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Diagnosis and Conservative treatment of Hormonal Disorder in Women With Polycystic Ovaries Disease in Germany

University Hospital Rechts der Isar Munich

9.8/10
location_onGermany, Munich

Department of Gynecology, Mammology and Obstetrics

The Department of Gynecology, Mammology and Obstetrics offers the full range of services in these fields, providing patients with the optimal treatment based on the very latest scientific advances and innovative technologies. The department's tasks include diagnostics and treatment of all gynecologic diseases and breast pathologies, as well as pregnancy management, childbirth and postnatal care for both mother and baby, elimination of fertility problems in women. The department has modern equipment for invasive and non-invasive diagnostics, three operating rooms equipped with state-of-the-art technology, especially in the field of minimally invasive and robot-assisted surgery, as well as special devices for microsurgery and fetal surgery. A competent medical team consisting of 18 senior physicians, 25 assistant physicians and medical specialists, obstetricians and specially trained nursing staff annually admits approximately 5,000 women for inpatient treatment and provides outpatient medical care for 14,000 patients. In addition, the department has four maternity rooms, in which about 2,000 babies are born annually.

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University Hospital Tuebingen

9.2/10
location_onGermany, Tuebingen

Department of Adult and Pediatric Gynecology, Mammology, Obstetrics

According to the Focus magazine, the Department of Adult and Pediatric Gynecology, Mammology, Obstetrics is included in the ranking of the top German departments specializing in obstetrics and breast cancer treatment! The department offers the full range of diagnostics and treatment of diseases of the female reproductive system, breast pathologies. Also, the specialists of the department provide a comprehensive management of pregnancy, childbirth and postpartum care for both mother and child. Key attention is paid to the treatment of female genital cancers, as well as breast cancer treatment. For this purpose, the department has all the modern therapeutic techniques, as well as its our own innovative developments by the department doctors.

University Hospital Ulm

8.7/10
location_onGermany, Ulm

Department of Obstetrics, Adult and Pediatric Gynecology

The Department of Obstetrics, Adult and Pediatric Gynecology offers the full range of services in these fields and specializes in the diagnostics and treatment of general gynecological diseases, oncological diseases of the female reproductive system, breast, endometrial pathologies and urinary incontinence. In the clinical practice, only proven accurate diagnostic methods and effective therapeutic measures are used. In addition, the department is the Level I Perinatal Center, in which about 3,000 babies are born annually.

University Hospital Carl Gustav Carus Dresden

9.1/10
location_onGermany, Dresden

Department of Adult and Pediatric Gynecology, Mammology, Obstetrics and Reproductive Medicine

The Department of Adult and Pediatric Gynecology, Mammology, Obstetrics and Reproductive Medicine offers the full range of surgical and conservative treatment of pathologies of the female reproductive system, breast, as well as top-class obstetric services, including management of birth and postnatal care for both mother and baby. The department also has a Center for Reproductive Medicine, where one can undergo comprehensive diagnostics to detect the causes of infertility and use modern assisted reproductive technologies. The department's excellent technical equipment, highly qualified medical staff and the availability of advanced treatment methods allow providing optimal and individualized treatment at the highest level. The treatment of female reproductive cancers is of primary interest to the department's gynecologists. The department also admits girls and young women with congenital anomalies of the genital organs, menstrual disorders, delayed or premature puberty.

University Hospital Frankfurt am Main

10/10
location_onGermany, Frankfurt am Main

Department of Adult and Pediatric Gynecology, Obstetrics and Mammology

According to the Focus magazine, the Department of Adult and Pediatric Gynecology, Obstetrics and Mammology ranks among the top German departments specializing in the provision of obstetric services and breast cancer treatment! The department offers all diagnostic and therapeutic options for patients of all ages with diseases of the female reproductive system, mammary gland, as well as provides the comprehensive pregnancy management, childbirth and postpartum care in accordance with the highest standards of modern obstetrics. One of the priority focuses of the department’s work is the treatment of oncopathology in women. All specialists have excellent qualifications and tremendous experience, and therefore they achieve successful results even in extremely difficult clinical cases.

