PCO syndrome

Overview: What is PCO syndrome?

PCO syndrome occurs in around 6 to 18 percent of all women of childbearing age. Nevertheless, the disease is often not recognized because it does not present itself in a clear and uniform way. In order to be able to make a diagnosis of polycystic ovary syndrome, various symptoms are queried or examined. PCOS can only be diagnosed if at least two of the following three characteristics are present – provided that other diseases with similar symptoms (known as differential diagnoses) have been ruled out beforehand:

• Disturbed menstrual cycle: This means either missing periods or irregular (i.e. more than 35 days between periods) or, more rarely, significantly shortened cycles (i.e. less than 21 days between periods).
• Excess male hormones (androgens) in the blood or increased hair growth in areas of the body that are atypical for women (so-called male hair type / hirsutism).
• Polycystic ovaries (ovaries). This means that in at least one of the two ovaries, more than 20 fluid-filled follicles with a diameter of up to 9 millimeters can be counted. Another ultrasound criterion for the diagnosis is at least one ovary with a volume greater than 10 milliliters.

The vesicles in the ovaries are not “cysts”, even though this term originally gave the disease its name. These are growing follicles that contain a mature egg cell at the end of the process. Although PCO syndrome often remains undiagnosed, the reverse case of misdiagnosis is also not uncommon. Careful diagnostics with recording of the cycle duration, ultrasound examination of the ovaries, physical examination with a special focus on the hair and blood tests are therefore important. Before a definitive diagnosis of PCO syndrome can be made, other causes must be ruled out. For example, irregular periods or an increased androgen level, which are caused by other disorders. It must also be ensured that no disease of the pituitary gland, adrenal cortex or other ovarian disease is responsible for the symptoms.

PCO syndrome: What are the causes?

The exact cause of polycystic ovary syndrome is not yet fully understood. As the disease occurs more frequently in some families, genetic factors probably play a role in its development. Studies have shown that an above-average number of women whose mothers have also been diagnosed with PCOS are affected. The affected women often have fathers who developed hormone-induced baldness at an early age. It is also possible that hormonal influences in the womb are involved in a newborn girl later developing polycystic ovary syndrome. The disease is triggered by a disruption in the body’s own regulatory mechanisms. It is currently unclear whether the cause is primarily the ovary or the sugar metabolism, or both. The central regulation of the pituitary gland (hypophysis) also shows abnormalities in the secretion of the hormones that control the menstrual cycle: the so-called luteinizing hormone (LH) is secreted more in relation to the follicle stimulating hormone (FSH). FSH is crucially responsible for the healthy development of egg cells in the female organism. Studies show that a large proportion of women with PCOS – regardless of whether they are overweight or of normal weight – have a disturbed insulin metabolism. Increased insulin secretion can increase the production of male hormones, as well as the release of luteinizing hormone from the pituitary gland and promote the development of obesity.

Symptoms: How does PCO syndrome manifest itself?

The signs of PCOS are very diverse and often vary greatly from person to person. You may only feel a few physical changes, but the symptoms can also be very pronounced. This makes it difficult to reliably diagnose the disease.

• The majority of affected women experience irregular or absent periods. As the interaction of the female hormones is disrupted and women with PCOS ovulate less frequently or not at all, it can be difficult to get pregnant or PCOS can lead to (very treatable) infertility due to the lack of ovulation.
• Due to cycle disorders, affected women often need support to make their wish for a child come true.
• During an ultrasound examination, your doctor will usually detect an increased number of follicles and/or an enlarged ovary.
• Furthermore, a high proportion of women with PCO syndrome are insulin resistant. This means that your body cells do not react sensitively enough to the hormone insulin. The cells therefore absorb less sugar (glucose) from the blood, causing the blood sugar level to rise. In order to regulate blood sugar, the high glucose level signals the pancreas to produce even more insulin. The risk of developing diabetes (type 2) also increases. The sugar metabolism disorder is found particularly, but not exclusively, in overweight PCOS patients.
• The chronically elevated insulin level promotes the increased production of male hormones (androgens) already caused by the high number of small follicles. A common consequence is that affected women develop more hair on their face, stomach, back or pubic area. Acne and oily skin are also common symptoms.
• The majority of women with the disease are overweight or have difficulty keeping their weight down. Obesity has an amplifying effect on the hormonal changes in PCO syndrome. Many PCOS patients develop a non-alcoholic fatty liver.
• Many women affected by PCO syndrome experience their illness as psychologically stressful. It is not uncommon for anxiety and emotional upsets or even depression to occur.
• If the patient wishes to have children, delayed pregnancy is often an additional burden. However, there are very effective aids that also make pregnancy possible. Fertility specialists know best about support options.

In order to be able to offer you the most modern and effective treatment options for these symptoms, there is a center for PCOS at the University Hospital Zurich where specialists from internal medicine, reproductive medicine, nutritionists, sports physicians, physiotherapists, dermatologists and psychiatrists will put together a treatment concept tailored to your needs. We are also working on various research projects at this center to further improve the detection and treatment options for PCOS.

