PCO syndrome: symptoms and treatment

What is PCO Syndrome?

Polycystic ovary syndrome is a dysfunction of the ovaries caused by a disruption in the female hormonal balance. A high concentration of male sex hormones in the woman’s body impairs egg cell maturation and ovulation. The high concentration is ultimately responsible for a pathological change in the structure of the ovaries, which disrupts egg cell maturation and ovulation and can thus lead to infertility in a woman. Sometimes there is even no menstruation at all. The cause of the occurrence of the hormonal disorder has not yet been conclusively clarified.

How does the PCO syndrome manifest itself?

Strictly speaking, the PCO syndrome is not a diagnosis in its own right, but merely describes a complex of symptoms that are always the same, which are summarized under the term PCO syndrome. Often the decisive point for an examination for the PCO syndrome is an unfulfilled desire to have children, which can result from some of the known symptoms. According to the official medical definition, a PCO syndrome can be said to exist if two of the following three criteria are met.

• Polycystic ovaries: The excess of male hormones in the woman’s blood leads to an intensifying cycle of disturbed hormone release. The male sex hormones, so-called androgens, are converted into estrogens in the female body and released independently of the woman’s natural menstrual cycle . The menstrual cycle and with it the maturation of the egg cell are disturbed and numerous, immature egg sacs form in the ovaries, which accumulate there as small, benign cysts.
• Oligo- or anovulation: Due to the disturbed hormonal balance and the lack of ovulation, the woman’s cycle can be extended to more than 35 days or the period can even stop completely. The cycle described above continues here, since the lack of menstrual bleeding means that even more male hormones are released and the processes are thus further intensified. These cycle disorders can ultimately lead to infertility in women .
• Hyperandrogenism: The high concentration of male sex hormones in the blood leads to a change in the external appearance of many women, which is usually more pronounced in men. This can lead to increased hair growth, especially on the face and chest, known as hirsutism. The onset of hair loss can also be a symptom of PCOS.

Other signs of a hormonal imbalance and a possible PCOS are acne, oily skin and being overweight. The latter can be both an influencing factor for the development of the symptoms and a consequence of them. As weight increases, so does the likelihood of insulin resistance. As a result, the cells cannot absorb enough glucose from food, which leads to deficiency symptoms. The body tries to compensate for this by producing more insulin. Since insulin has a significant influence on the function of the ovaries, they react to excessive insulin levels with increased release of androgens.

External change

As a result of the external changes, many women experience serious psychosocial problems, as they feel that their quality of life and satisfaction is restricted and their sexuality impaired. It is therefore important to understand that PCOS is more than just a fertility disorder. It should also be noted that a PCO syndrome makes a spontaneous pregnancy unlikely, but does not rule it out.

How is the PCO syndrome diagnosed?

In a preliminary talk, the gynecologist gets an overview of the previous medical history in order to find out whether there are any menstrual disorders or an unfulfilled desire to have children. Both can be a sign of the presence of a PCO syndrome. As part of a detailed examination, the doctor treating the patient can then look for the typical symptoms of the syndrome. The following examinations are always carried out:

• Physical examination: During the external examination, the doctor looks for obvious signs of PCO syndrome, such as increased hair growth, obesity and impure skin.
• Vaginal Ultrasound: Ultrasound can be used to determine if the ovaries are enlarged. The ultrasound image also shows the cysts, which are typically arranged like pearls on a string. If these cysts appear on both sides, this is a strong indication of PCO syndrome.
• Hormone tests: Blood tests are used to check the patient’s hormone levels and detect any elevated levels of androgens or insulin.

If the hormone tests show that the androgen level in the woman’s body is elevated, a further examination to localize the androgen production is usually carried out in order to rule out that the increased values ​​are due to overactive or malfunctioning kidneys. A glucose tolerance test, along with checking insulin levels, is also done in many cases, especially in overweight patients.

How can the PCO syndrome be treated?

Since the PCO syndrome is not a heterogeneous clinical picture, the therapy also depends on the severity of the individual symptoms.

• If the symptoms are primarily caused by being overweight, this can easily be remedied by losing weight. A reduction of two to five percent of body weight is often enough to achieve the desired goal. When losing weight, those affected should make sure to reduce their carbohydrate intake in particular, since women with PCO syndrome are particularly good at converting them into fat.
• In order to suppress the androgenetic symptoms, a contraceptive pill with an antiandrogenic component is usually administered. The excessive production of male hormones is thus suppressed and the menstrual cycle regulated.

PCO syndrome and desire to have children

• Even if there is a desire to have children, patients are often first prescribed a contraceptive pill so that the menstrual cycle can normalize and the hormone balance can be balanced. The recurring, regular bleeding can also prevent a permanent thickening of the uterine lining.
• This is usually followed by drug treatment with clomiphene. The active ingredient inhibits estrogen production, thus promoting egg cell maturation and can synthetically trigger ovulation. Artificial insemination can also be used at this point.
• Another option for drug treatment is to take the diabetes drug metformin. The preparation enhances the effect of the body’s own insulin and improves the uptake of glucose into the cells. The overproduction of insulin and its negative impact on the function of the ovaries can be eliminated in this way. Combined treatment with metformin and clomiphene is the most effective in many cases.
• If the overproduction of androgens is being caused by the adrenal glands, there is an option to take an anti-inflammatory drug to regulate the overfunctioning.
• If other treatment options don’t help, surgery can destroy some of the ovarian tissue, thereby reducing androgen production. However, this treatment is rarely used and mostly used as a last resort.

Important: Even if the symptoms in some women are only very mild and they do not feel affected by them, a persistently changed hormone level can lead to long-term consequences such as diabetes, cardiovascular problems such as high blood pressure or heart attack, or uterine cancer. Detailed medical advice and early treatment of the symptoms are therefore highly recommended.

Further information

You can find more information about the causes of female and male infertility in our “ Infertility ” section. You can find more about natural methods to help you get pregnant in “ Getting pregnant ”. Methods of fertility medicine are described in more detail in ” Artificial Insemination “.