Charite University Hospital Berlin

9/10
location_onGermany, Berlin

Department of Adult and Pediatric Gynecology, Mammology

According to the Focus magazine, the Department of Adult and Pediatric Gynecology, Mammology ranks among the top German medical facilities in the fields of its specialization! The department offers all options of modern medicine for the diagnostics and treatment of diseases of the female reproductive organs and breast. Of particular interest is the treatment of cancers of the female reproductive organs and breast (certification of the German Cancer Society). In addition, the department's doctors have exceptional competence in the treatment of gynecological problems in children of all age groups, including surgical correction of congenital malformations of the reproductive organs. The department is proud of its outstanding treatment results achieved thanks to the professional skills of doctors and excellent technical base.

University Hospital Heidelberg

9.8/10
location_onGermany, Heidelberg

Department of Obstetrics, Adult and Pediatric Gynecology

According to the Focus magazine, the Department of Obstetrics, Adult and Pediatric Gynecology ranks among the top departments in Germany specializing in obstetrics and breast cancer treatment! The department offers the full range of diagnostics and treatment of diseases of the female genital organs, as well as provides first-class obstetric services, prenatal diagnostics and comprehensive management of pregnancy, including high-risk pregnancy. As part of the National Cancer Center (NCT), the department ensures an individualized, interdisciplinary treatment of female oncopathology. All the therapeutic measures carried out by the doctors of the department meet the highest international standards. 

University Hospital of Ludwig Maximilian University of Munich

10/10
location_onGermany, Munich

Department of Obstetrics, Adult and Pediatric Gynecology

The Department of Obstetrics, Adult and Pediatric Gynecology offers the full range of preventive, diagnostic, and therapeutic services for girls and women. The department treats general gynecologic diseases, precancerous conditions, and cancers of the female reproductive system. It also provides medical care to patients with hormonal disorders caused by gynecologic diseases and infertility. The medical facility also offers top-class obstetric services for pregnancy, childbirth, and postpartum care. In addition, the department's gynecologists admit girls and young women with gynecologic problems and puberty disorders. The medical team specializes in conservative and surgical treatment, while almost all surgical procedures are performed using minimally invasive techniques. The department is awarded quality certificates for the treatment of endometriosis, cervical dysplasia, ovarian cancer, and other pathologies. More and more women entrust their health to the department's gynecologists every year, which also indicates the highest level of medical service.

University Hospital Erlangen

9.1/10
location_onGermany, Erlangen

Department of Adult and Pediatric Gynecology, Mammology, Obstetrics

According to the Focus magazine, the Department of Adult and Pediatric Gynecology, Mammology, Obstetrics ranks among the top German departments specializing in obstetrics and breast cancer treatment! The department offers the full range of services in the areas of its specialization and is one of the largest medical facilities of this kind in Germany. Of particular interest is the treatment of cancers of the female reproductive system, including breast cancer, medical care for hormonal imbalance of gynecological genesis, treatment of urinary incontinence and pelvic organ prolapse in women, top-class obstetric care and integrated pregnancy management. In addition, the department's gynecologists admit women suffering from infertility. They can undergo comprehensive diagnostics of the reproductive system and the further required therapeutic manipulations, such as uterine fibroid removal, treatment of endometriosis and other pathologies, which prevent the conception of a child. The department also specializes in the treatment of congenital malformations and acquired gynecological diseases in children. The highly qualified team of doctors with colossal experience, who keep pace with advanced innovations in medicine, take care of the patients' health. The specialists do everything possible to restore the health of patients, taking into account their needs and wishes.

University Hospital Halle (Saale)

9.6/10
location_onGermany, Halle

Department of Gynecology and Mammology

According to the Focus magazine, the Department of Gynecology and Mammology ranks among the top German departments specializing in breast cancer treatment! The department offers the full range of accurate diagnostics, conservative and surgical treatment of diseases of the female reproductive system, breast. The department’s state-of-art infrastructure, advanced diagnostic equipment and the highest professionalism of doctors allow for the achievement of excellent treatment results.

University Hospital Hamburg-Eppendorf

9.2/10
location_onGermany, Hamburg

Department of Gynecology and Mammology

According to the Focus magazine, the Department of Gynecology and Mammology ranks among the top German departments specializing in breast cancer treatment! The department offers the full range of diagnostic and therapeutic services in its areas of specialization. Due to its successful clinical activities, the department has the status of a supraregional Competence Center for Surgical and Conservative Gynecologic Oncology, as well as of the leading Breast Cancer Center. All therapeutic measures meet the modern standards of both national and international specialized societies.