Prognosis: How does PCO syndrome progress?

PCOS is one of the most common hormonal disorders in women. Polycystic ovary syndrome usually occurs between the ages of 20 and 30 (sometimes even earlier). In addition to menstrual irregularities, unwanted hair growth and acne often lead to a visit to the doctor. However, the disease may not be diagnosed until an expected pregnancy fails to materialize. At the same time, however, PCO syndrome also has the advantage that, due to the above-average egg reserve in women with PCOS, fertility is maintained somewhat longer than would be expected against the background of biological age. Women with PCOS therefore typically enter the menopause later.

Treatment: How is PCO syndrome treated?

Polycystic ovary syndrome cannot be cured, but accompanies those affected for the rest of their lives. However, your doctor can treat symptoms and sequelae well:

Treating PCO syndrome with the contraceptive pill

The hormonal imbalance in PCOS patients can often be regulated by taking the contraceptive pill . It can also reduce the production of male hormones and the resulting changes (acne, strong body hair). However, be sure to ask your doctor for the right preparation. Not every pill works optimally for PCO syndrome. If the pill alone is not enough, there are additional medications that can further reduce male hormones.

Other medications for PCOS

The active ingredient metformin has the effect of increasing sensitivity to insulin and lowering blood sugar levels. Metformin can also help with weight loss and the reduction of male hormones. The active ingredients letrozole and clomiphene promote the maturation of follicles and ovulation; this increases fertility and therefore the chance of pregnancy. Studies have shown that combined therapy with metformin and letrozole is particularly effective. However, both medications must be prescribed by a doctor and regular ultrasound checks must be carried out, especially when taking ovulation-promoting medication. The natural active ingredient inositol can also help by regulating the hormone balance. The current study situation promises a similarly good effect as metformin. However, more studies are needed for widespread use.

Laparoscopic Ovarian Drilling

The removal of excess follicles is intended to normalize the menstrual cycle, which is out of sync, and the overproduction of male hormones. With the help of an electric needle or laser, they can usually be reduced in a targeted manner during a laparoscopy. The normalization of the follicle count achieved in this way should also lead to a normalization of the cycle and ovulation. This procedure is called drilling (internationally often: laparoscopic ovarian drilling, LOD for short). It is usually only used as a PCOS therapy if treatment of the hormonal disorder is unsuccessful and is rarely necessary.

A healthy lifestyle can reduce PCOS symptoms

Regular exercise can help to reduce excess weight. Adequate nutrition is another important factor. Patients suffering from PCO syndrome often experience a reduction in their symptoms as a result of weight loss. The likelihood of having children despite PCOS also increases: a weight reduction of just five percent leads to improved fertility and more regular cycles. A healthy diet leads to a lower release of insulin. This normalization of the blood sugar level often noticeably reduces the symptoms of the disease. It is important to have your sugar metabolism checked regularly, usually once a year. Successful treatment of polycystic ovary syndrome

• the balance of hormones is restored.
• menstrual cycles become more frequent and regular.
• the body’s cells react more sensitively to insulin. This also allows the pancreas to recover and reduce insulin production to a normal level. This in turn reduces the likelihood of developing diabetes.
• blood lipid levels and blood pressure also improve.
• a fatty liver that may have developed can regress.

All this also increases fertility and the chance of pregnancy despite the PCO syndrome diagnosis.

PCOS and the desire to have children

If you are a PCOS patient and wish to become pregnant, you should discuss this with your doctor at an early stage. The goal of bringing about egg maturation in the natural cycle can be well supported medically, but often takes some time. It therefore makes sense to start medical support sooner rather than later. Sometimes it is not possible to bring a single egg to maturity without other eggs also starting the maturation process. As there is no wish to run the risk of a higher-grade multiple pregnancy, such treatment cycles are discontinued and a new attempt is made. If it is not possible to bring a maximum of 2 eggs to maturity at the same time, artificial insemination may be an alternative. In this case, the possibility is used to bring a larger number of eggs to maturity in parallel, thus creating a reserve for several attempts to become pregnant or, in the best case, to create the conditions for the entire family planning with one treatment. Artificial insemination – technically known as in vitro fertilization (IVF) or – if the sperm must be injected directly into the egg due to limited sperm quality – intracytoplasmic sperm injection (ICSI) should be carried out in a fertility clinic with many years of experience. This is the case at the Fertility Center of the University Hospital Zurich – here you can expect not only state-of-the-art technology, but also constant personal care that is precisely tailored to your needs.

Many young women who suffer from polycystic ovary syndrome fear that they may not be able to have children – and feel stressed at the thought. This is where a consultation can help you by informing you about PCOS and its effects on your health, including fertility. To reassure you: Even with PCOS, you have excellent prospects of fulfilling your wish for a child – even if you may need some support along the way. A large Swedish study of more than 45,000 PCOS patients found that they were on average one year older at the birth of their first child than women without PCO syndrome. But they had a baby just as often.