Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome is a common hormonal condition that affects roughly 1 in 10 women of reproductive age. It combines irregular ovulation, higher levels or effects of male-type hormones, and ovaries that contain many small follicles on ultrasound.

The name is misleading: the small follicles are not true cysts and need no removal. PCOS is a lifelong tendency, not a disease that is cured. Its features, including irregular periods, unwanted hair, acne, difficulty conceiving and metabolic risk, can each be treated well.

Symptome

• Infrequent, irregular or absent periods
• Excess hair on the face, chest or abdomen
• Persistent acne
• Thinning scalp hair
• Weight gain, especially around the waist, and difficulty losing it
• Difficulty becoming pregnant
• Dark velvety skin patches in the neck or armpits
• Low mood or anxiety

Ursachen und Risikofaktoren

The exact cause is unknown. It runs in families and involves two linked disturbances: the ovaries produce more androgens than usual, and most women have insulin resistance, which drives the ovaries further and promotes weight gain. Excess weight makes every feature worse, yet lean women have PCOS as well. Over the long term it raises the risk of type 2 diabetes, high blood pressure, abnormal cholesterol, sleep apnoea, pregnancy diabetes and, when periods are very infrequent, thickening of the womb lining.

Wie es diagnostiziert wird

• Rotterdam criteria: Two of three are required: irregular ovulation, clinical or blood evidence of raised androgens, and polycystic ovaries on ultrasound or a high AMH, after other causes have been excluded.
• Hormone blood tests: Testosterone, SHBG, LH and FSH, with prolactin, thyroid function and 17-hydroxyprogesterone to rule out conditions that mimic PCOS.
• Pelvic ultrasound: Counts follicles and measures ovarian volume. It is not used for diagnosis within 8 years of the first period because the appearance is normal in adolescence.
• Metabolic screening: Glucose tolerance test or HbA1c, lipid profile, blood pressure and waist measurement, repeated every 1 to 3 years.

Behandlungsmöglichkeiten

• Lifestyle change: Regular activity and a weight loss of 5 to 10 percent, where weight is raised, often restore ovulation and improve every other feature.
• Combined contraceptive pill: Regulates bleeding, protects the womb lining and reduces acne and hair growth.
• Metformin and newer weight-loss medicines: Improve insulin resistance and weight. GLP-1 medicines must be stopped before trying to conceive.
• Anti-androgens and hair removal: Spironolactone taken together with reliable contraception, eflornithine cream and laser hair removal.
• Ovulation induction: Letrozole is the first choice, followed by gonadotrophin injections with careful ultrasound monitoring.
• IVF: Used when simpler treatment fails. Protocols are adjusted because women with PCOS have a higher risk of ovarian hyperstimulation.
• Laparoscopic ovarian drilling: A second-line surgical option that is now used less often.

Wenn es dringend ist

PCOS itself does not cause emergencies. Sudden severe pelvic pain with vomiting, very heavy bleeding that soaks a pad every hour, or, during fertility treatment, rapid abdominal swelling with breathlessness and reduced urine should be assessed urgently near you.

Reisen nach Türkiye zur Behandlung

Day-to-day management of PCOS belongs with your own doctor and needs no travel. A visit can offer a complete hormonal and metabolic work-up in a few days, laser hair removal as part of another trip, or fertility treatment. IVF needs about 2 to 3 weeks on site, or two shorter stays. Ask specifically about the clinic's approach to preventing ovarian hyperstimulation, for example freezing all embryos and transferring later.

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