University Hospital Würzburg

9.2/10
location_onGermany, Würzburg

Department of Adult and Pediatric Gynecology, Mammology and Obstetrics

The Department of Adult and Pediatric Gynecology, Mammology and Obstetrics offers the diagnostics and treatment of all gynecological diseases. The department specializes in the treatment of breast cancer and cancer of the female reproductive organs. All traditional and modern conservative and surgical methods are used for this purpose. The department also provides reliable and individual obstetric services at the Center for Mother and Child and offers all methods of prenatal diagnostics.

University Hospital RWTH Aachen

8.9/10
location_onGermany, Aachen

Department of Gynecology, Mammology and Obstetrics

According to the Focus magazine, the Department of Gynecology, Mammology and Obstetrics ranks among the top German medical facilities specializing in breast cancer treatment and provision of obstetric services! The department provides all modern medical services in the fields of its specialization. The gynecologists treat both general and oncological diseases of the female reproductive sphere. Should surgical treatment be required, minimally invasive techniques will be used. The department's mammologists specialize in the treatment of breast cancer using all the classic and innovative therapeutic options. The department is also the Level I Perinatal Center, in which the patient receives the highest quality pregnancy management, comfortable childbirth and postpartum care.

University Hospital Duesseldorf

9.5/10
location_onGermany, Duesseldorf

Department of Adult and Pediatric Gynecology, Obstetrics and Mammology

According to the Focus magazine rating, the Department of Adult and Pediatric Gynecology, Obstetrics and Mammology ranks among the top German departments specializing in breast cancer treatment! The department offers the full range of services in these medical fields. In the field of gynecology, it provides the diagnostics and treatment of all pathologies of the female reproductive system, including the gynecological problems in girls aged from 0 to 18 years. The department's obstetricians provide quality care for expectant mothers before, during and after pregnancy. The department's scope of activities also includes the management of high-risk pregnancies. The key focus of clinical activities is the treatment of oncological diseases of the female genital organs, including breast cancer.

University Hospital Muenster

9.8/10
location_onGermany, Muenster

Department of Adult and Pediatric Gynecology, Obstetrics

According to the Focus magazine, the Department of Adult and Pediatric Gynecology, Obstetrics ranks among the top German departments specializing in obstetrics! The department offers the full range of diagnostics and treatment of all gynecologic diseases in women and girls. The specialization includes surgical gynecology and gynecologic oncology, obstetrics and perinatal medicine, gynecological endocrinology and reproductive medicine. A special focus is made on the treatment of malignant tumors of the female reproductive organs, which is carried out within the Comprehensive Cancer Center Muenster. All the very latest and most effective treatment methods are available here.

University Hospital Bonn

9.2/10
location_onGermany, Bonn

Department of Gynecology and Gynecologic Oncology

The Department of Gynecology and Gynecologic Oncology offers the full range of modern diagnostics and treatment of various diseases of the female reproductive system. Of particular interest is the surgical treatment of malignant diseases of the female reproductive organs. The department also specializes in the conservative and surgical treatment of inflammatory processes, benign tumors. The department's doctors have in their arsenal a variety of minimally invasive surgical techniques with the use of laparoscopy and hysteroscopy, which contributes to the most sparing and safe therapeutic process. An integral part of clinical practice is urogynecology, in particular the treatment of urinary incontinence and pelvic organ prolapse.

Polycystic ovary syndrome (PCOS) is a hormonal disorder caused by genetic factors. PCOS causes many unpleasant symptoms due to increased male sex hormone levels. Irregular periods may also occur, infertility often develops, and the risk of developing diabetes mellitus and cardiovascular diseases increases. Most hormonal infringements can, however, be eliminated with medications. You can undergo your diagnostics and treatment in Germany. You are welcome to use the Booking Health website to find the cost of treatment in Germany and choose a medical care program.

Content

  1. What hormonal imbalances can develop due to PCOS?
  2. Diagnostics
  3. Treatment of polycystic ovary syndrome
  4. Where to undergo diagnostics and treatment?

What hormonal imbalances can develop due to PCOS?

 

Women with PCOS have alterations in their hormone levels, which affect metabolic processes, the menstrual cycle, and reproductive function. The main alterations that occur in polycystic ovaries are:

  • high male sex hormone levels;
  • changes in the ratio of gonadotropins: FSH and LH (these hormones ensure the maturation of follicles in the ovaries and stimulate the production of female sex hormones);
  • high anti-Mullerian hormone (AMH) levels;
  • high insulin levels in the case of insulin resistance.

