PCOS: Hormone disorder that many have but nobody knows about

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PCOS: Hormone disorder that many have but nobody knows about

The PCO syndrome is the most common hormonal disorder in women and can be one of the reasons for an unfulfilled desire to have children. Nevertheless, very few people know anything about it.

About every tenth young woman in Austria is affected by the PCO syndrome. However, many do not even know. The hormone imbalance occurs in women of childbearing age and can pose a problem when trying to conceive. However, there are good treatment options. We have gynecologist Dr. Johannes Seidel asked for the most important information about PCOS.
What does PCOS stand for and what exactly is it?

Johannes Seidel: PCOS stands for Polycystic Ovary Syndrome. It is one of the most common hormonal imbalances in younger women and is associated with the ovaries producing too many male sex hormones. This usually hinders or delays egg maturation, which in turn leads to delayed ovulation. As a result, women have longer cycles. There are all possible variations from bleeding every five to six weeks to every three months to menstrual bleeding that never occurs.

In general, we differentiate between different types of PCOS syndrome: The classic PCOS type is associated with being overweight, which is often accompanied by insulin resistance or a higher tendency to diabetes. This insulin resistance leads to more male sex hormones being produced, which worsens the typical symptoms of PCOS. It’s a bit of a vicious circle.

This also leads to these menstrual cycle disorders, less frequent bleeding or symptoms such as skin blemishes to acne, unwanted body hair to hair loss.

But slim women can also be affected?

Exactly, that’s the other variant. This is not associated with a tendency to diabetes, but here too there are disorders in the area of ??ovulation, significantly longer cycles and even no bleeding at all. If you ovulate less often and have longer cycles, it is of course only more difficult to get pregnant at that time.

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How is PCOS determined?

In principle, the exact hormone status is determined by taking a blood sample, the male sex hormones and female hormones in the blood are determined. Then you can also look at the insulin resistance and other blood values. This makes it easy to see whether there is a tendency to PCO or a PCO syndrome.

Another criterion is the ultrasound: there you can often see polycystic ovaries, i.e. a lot of follicles on the ovaries of the young women. The ovaries are often a bit enlarged and then you have many small follicles lined up like on a string of pearls. This is caused by many eggs growing up to ovulate but not bursting and then the next cohort grows up and the next. That’s why you have so many, which is clearly visible in the ultrasound.

It happens again and again that young women are wrongly diagnosed with PCO syndrome, precisely because many follicles are visible, so you really have to look at all the criteria carefully.

How can you treat PCOS? Does it necessarily have to be treated? A lot of women don’t even know they have it…

In itself, PCO is not dangerous. If a woman is not overweight and has no severe symptoms, there is no need for treatment. You have to treat it if she is suffering from symptoms such as severe skin blemishes, hair loss, etc. or if she wants to get pregnant but is not ovulating. Then you have to help.

And how?

In the case of overweight women, this can usually be managed well with lifestyle measures. Weight loss, exercise, diet. If she is struggling, you can also add certain substances such as metformin (also given for diabetes), which help to improve sugar metabolism, lower the male sex hormones in the blood and thus also get a more regular cycle together in the medium term.

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If women lose just ten percent of their body weight, the cycle often returns to normal. With slim young women, this is of course not possible with weight reduction.

How would that work?

A woman who does not want to have children but suffers from increased skin blemishes or increased body hair, for example, can be given the birth control pill, for example. The pill highly productively suppresses hormone production in the ovaries, including the production of male sex hormones. As a result, symptoms such as skin blemishes, unwanted body hair and hair loss become significantly better.

This is a measure that generally helps very quickly. However, it is not the case that the pill cures the PCO syndrome itself, but only improves the symptoms. This is a popular option for young women who are suffering and need contraception anyway.

What if she doesn’t want to take the pill?

Of course, there are also women who do not want to take birth control pills or hormonal contraceptives in general, or are perhaps so overweight that the pill itself poses a health risk. If you are overweight, as already mentioned, you should make sure that you lose weight, possibly with the addition of metformin.

A slim woman who has no insulin resistance and no diabetes tendencies will not be given metformin, it makes no sense. Often you don’t have to do anything here, it’s not dangerous in itself. It’s not a problem if she only ovulates three to four times a year and has consecutive menstrual bleeding.

If women only bleed very rarely but have normal estrogen levels, which is the case with PCO syndrome, and do not want to take the pill, they are given natural progesterone every three months so that the uterine lining bleeds. Otherwise, changes in the lining of the womb may develop over time, which are associated with a higher risk of non-benign changes in the lining of the womb.

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What if the patient wants to have children?

If she still ovulates here and there, she can of course try to get pregnant. That can definitely work. If she only very rarely bleeds and rarely ovulates, then you have to regulate it hormonally, which means that medication is administered for about four to five days from the first day of bleeding. The hormonal stimulation ensures that the ovary is stimulated to quickly produce an egg sac for ovulation.

The ultrasound control is important here in order to follow how the follicle grows. The couple must then have sexual intercourse in a timely manner. So these are several steps that usually lead to a positive result.

If it still doesn’t work, you can still support the whole thing with hormone injections that stimulate the ovary to produce a follicle.

What is the reason for being affected by PCO syndrome? Is that genetic?

That’s a good question. You really don’t know for sure. It is believed that there is a hereditary component – ??the weight component in particular, it is also hereditary in a way. It’s probably also related to lifestyle – lack of exercise, etc.

If young women have significantly longer cycles two or three years after the onset of the first menstrual period and are also overweight, it is advisable to start early, as the tendency to diabetes can increase. Basically, PCOS is nothing to worry about.

Do the symptoms go away on their own with menopause?

Exactly, with the menopause the whole thing is basically over, because you no longer have a cycle or ovulation. However, if women continue to be overweight and as a result have a tendency to diabetes or insulin resistance, this will of course continue to be an issue.

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