively unknown in most women – similar to endometriosis symptoms.
What are the Symptoms of PCO Syndrome?
The following irregularities may be PCOS symptoms:2
- menstrual bleeding is too rare or absent (thus leading to infrequent or lack of ovulation)
- excessively high insulin and androgen levels
- cysts in the ovaries and enlarged ovaries
If two of these three abnormalities are present, a PCO syndrome is assumed,3 but this does not mean that a PCO disorder is definitively established. The symptoms listed above can also be caused by metabolic diseases, chronic thyroid inflammation (e.g. Hashimoto) or a weakness of the pituitary gland, which then releases too few hormones. Stopping the pill can also disturb the hormonal balance and cause similar symptoms. Other PCOS symptoms may include acne and obesity.4
Rare Menstrual Bleeding (Oligomenorrhea)
If there is a gap between two bleedings of more than 35 days (but less than 3 months), this is referred to as oligomenorrhea. Ovulation takes place too rarely in this case. However, if the period occurs at these intervals, this does not necessarily mean that this is due to the PCO syndrome – the cause can also be high physical or mental stress or malnutrition.
High Androgen Levels (Hyperandrogenemia)
Hyperandrogenemia is a hormonal disorder in which too much androgen is released, which leads to a “masculinization” of the body’s and genital organs, e.g. increased body hair (the so-called hirsutism), but also hair loss.
Cysts in the Ovaries (Polycystic Ovaries)
The presence of cysts in the ovaries can be detected by ultrasound. In this case, several small black “holes” can be seen in the ovaries on the ultrasound image. However, the presence of cysts in the ovaries alone does not mean that you suffer from the PCO syndrome, since polycystic ovaries can be detected in up to 23% of all women with a normal cycle.5
Therapy of PCOS
In overweight women, weight loss in many cases already leads to an improvement of the PCOS symptoms. But the drug approach is also often promising.
The Optimal Diet
Irrespective of the desire to have children, the diet should be changed at PCOS, as the disease is often considered to be the cause of other diseases such as diabetes mellitus type 2, cardiovascular diseases, gestational diabetes or certain types of cancer. The LOGI pyramid provides a good orientation. Low-starch vegetables, salads and fruits are recommended as a nutritional basis, which should be combined with high-protein foods. The quality of edible fats also plays a role. For example, monounsaturated fatty acids should be used and a favourable ratio of omega-6 to omega-3 fatty acids should be ensured.7
Further Therapy Options
In order to further reduce the “insulin resistance”, drugs such as metformin or glitazone, which are both used in the treatment of diabetes mellitus type 2, can also be used. This may also improve androgen-related problems. Even without diabetes, these drugs can help to increase the number of ovulation in women by a factor of five to ten.2 Another possibility is the use of clomiphene or letrozole.8 Side effects are possible with both drugs, however.9 Slim women with PCO syndrome can also receive a treatment containing FSH, a hormone that stimulates the formation of follicles. When they have been formed, ovulation can be triggered by the pregnancy hormone hCG. It is also possible to induce the formation of follicles and ovulation via drug with the neurohormone GnRH.10 If there is no desire to have children, birth control pills with anti-androgenic components are often prescribed. It prevents the formation of male hormones; in addition, the progestin contained protects the endometrium from excessive growth. However, the pill is not suitable for every woman; PCOS in particular can double the risk of thrombosis by taking combined pills.11
Can I Become Pregnant with PCOS?
The presence of PCO syndrome is not synonymous with infertility! Even with PCOS, there is a possibility that spontaneous pregnancy may occur, even if this possibility is not very high. An adequate treatment can increase the chances of pregnancy.
PCO Syndrome and the Desire to have Children
Overweight women who are diagnosed with PCOS should first talk to their doctor about a change in diet and incorporate more physical activity into their daily routine in order to reduce obesity. Losing weight or even more exercise leads to a recurrence of the cycle in 10% of overweight women with PCOS and to a normalisation of the androgen level.4 A 5% reduction in weight alone reduces the symptoms of PCOS considerably.2 The explanation for this is the fact that PCOS symptoms are reduced by 5%: Insulin is no longer as effective in women with PCOS as it should be – a so-called “insulin resistance”. The body therefore releases more insulin, which in turn promotes overweight and confuses the hormonal balance.2
In slim women with PCO syndrome, ovulation is often induced by means of medication.
PCO Syndrome and Pregnancy
If patients become pregnant after successful treatment of PCOS, an early examination for gestational diabetes and regular monitoring of blood sugar is recommended. An examination of the thyroid gland is also recommended, as some women with PCOS additionally suffer from an autoimmune inflammation of the thyroid gland, which can lead to hypothyroidism. During pregnancy, thyroid hormones are increasingly needed.6
Cycle Monitoring with cyclotest myWay
The chances of pregnancy can also be increased without side effects by closely observing the menstrual cycle, as the period of ovulation is then known and sex should take place during this period. cyclotest myWay supports you as an aid for natural contraception – especially if ovulation does not occur as regularly as it does with PCO syndrome. The cyclotest myWay can also be used for irregular cycles of up to 45 days.
1 Schöfl, C. et al.: Polyzystisches Ovarialsyndrom und Insulinresistenz. Deutsches Ärzteblatt 2004, 101(6): A-346 / B-294 / C-287
2 Lehnert, H.: Endokrinologie 2007; Deutsche Medizinische Wochenschrift 2007; 132: 1420-1423
3 The Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group. (revised 2003) Consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reproduction, 19, 41-47.
4 Diedrich, K. et al.: Gynäkologie und Geburtshilfe. 2nd edition, Heidelberg 2007.
5 Polson D. W. et al.: Polycystic ovaries – a common finding in normal women. Lancet 1988; 1: 870–872
6 PCOS Selbsthilfe Deutschland e. V.: Häufig gestellte Fragen, retrieved on 17/05/2016 at http://pcos-selbsthilfe.org
7 Worm, N.: Ernährung beim polyzystischen Ovarialsyndrom. Gynäkologie 4/2008.
8 Ärzteblatt: PCOS: Letrozol erhöht Chance auf Schwangerschaft, retrieved on 18/05/2016 at www.aerzteblatt.de
9 Legro, R. S. et al.: Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl JMed 2014; 371:119–129
10 Baltzer J. et al.: Praxis der Gynäkologie und Geburtshilfe. Stuttgart 2004.
11 Bird, S. T. et al.: Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis. CMAJ, 03/12/2012.