Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that affects about 5-10% of women of reproductive age worldwide. It is associated with hormonal imbalances that cause symptoms of varying severity, ranging from menstrual cycle disturbances to elevated androgen levels to selected hyperandrogenism and polycystic ovaries. This disorder is an important cause of female infertility and is also associated with an increased risk of metabolic disorders such as insulin resistance and type 2 diabetes mellitus. The diagnosis and management of PCOS is complex as the manifestations of the disease can vary widely. A multidisciplinary approach involving both medical intervention and lifestyle changes is needed to ensure successful treatment and patient quality of life.

What is polycystic ovary syndrome (PCOS)?

PCOS is an endocrine disorder characterised by three main symptoms: ovulatory dysfunction, hyperandrogenism and polycystic ovaries. Although the exact mechanism of PCOS development is not fully understood, it is thought to involve a complex interaction of genetic and environmental factors. Ovulatory disorders cause irregular menstruation or even amenorrhoea, while hyperandrogenism can manifest as hirsutism, acne and alopecia. Polycystic ovaries are diagnosed by ultrasound when numerous small follicular cysts are identified in the ovaries. The definition of PCOS does not necessarily require the presence of all three symptoms and the diagnosis is usually made on the basis of the Rotterdam criteria, which require two of the three criteria.

Causes and risk factors of PCOS

Genetic factors

PCOS has a strong genetic component, as shown by the high incidence in families. Studies point to several potential genes related to hormonal regulation and metabolic processes. For example, studies have identified genes related to the luteinising hormone receptor, insulin receptor and androgen synthesis that may play a role in the development of PCOS. The presence of genetic factors may explain why some women develop PCOS while others with similar lifestyle conditions do not.

Lifestyle impact

Lifestyle, especially diet and physical activity, plays an important role in the development and manifestation of PCOS. Overweight and obesity often exacerbate PCOS symptoms and are associated with an increase in insulin resistance. Studies show that 70% of women with PCOS suffer from insulin resistance, which is associated with elevated insulin levels and hyperandrogenism. A healthy diet and regular exercise help to improve insulin sensitivity and may reduce the severity of symptoms.

Environmental factors

In addition to genetic and lifestyle factors, environmental influences can play a role in the development of PCOS. Studies have shown that endocrine disruptors such as bisphenol A (BPA) can negatively affect hormonal processes and contribute to the development of PCOS symptoms. These chemical compounds can interact with hormonal receptors, disrupting the endocrine system. The presence of toxins in the environment can also affect the onset of puberty and hormonal regulation, potentially increasing the risk of developing PCOS.

Symptoms and diagnosis of PCOS

Main symptoms

The symptoms of PCOS are varied and can vary depending on individual factors. The most common symptoms include menstrual cycle disorders such as oligomenorrhoea or amenorrhoea resulting from ovulatory dysfunction. Hyperandrogenism causes clinical symptoms such as hirsutism, acne and alopecia. In addition, PCOS can cause fertility problems and an increased body mass index. PCOS also affects metabolism, leading to increased appetite and weight gain, which in turn contributes to insulin resistance.

Diagnostic methods

The Rotterdam criteria are used to diagnose PCOS, which requires at least two of three symptoms: ovulatory dysfunction, hyperandrogenism and polycystic ovaries on ultrasonography. Additional diagnostic tests may include hormone levels to assess androgen levels and possible adrenal or pituitary dysfunction. An insulin level test is important if insulin resistance or metabolic syndrome is suspected.

Additional diagnostic tests

To better understand the impact of PCOS on an individual, additional tests may be needed, such as a glucose tolerance test to determine the risk of diabetes and a lipid profile to assess the risk of cardiovascular disease. Hormone level tests, as well as cortisol and prolactin levels, can help to rule out other endocrine diseases. Creatinine and liver function tests can be useful to assess general health and identify other possible disorders.

Health effects of PCOS

Reproductive health

Metabolic syndrome and other health problems

PCOS is strongly associated with an increased risk of metabolic disorders such as insulin resistance and type 2 diabetes. There is also a high risk of cardiovascular disease, as insulin resistance can lead to high blood pressure and dyslipidaemia. PCOS is also associated with an increased risk of endometrial cancer, as frequent chronic anovulation leads to an excess of oestrogen in the uterus. PCOS patients are also at increased risk of hypertension and dyslipidaemia, which have important implications for long-term cardiovascular health.

Mental health problems

PCOS can also be associated with mental health problems such as depression and anxiety. Hormonal imbalances as well as physical symptoms such as hirsutism and acne can negatively affect women's self-esteem and emotional well-being. Studies show that women with PCOS are more likely to suffer from eating disorders and low self-esteem, which can impair emotional well-being. It is therefore important that the treatment plan includes psychological support, which can help to improve quality of life and reduce psychological distress.

Treatment options for PCOS

Medical treatment

Lifestyle changes

Lifestyle changes are an essential part of managing PCOS. Adjusting diet to reduce weight and improve insulin sensitivity can significantly reduce the severity of symptoms. Regular physical activity not only helps with weight control, but also improves mood and reduces the risk of depression, which is common in PCOS patients. Dietary measures that include low glycaemic index products and high fibre are recommended as part of the treatment plan. This approach not only improves insulin sensitivity but also reduces the risk of cardiovascular disease.

Alternative therapies

Some patients may seek alternative therapies such as acupuncture or herbal remedies to relieve PCOS symptoms. Although some studies suggest possible benefits, these therapies should be used with caution and should not replace evidence-based medical treatment. It is important to consult a healthcare professional before starting any alternative methods. Acupuncture, for example, can help reduce stress levels and improve endocrine function, but further research is needed to determine its exact effectiveness in the treatment of PCOS.

Conclusions and future perspectives

PCOS is a complex syndrome with many different manifestations and complications. Effective management of PCOS requires an individualised approach that includes the integration of both medical and lifestyle measures. As PCOS affects many areas of women's lives, including reproductive health and metabolic systems, further research into the genetic and environmental factors that contribute to the development of PCOS is essential. Understanding the impact of PCOS and how to improve treatment strategies can significantly improve the quality of life of patients and reduce the complications associated with the syndrome.