Polycystic ovarian syndrome E28.2

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 01.01.2022

Synonym(s)

CHA; Chronic hyperandrogenemic anovulation; FOHA; Functional ovarian hyperandrogenemia; PCOD; PCOS; PCO Syndrome; Polycystic ovarian disease; polycystic ovaries; Polycystic ovary syndrome; Stein-Leventhal Syndrome

Definition
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Acronym for "Polycystic ovary syndrome." PCOS is one of the most common metabolic disorders of sexually mature women, which is triggered by different pathogenetic mechanisms. It is the most common cause of increased androgen levels (hyperandrogenism), cycle disorders and infertility in women.

Occurrence/Epidemiology
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Occurs in 4-12% of women of childbearing age. Most common hormonal disorder in women of this age group as well as the most common cause of infertility due to cycle disorders.

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Etiopathogenesis
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The pathogenesis is not fully understood. An increased serum concentration of LH combined with normal FSH can be detected in many, though not all cases. Presumably, a hyaline thickening of the basal lamina leads to an FSH resistance of the granulosa cells of the ovary and to a permanent stimulation of the LH secretion (consequence: increase of androgen production).

Manifestation
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Occurs exclusively in women. Overweight women are significantly more frequently affected.

Clinical features
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According to the criteria of the conference of the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM), a PCO syndrome is present if 2 of 3 of the following criteria are met:

Polycystic ovaries (whether polycystic ovaries are present can be determined by the gynaecologist using ultrasound diagnostics).
Oligo- and/or anovulation - chronic cycle disturbances in the form of oligo-/amorrhoea.
Virilisation (clinical sign of hyperandrogenism); exclusion of other diseases of the pituitary gland, adrenal gland and ovary should be requested.

Clinically, virilization manifests itself as seborrhoea, acne vulgaris (up to 30%), syndrome-specific hirsutism or as androgenic alopecia.

Laboratory
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Increased levels of testosterone, androstendione, dehydroepiandrosterone sulphate and prolactin. LH/FSH ratio: > 2 (not necessarily present).

Diagnosis
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Endocrinological examination.

Differential diagnosis
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S.a. HAIR-AN syndrome; SAHA syndrome

Therapy
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The therapy is carried out in cooperation with a gynecologist. In the foreground are weight normalization, reduction of insulin resistance, antiandrogenic therapy aimed at lowering the androgen level. To protect the endometrium, especially if it is already thickened, treatment with progesterone may also be indicated.

As insulin plays an important role in the disease process, the diabetes drug metformin (2x1000mg/day, depending on body weight) is often recommended as an off-label-use, which improves the response of the body's cells to insulin and thus also increases the ovulation rate. This measure is an option especially if there is an unfulfilled desire to have children.

Naturopathically, evening primrose oil 500, 60 capsules (3 packs for 3 months) is recommended. This is to treat estrogen dominance.

Diet for PCO syndrome: The most important treatment for PCO syndrome is a reduction in body weight. This will decrease the excessive androgen levels and improve ovarian function. Furthermore, weight reduction has a positive effect on the insulin sensitivity of the body's cells: insulin resistance decreases and the elevated insulin level decreases. Most effective is a change of eating habits towards a low-calorie, low-carbohydrate and high-fibre diet.

In clinically manifest acne, the usual therapeutic applications of acne are considered.

Note(s)
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It is known that insulin can stimulate ovarian androgen production. Therefore, insulin resistance with subsequent hyperinsulinemia (excessive insulin production) is becoming increasingly important in the pathogenesis of PCOS. Hyperinsulinemia also increases the amount of free testosterone by reducing the synthesis of sex hormone-binding globulin (SHBG) in the liver and thus increases the effect on the androgen receptor.