The polycystic ovary syndrome (PCOS) is a hormonal disorder that affects women of reproductive age. It is one of the most common endocrine disorders, with around one million women in Germany affected. Many of these women struggle with infertility.
Symptoms of PCOS
PCOS presents with a variety of symptoms, making it a complex condition. Some women with PCOS have ovaries surrounded by small, pearl-like cysts, while others may have cysts without actually having PCOS.
Common symptoms include:
- Irregular menstrual cycles or absent ovulation
- Infertility
- Weight gain and insulin resistance
- Type 2 diabetes
- High testosterone levels leading to excessive hair growth (hirsutism), acne, and hair loss
- Psychological and social issues due to hormonal imbalances, significantly impacting quality of life
Since symptoms vary from person to person, a single symptom does not confirm PCOS, and the presence of cysts alone is not enough for diagnosis.
Diagnosis Criteria
To ensure a standardized diagnosis, the 2018 ESHRE Guideline outlines the Rotterdam criteria, which require at least two of the following three symptoms (after ruling out other conditions):
- Hyperandrogenemia or clinical signs of hyperandrogenism: Elevated levels of male hormones (androgens), leading to acne, hair loss, and excessive body hair.
- Oligo- or amenorrhea: Cycles longer than 35 days or absent menstruation, which can reduce fertility.
- Ultrasound findings: More than 20 follicles per ovary or ovarian volume ≥10 ml.
If a woman has irregular cycles and hyperandrogenism, ultrasound is no longer required for diagnosis.
Importance of Medical Consultation
A thorough consultation is essential to minimize long-term health risks. The diagnostic process includes:
- A detailed patient history and physical examination
- Skin and body hair assessment
- Blood tests to evaluate hormone levels
- Ultrasound of the ovaries (if necessary)
Irregular Cycles Do Not Always Mean PCOS
Many women assume PCOS is the cause of their irregular cycles, leading to self-diagnosis errors. However, 70% of women have irregular cycles at some point, yet many still ovulate and are fertile.
Other factors affecting the menstrual cycle include:
- Thyroid disorders
- Stress and emotional strain
- Time zone shifts (travel-related)
- Hormonal changes during puberty or menopause
With OvulaRing, women can track their individual cycle and fertility patterns, even with irregular or long cycles, and determine whether they ovulate.
Causes of PCOS
Both genetics and environmental factors contribute to PCOS. The key issue is hormonal imbalance, primarily involving:
- Elevated androgens (male hormones)
- Disruptions in luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
Obesity and insulin resistance also play a significant role. High insulin levels reduce androgen conversion into estrogen, exacerbating hormonal imbalances.
Why Does PCOS Cause Infertility?
In a healthy cycle, a follicle develops, matures, and releases an egg during ovulation. However, high androgen levels in PCOS disrupt follicular maturation, leading to numerous immature follicles that do not develop or ovulate. As a result, ovulation does not occur, preventing natural conception.
Not All Women With PCOS Are Infertile
Studies have shown that:
- Over one-third of women diagnosed with PCOS still ovulate naturally (Direito 2012).
- 15% of these women ovulate after day 36 of the cycle.
- The number of anovulatory cycles is lower than previously thought.
However, late ovulations often go undetected, leading doctors to refer women to fertility clinics too soon, even though natural conception may still be possible.
Tracking Your Cycle With PCOS
OvulaRing allows women to monitor their cycle patterns and detect ovulation—even if it occurs late.
With continuous core body temperature measurement (288 data points per day), OvulaRing accurately identifies fertile days and ovulation. This is particularly important for PCOS patients, as it helps:
- Confirm if ovulation occurs
- Track long and irregular cycles
- Optimize fertility treatment timing
References
Direito A et al. (2012). Relationships between the luteinizing hormone surge and other characteristics of the menstrual cycle in normally ovulating women. Fertil Steril. doi: 10.1016/j.fertnstert.2012.08.047.
Der Privatarzt Gynäkologie, Medizin & Management. 2014. Sonderbericht: Zeitpunkt der Ovulation. 3: S. 16-17.
