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.
- What hormonal imbalances can develop due to PCOS?
- Treatment of polycystic ovary syndrome
- 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.
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.
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 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);
- 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:
- cardiovascular diseases;
- 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.
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!
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Johns Hopkins Medicine