Hormonal infringements are manifested by signs of hyperandrogenism, insulin resistance, irregular periods, and infertility. In the case of polycystosis, menstrual irregularities are one of the criteria for establishing a diagnosis. A normal period lasts from 21 to 35 days. Women with polycystosis often have no menstruation for months, or the periods become very long. They are often accompanied by scanty bleeding and pain in the belly.

Diagnostics

 

During polycystic ovary syndrome diagnostics, doctors set themselves the following tasks:

  • determination of the presence of PCOS, distinguishing this condition from other ovarian diseases;
  • assessment of hormonal infringements;
  • assessment of the consequences of PCOS, such as irregular periods, infertility, etc.

Two of the following three criteria are sufficient to confirm the diagnosis:

  • polycystic ovary syndrome diagnosis, based on an ultrasound scan;
  • oligo- or anovulation (eggs in the ovaries rarely mature or do not mature at all);
  • clinical (determined by symptoms) or biochemical (determined by tests) hyperandrogenism (high male hormone levels).

At hospitals in Germany, diagnostic approaches differ between adolescents and adult women. The difference is that ultrasound criteria (presence of multiple ovarian cysts) are not usually used for adolescents.

Ultrasound examinations

 

With the help of ultrasound examinations, doctors can assess the condition of the ovaries. The criterion for PCOS is the presence of more than 20 follicles with a diameter of 2 to 9 mm. An ultrasound scan is performed on the 3-5th day of the menstrual cycle. If it is irregular or there is no menstruation at all, it will be induced with progesterone preparations. Surveys are carried out not through the belly but through a transvaginal approach, which means that a transducer is placed into the vagina.

Ultrasound scanning often shows that the dominant follicle is missing. This means that in the current period, conception is impossible as the egg does not mature. Although many follicles grow, none of them reaches maturity.

Ultrasound examinations can also be used to determine an increase in ovarian volume of up to 10 cubic centimeters or more. In countries with poor medicine, this criterion of pathology is often used as the main one since to assess the ovarian volume, an outdated ultrasound diagnostic system is sufficient, which is not able to distinguish between small follicles.

Ultrasound criteria for polycystic ovary syndrome are not reliable enough before menarche and for 8 years after menarche since the multicystic structure of the ovaries can often be found even in the norm during this period in women without hormonal infringements.

Hyperandrogenism assessment

 

Hyperandrogenism means an increased influence of male sex hormones on the female body. Every woman has such hormones, but in the case of polycystic ovary syndrome, their number becomes too high. They disrupt the menstrual cycle and cause the following symptoms of hyperandrogenism:

  • facial hair growth (hirsutism that occurs in 75% of women with PCOS);
  • acne;
  • excessively oily skin;
  • hair loss.

Doctors at hospitals in Germany use the Ferriman-Gallwey score to assess hirsutism. It calculates the number of points, which differs for different ethnic groups.

The presence and severity of hirsutism is not always directly related to male sex hormone levels. This is due to the fact that target organs in different women have different sensitivity to testosterone.

Hirsutism is used as the main and only sign of clinical hyperandrogenism in adult women. In adolescents, the presence of acne is used instead.

Carbohydrate metabolism disorders

 

Many women with PCOS develop diabetes mellitus or pre-diabetes. They have impaired tissue sensitivity to insulin. The condition can be caused by both hormonal imbalances and excess weight, which is common in many women with polycystic ovary syndrome.

Carbohydrate metabolism can be assessed with glucose and glycated hemoglobin tests. Insulin resistance can be determined by the results of a HOMA test.

All women with PCOS have their body mass index determined. If they have excess weight, they are recommended diet, exercise, and sometimes drugs to normalize their weight. With weight loss, the risk of developing type 2 diabetes mellitus is reduced by 4 times. In addition, the risk of developing the following diseases is also reduced:

  • infertility;
  • cardiovascular diseases;
  • depression;
  • complications during a pregnancy;
  • endometrial cancer.

Tests for hormonal imbalance diagnostics

 

Diagnostics for hyperandrogenism at hospitals in Germany involves a testosterone blood test. The protein that binds it is also determined, and the free androgen index is calculated. To accurately determine the concentration of active testosterone, doctors also determine albumin protein levels, as this protein takes part in the transport of hormones.

Below are some other hormones whose levels can be assessed in PCOS:

  • DHEA and androstenedione levels can be tested to determine the causes of hyperandrogenism in women with normal testosterone blood levels;
  • progesterone levels can be tested to assess ovulatory function;
  • women with polycystic ovary syndrome have elevated anti-Mullerian hormone levels, although the levels of this hormone are not included in the diagnostic criteria;
  • insulin levels can be assessed with diabetes mellitus or pre-diabetes mellitus suspected.

