Polycystic ovarian syndrome
Polycystic ovarian syndrome (PCOS in short) is a common hormonal disorder affecting up to 18% of all women.
It often results in a menstrual cycle of more than 35 days or less than 21 days, as ovulation occurs less frequently or not at all.
PCOS can also be associated with an excess of male hormones, which often results in increased body hair or hair loss.
Obesity is also a common side effect of PCO syndrome, as insulin resistance may be present.
The consultation process often proceeds as follows:
The ultrasound shows more than 20 fluid-filled follicles in at least one of the two ovaries and the ovary is enlarged.
A blood sample is taken at the beginning of the cycle on days 3-5, during which the hormones are analysed and an imbalance can be detected. Typical for PCOS would be an increased testosterone level, an LH > FSH level, which corresponds to the situation in the body of constantly ovulating, which is why the follicles do not grow. There is also often an elevated AMH (anti-Mullerian hormone).
Insulin and sugar levels must also be checked if these signs are present. This is done using the HOMA / index of fasting insulin and sugar in the blood to rule out insulin resistance or incipient diabetes mellitus.
Now the question is: what to do?
This depends on whether there is a desire to have children or not:
If there is no desire to have children, it is advantageous to take a pill, a progestogen-only pill or an oestrogen/progestogen pill, or even a hormonal coil, to ensure regular cycles and regular remodelling of the lining of the uterus.
If you want to have children, you need to have an ultrasound scan to check whether or not you are ovulating and, if ovulation is detected, have targeted sexual intercourse.
If there is no ovulation, it can be induced with e.g. Letrozole or Clomiphene or F-Gonal and then triggered. However, you have to ask your health insurance company beforehand, but this is usually covered.
In addition, taking metformin or inositol can lower blood sugar levels, which helps with weight loss. This alone often leads to ovulatory cycles (cycles with ovulation). You still need to have your sugar level checked annually.
Of course, nutritional advice and regular exercise are also an important pillar in the treatment of PCOS and the stabilisation of the sugar balance.
A last option, but one that is rarely used, is a laparoscopy in which the ovaries are treated specifically to mechanically reduce the number of follicles. It is called ovarian drilling and is only used in very stubborn cases.
CONCLUSION:
Do not be afraid of PCOS or of being diagnosed with it. Go to the gynaecologist and address the issue. Diagnosis and therapy are important and absolutely feasible.
