Polycystic ovary syndrome: symptoms, testing and treatment

PCOS is a hormonal disorder that affects women. But what is PCOS exactly? PCOS stands for “polycystic ovary syndrome”. Despite the name, PCOS does not cause cysts. Instead, the condition causes multiple egg cells to develop at the same time. How many women suffer from PCOS? The condition affects between 6% and 18% of women of childbearing age.

The direct cause of PCOS is a hormonal imbalance, particularly of the sex hormones. We do not conclusively know how this imbalance comes about, but there are a number of potential triggers that may combine to cause the condition:

• Genetic factors: research shows that women with PCOS often pass it on to their children. Their fathers also often go bald at a young age due to hormonal factors.
• Sugar metabolism: PCOS is often associated with an impaired sugar metabolism. This affects the regulation of hormones and stimulates the production of androgens, i.e. male sex hormones.
• Impaired hormone regulation: PCOS leads to dysregulation in the pituitary gland, which affects the development of egg cells.
• Insulin resistance: many women with PCOS are insulin-resistant. Their cells are less responsive to insulin, which causes their bodies to produce more of the hormone. This stimulates the release of male hormones in the ovaries, and aggravates the symptoms of PCOS.
• Chronic stress: although stress alone is not a direct cause of PCOS, it may impact the health of women who suffer from the condition. This is because it exacerbates the hormonal imbalance and aggravates other symptoms of PCOS such as abnormal menstruation or insulin resistance.
• Being overweight: many overweight people suffer from insulin resistance or sugar metabolism disorders, both of which are potential triggers for PCOS. Being overweight may therefore be an indirect cause of PCOS.
  

PCOS causes a variety of different symptoms:

• Male physique: PCOS often gives women a figure with male proportions. This is because of the increased levels of androgens in the body.
• Hair loss: the high androgen levels lead to hair loss in some cases of PCOS.
• Male body hair: in many instances, PCOS leads to stronger body hair growth. Sufferers experience pronounced hair growth on their chest, back, thighs, pubic area and face. This is also due to the male sex hormones.
• Skin changes: PCOS increases the risk of acne, because androgens stimulate the production of sebum. Dark skin discolourations may also appear on the neck, armpits and crotch as a result of raised insulin levels.
• Pain: PCOS can sometimes cause headaches. It doesn’t usually cause abdominal pain, however.
• Being overweight: the symptoms of PCOS also include excessive weight gain, which may exacerbate existing symptoms. Being overweight is also considered a possible (albeit indirect) cause of PCOS.
• Liver disease: in certain cases, PCOS can lead to non-alcoholic fatty liver disease. If left untreated, this can lead to cirrhosis of the liver.
• Irregular cycle: PCOS is typically associated with irregular periods and ovulation. Women with PCOS may also experience PMS when menstruating. However, some women with PCOS never get their period. Others experience anovulatory cycles, i.e. cycles in which ovulation does not occur. These women are unable to conceive.
• Psychological symptoms: PCOS also affects sufferers’ mental health, with potential symptoms including anxiety and low moods. PCOS can also cause depression, as many sufferers find the symptoms irksome.
• Lack of libido: PCOS is often associated with a low sex drive. Sufferers feel unattractive because of the changes in their body such as excess body hair, being overweight or acne. The mental strain also contributes to this loss of libido.
• Increased risk of diabetes: Because they frequently also suffer from insulin resistance, women with PCOS often have an increased risk of developing type 2 diabetes. 

By the way, although the symptoms of PCOS are not life-threatening, they are a risk factor for cardiovascular disease, diabetes and depression. It is not clear whether PCOS has a direct impact on life expectancy.

The test for PCOS involves multiple steps. First of all, the doctor will enquire about your medical history, as well as symptoms such as an irregular cycle or strong body hair growth. In order to diagnose PCOS, they will also perform an ultrasound scan of the ovaries. A blood test will additionally be carried out if PCOS is suspected. The hormone and blood sugar levels are particularly important in this regard. Patients with polycystic ovary syndrome have elevated levels of androgens and blood sugar. The level of luteinising hormone (LH) is also higher than normal. 