Before the diagnostics of hormonal infringements due to PCOS, it is important to stop taking oral contraceptives and any other hormonal drugs, as they affect the test results. It is also advisable to stop taking drugs 1-3 months before your diagnostics.

Treatment of polycystic ovary syndrome

 

Treatment depends on what requirements a woman has for her treatment results and whether she has reproductive plans. It is impossible to cure polycystic ovary syndrome once and for all, as it is a chronic disease. But the condition can be successfully controlled with drugs to:

  • ensure a normal menstrual cycle to prevent the development of diseases of the endometrium;
  • eliminate any manifestations of hyperandrogenism;
  • achieve a pregnancy;
  • improve carbohydrate and lipid metabolism.

When dealing with the treatment of polycystic ovary syndrome, not only drugs but also lifestyle modifications can be helpful. If a woman has excess weight, she can get rid of it with the help of a diet and regular physical activity. As a rule, weight loss is enough to normalize irregular periods and restore reproductive function.

A treatment regimen for women who do not have any reproductive plans includes the constant use of combined oral contraceptives. At hospitals in Germany, women are treated with modern and safe drugs that have a good effect on hormonal and endometrial conditions, eliminate hyperandrogenism, and, at the same time, minimize the risk of side effects. Drugs are selected individually, considering the goals of treatment and depending on the prevailing symptoms, the age of the woman, and the presence of hirsutism. Any oral contraceptive "turns off" the reproductive function temporarily. Nonetheless, they do not affect fertility in the long term.

Antiandrogens are used as second-line drugs. These are medicines that reduce the activity of male sex hormones. They can be used if treatment with combined oral contraceptives has not yielded results within 6 months, as well as in the case of contraindications for their prescription or if a woman refuses treatment due to developing side effects.

In women with polycystic ovary syndrome, the risk of hyperhomocysteinemia is 3 times higher, and it increases the risk of developing cardiovascular diseases. Therefore, doctors at hospitals in Germany often include folates in the treatment regimen, which reduces the homocysteine ​​levels. In the case of impaired carbohydrate metabolism, hypoglycemic agents can be prescribed as well.

If the main goal of treatment is to restore reproductive function and achieve a pregnancy, doctors carry out drug induction for ovulation with antiestrogens. These drugs are taken over a course of 5 days in the first half of the cycle. They block the receptors of female sex hormones and increase the production of gonadotropins, which induce ovulation.

Where to undergo diagnostics and treatment?

 

If you have polycystic ovary syndrome, you can seek medical attention from one of the hospitals in Germany. You are welcome to use the Booking Health service to choose the best Department of Gynecology for the treatment of this pathology. Here you can find the cost of treatment in Germany and make your treatment appointment on the preferred dates.

There are a few reasons for you to undergo your diagnostics and treatment in Germany. These are as follows:

  • high-quality ultrasound systems that help doctors to assess the condition of the female genital organs, such as ovaries and endometrium, and distinguish polycystosis from other diseases;
  • modern laboratory tests allow doctors to accurately determine the levels of sex and other hormones in the blood, and thus to diagnose any hormonal imbalances;
  • the use of the latest drugs with high efficacy and a low risk of side effects;
  • individual recommendations for lifestyle modifications to improve hormonal balance;
  • personalized selection of a therapy regimen for a pathology based on the goals of treatment, age, concomitant diseases, and reproductive plans in the near or distant future;
  • if it is necessary to overcome infertility, the vast majority of women get pregnant with the help of conservative therapy of the disease but without any surgery or IVF;
  • doctors can use additional diagnostic procedures and therapy to normalize carbohydrate metabolism, reduce the risk of developing diabetes mellitus, and prevent cardiovascular diseases.

The Booking Health website offers the best hospitals where you can undergo your polycystic ovary treatment. Please leave your request for a consultation. The specialists from the Booking Health company will help you to select the best clinic for your treatment in Germany, which specializes in ovarian diseases and achieves the best results in this medical field. When contacting the clinic through the Booking Health service, the cost of treatment in Germany will be reduced due to the absence of additional fees for foreign patients.

 

Authors: 

The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

 

Sources:

National Library of Medicine

MedlinePlus

Johns Hopkins Medicine




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