Polycystic ovary syndrome or PCOS

Polycystic ovary syndrome, PCOS for short, is an endocrine disorder that often occurs in women of fertile age.

It can lead to irregular menstrual cycles and infertility.
The PCOS can also change the appearance. If left untreated, serious health problems such as diabetes and heart disease can occur over time.

In most PCOS patients, many small cysts form in the ovaries.

Ovarian cysts can develop due to a variety of causes, even if sexual intercourse has not yet taken place.
To confirm the diagnosis of a PCO syndrome, it is mainly the symptoms that are decisive, rather than the appearance of cysts.
5-10% of all women of childbearing age suffer from polycystic ovary syndrome; PCOS is also one of the most important causes of infertility in women.
Symptoms may begin in adolescence with irregular menstrual cycles, but as long as there are no symptoms and/or infertility, a woman may not know about her condition.


What effect do hormones have on the menstrual cycle?

Men and women produce sex hormones, but in different amounts. In women, estrogen, progesterone and also androgens are formed in the ovaries. These hormones regulate a woman’s menstrual cycle and ovulation.
Although androgens are sometimes referred to as “male hormones,” they are also produced by every woman.
In women with polycystic ovary syndrome, the ovaries form an excess of androgens, which can interfere with the development and release of the egg. Instead of egg maturation, cysts can develop, which are small bubbles filled with fluid.
Instead of releasing the egg, as happens in a normal cycle during ovulation, the cysts that originate in the ovaries can grow. Since women with polycystic ovary syndrome cannot release an egg every month, irregular or absent menstrual bleeding is quite normal for them.

What are the causes of the PCO syndrome?

The causes of polycystic ovary syndrome are still largely unknown. Most experts are of the opinion that various factors can play a role in this disease, predisposition is one of them.
An important disorder associated with polycystic ovary syndrome is hormonal imbalance.
In women with PCOS, an excessive amount of androgens are produced by the ovaries.
Androgens are male hormones that are also produced by women.
The increased concentration of this hormone can affect the development and release of the egg during ovulation.

Scientists believe that insulin may be associated with PCO syndrome.
Insulin is a hormone that ensures that sugar is transported from the blood into the cells to gain the necessary energy.
Many women with PCOS have too much insulin in their bodies.
An excessive amount of insulin appears to stimulate androgen production. The excess of male hormones causes:

  • acne,
  • excessive hair growth,
  • Weight gain.

What symptoms does polycystic ovary syndrome cause?

Symptoms of PCOS can vary from woman to woman.
Typical symptoms include:

Infertility, i.e. pregnancy cannot occur due to the absence of ovulation.
PCO syndrome is the main cause of infertility (the woman is unable to conceive) and miscarriage.

Possible cycle disorders:

  • absence of periods (amenorrhea),
  • interval changes in the menstrual cycle (oligomenorrhea) and delayed menstrual bleeding,
  • bleeding regardless of ovulation,
  • male hair type (hirsutism), with increased hair growth, especially on the face, chest, stomach, back, thumb or toes,
  • ovarian cysts,
  • Acne, oily skin or dandruff,
  • hair loss or baldness,
  • pain in the ovaries,

Examinations and diagnosis of polycystic ovary syndrome

There is no special examination procedure for the definitive diagnosis of polycystic ovary syndrome. Diagnosis is made by exclusion.
The doctor takes into account all the signs and symptoms that arise, and then rules out other possible disorders.

At least two of the three characteristics must occur in order to diagnose the disease.

  • Polycystic ovary (12 or more follicles) at the edge of the ovaries or enlargement of the ovary.
  • Rare or missing ovulation.
  • Clinical or biochemical signs of androgen excess (hyperandrogenism).

When diagnosing, the doctor takes into account a variety of factors:

Medical history
The doctor analyzes irregularities of menstrual cycles and weight, as well as other symptoms.

Physical examination The physical examination
measures height, weight and blood pressure.

Gynecological examination During the gynaecological palpation examination
, the doctor pays attention to enlargements and elevations on the ovaries and other abnormalities of the reproductive organs.

Blood analysis
The blood test measures certain hormone levels to rule out other possible causes of irregular menstruation or excess androgens.
In addition, the cholesterol, triglyceride and blood sugar levels can be measured and the glucose tolerance test can be performed.

Ultrasound examination
An ultrasound examination of the ovaries indicates the appearance and thickness of the uterine lining. During the examination,
the doctor inserts the transducer directly into the vagina (transvaginal ultrasound).

Complications of PCO syndrome

Polycystic ovary syndrome is a serious disease, in some cases it can be dangerous due to the complications caused.

Rare (oligomenorrhea) or absent menstrual bleeding (amenorrhea) are known prerequisites for an increase in the volume of the uterine lining (endometrial hyperplasia) and for endometrial cancer if not treated.
The absence of bleeding should be caused by progestin therapy at least every 3 to 4 months.

Important are the risk factors for the heart and circulation, such as obesity, elevated androgen levels (hyperandrogenism), increased concentration of cholesterol, triglycerides and lipoproteins (hyperlipidemia) and elevated insulin levels (hyperinsulinemia).
For this reason, women with PCO syndrome are strongly recommended to lose weight, because the risk of developing cardiovascular disease is high.