A reliable diagnosis can be made if at least two of the PCOS symptoms described below are identified and diseases with similar symptoms can be ruled out:

• Irregular menstrual cycle: you don’t get your period or at least 36 days pass between periods. A shortened cycle, when you get your period every 20 days or less, is also possible, but rare.
• Excess androgen: this manifests itself in the form of raised hormone levels in the blood or hirsutism.
• Polycystic ovaries: at least one ovary contains more than 20 fluid-filled follicles. These are small sacs inside the ovaries in which egg cells mature. In cases of PCOS, they can be up to 9 millimetres in size. Another characteristic is an ovary volume of over 10 millimetres.

It’s worth noting that even women with regular periods may have PCOS if they have excess androgen and polycystic ovaries. 

There is no cure for PCOS, but there are a number of different ways to treat it. From lifestyle changes to medical therapies, PCOS can be treated with a wide range of measures that could potentially provide relief. 

Treating PCOS: diet, exercise and mental health

Diet plays an important role in the treatment of PCOS, particularly if sufferers are overweight or insulin-resistant. In these cases, losing just 5% of your body weight can ameliorate the symptoms of PCOS. A balanced diet includes:

• Vegetables: eat a portion of vegetables with every meal. One portion is around 120g.
• Fruit: fruit is also part of a balanced diet, but you should only eat bananas and grapes occasionally. You should also avoid smoothies if possible on account of the large amounts of sugar they contain.
• Protein: incorporate sources of protein into your meal plan. These include dairy products, meat, and pulses such as lentils and chickpeas.
• Fibre: you should ideally avoid products made from white flour. Opt for alternatives made using wholegrains instead.
• Fluids: drink between two and two and a half litres of water or unsweetened tea every day. Only drink sweetened drinks on rare occasions.
• Sugar: reduce the amount of sugar you consume as much as possible. A small amount of sweet treats each day is plenty, and you should ideally eat them after your main meal.
• Breaks between meals: eat three meals a day, and try not to snack in between because that raises your blood sugar levels. Experts recommend not eating for a twelve-hour period, and during the other twelve hours you should try to eat a balanced diet. 

Some symptoms of PCOS, such as strong body hair growth, being overweight and insulin resistance, have a significant impact on the women who suffer from them. Not only do they cause physical problems, but they can also lead to anxiety, low mood and stress. Social interactions, relaxation and exercise help alleviate these symptoms, 

• so maintain your friendships and contact with acquaintances. Good social contact is beneficial to your well-being and health.
• Try exercises such as progressive muscle relaxation or autogenic training. These relax the body and reduce stress.
• Exercise regularly. Sport and exercise reduce your levels of stress hormones and boost well-being. 

For those with PCOS, another reason why sport can help alleviate the condition is that it helps with weight loss. You should ideally get at least two and a half hours of moderate to intense exercise every week. 

PCOS can cause anxiety or depression in some cases. Talk to your GP if you think that you could be affected.

PCOS: medical treatment

Medical treatment is very important in cases of PCOS. Various different approaches have proven to be effective.

• Treating PCOS with the pill: doctors often prescribe the contraceptive pill to treat PCOS, as this can inhibit the production of androgens. This means that it can stop hair loss due to PCOS, for example. It can also treat PCOS-related acne.
• Treating PCOS with other medications: other medications can be used to treat PCOS. These may contain biguanides, for example, which make the body more sensitive to insulin and reduce blood sugar levels. These medications may also support weight loss and the inhibition of androgens.
• Laparoscopic ovarian drilling (LOD): with this treatment, the doctor removes surplus follicles using an electric needle or laser. The procedure is usually performed during a laparoscopy. It normalises the patient’s cycle, and regulates the production of male hormones. Specialists perform LOD when other treatments have proven ineffective.
  

PCOS: household remedies

Some women report positive experiences with black cohosh, berberine and chaste tree for treating PCOS. Talk to your doctor before trying these or other remedies. You should ideally use household remedies alongside rather than instead of your PCOS treatment.

PCOS makes life a challenge for many who suffer from it, but there are effective ways to alleviate the symptoms. Talk to your doctor to find the treatment that suits you best.