PCOS patients have an increased risk of type 2 diabetes, especially in:

  • severe overweight,
  • a case of type 2 diabetes in the family,
  • from the age of 40,

Therefore, you should be examined.

Women with PCO syndrome may feel tired and sleepy throughout the day and snore at night; these symptoms may be caused by nocturnal respiratory arrest (sleep apnea).

Complications in pregnancy

PCOS patients have a greater risk of developing gestational diabetes, it can be more than twice as large.
If this disorder is present in women before pregnancy, should be tested before the 20th week of pregnancy whether gestational diabetes is present, in case of abnormalities a specialist should be consulted.
Women with polycystic ovary syndrome have an increased risk of premature birth and preeclampsia.


Unfortunately, polycystic ovary syndrome is not curable, but symptoms can be alleviated.
Depending on the symptoms, different treatment approaches are possible. Treatment options include:

  • Weight loss and healthy eating.
  • Hormone treatment, birth control pills or antiandrogens (drugs) can block the effect of male hormones on the body.
  • Diabetes drugs such as metformin are designed to increase the body’s insulin sensitivity.
  • Fertility-enhancing agents such as clomiphene; sometimes a more complex treatment is used, such as artificial insemination.
  • Eflornithine is a cream to stop excessive hair growth (hirsutism).
  • Surgery to treat the ovaries as part of a laparoscopy.

Other medications
If you are overweight, a slimming medicine can be taken, such as orlistat; however, here the possible contraindications and side effects must be noted.
If the cholesterol level in the blood is very high, the doctor may prescribe a cholesterol-lowering agent (statins), e.g. simvastatin. This medicine is not used in women who wish to have children.
The doctor may also recommend acne treatment.

Hormone therapy

Certain hormone preparations can block the action of the male hormones (e.g. testosterone) responsible for some symptoms of PCOS, especially excessive hair growth on the face and hair loss.
These drugs include:

  • Cyproterone acetate
  • Spironolactone
  • Flutamide
  • Finasteride

Hormonal treatment can also solve the problem of irregular or absent menstrual cycles.
The contraceptive pill can be used to induce regular menstrual cycles. This would also reduce the long-term risk of cancer of the uterine lining (endometrial cancer), which exists in the absence of bleeding.

Gonadotropins (hormones produced by the body that stimulate the ovaries) can be used in women for whom clomiphene (see below) has had no effect. However, gonadotropins can cause overstimulation of the ovary and lead to multiple pregnancies.
An alternative therapy is surgery (see below).

Clomiphene In women who wish to have children, the ovaries can be stimulated to induce ovulation with a drug called clomiphene
Clomiphene corrects hormonal imbalance and increases the likelihood of ovulation and thus fertility.

Diabetes medications
The diabetes drug metformin has a positive effect on ovulation in women with PCOS, along with other therapies.
In addition, the health risks associated with insulin resistance can be reduced, as well as the effects of male hormone excess. It can be taken together with clomiphene.
However, metformin is not a weight loss medication.

Eflornithine Eflornithine
is a cream that inhibits the action of an enzyme present in the hair follicles and necessary for hair growth.
The cream slows down the unwanted hair growth on the face, which can occur as a symptom of PCOS.
However, it does not remove facial hair, so it could be used together with a hair removal product.
Improvement is visible 4 to 8 weeks after treatment.


A minimally invasive surgical procedure as part of a laparoscopy is a treatment option.
Under general anesthesia, the doctor makes a small incision in the lower abdomen and inserts a long tool (laparoscope).
The ovaries are then surgically treated with heat or a laser.
The goal is to destroy the tissue that produces the male hormones (androgens).
The laparoscopic procedure is designed to lower the levels of testosterone and luteinizing hormone and increase the concentration of follicle-stimulating hormones. The operation corrects the hormonal imbalance and thus restores the normal functioning of the ovaries.

Natural remedies for polycystic ovary syndrome

In overweight women, PCOS-related symptoms and the possible long-term consequences of weight loss can be significantly reduced.
Losing weight reduces the amount of insulin that the body has to produce.
This lowers testosterone levels and increases the possibility of ovulation.
Menstrual problems and fertility improve, excessive hair growth subsides.
The easiest way to lose weight is through healthier eating habits and exercise, 45-60 minutes a day should be performed aerobic exercises.
The doctor may refer the patient to a nutritionist who will create a meaningful diet plan.
Even a weight loss of 5% can bring about a significant improvement in polycystic ovary syndrome.

Natural remedies include:

  • Acupuncture, because it stimulates female fertility.
  • Chasteberry acts on the pituitary gland (pituitary gland) and can promote the production of luteinizing hormone (LH) and reduce the release of follicle maturation hormone (FSH) in the blood.

Food supplement with vitamin B and folic acid

There are scientific studies that show that myo-inositol, which comes from the vitamin B group, together with folic acid, can reduce symptoms for the following reasons:

  • It promotes the action of insulin – a hormone that transports glucose into the cells and thus lowers blood sugar levels.
  • It regulates the level of androgens in the blood.

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