Creasphere Insights – Polycystic Ovary Syndrom (PCOS)
Polycystic ovary syndrome or better known as PCOS is a widespread yet often overlooked women’s health problem. It is caused by an imbalance of reproductive hormones. Due to the syndrome, an individual’s body produces polycystic ovaries, which contain a large number of underdeveloped 8mm follicles. As a result, ovulation might not occur as the altered follicles are often unable to release eggs. Approximately 5 – 10% of women in their reproductive age, mainly between 15 and 44 are affected by PCOS. The dark figure though might be much higher as close to 50% of women suffering from PCOS don’t show any symptoms. Regardless of race and ethnicity, all women are at risk to develop PCOS [1,2].
What exactly is PCOS, and what are possible causes?
Although the underlying causes of PCOS are not known, genetic and metabolic factors have been associated with the development of PCOS. On the one hand, PCOS has been shown to be hereditary. According to a study conducted at the University of Alabama, 24% of women suffering from PCOS had a mother with the condition and 32% had a sister that had PCOS . On the other hand, PCOS has been shown to be correlated with Insulin resistance. Responsible is a high insulin blood level which can often but not exclusively be found in women (and men) suffering from obesity . Insulin resistance causes the pancreas to produce more insulin in order to keep glucose levels even. An excess of insulin may lead to the failure of the ovaries and increased levels of androgens. Androgen is a hormone that is responsible for the development and maintenance of male characteristics .
What are common symptoms related to PCOS?
Overall PCOS can have a major impact on the quality of life as well as fertility. The hormonal imbalance can cause oligo-ovulation, a state describing fewer than 8 menses within a 12 months period or anovulation . Besides this, the excess of androgen, called hyperandrogenism, can promote weight gain, excessive hair growth/loss, acne and other skin problems . As a result both the reproductive as well as metabolic abnormalities put women suffering from PCOS at higher risk to develop infertility, obesity, type 2 diabetes mellitus and endometrial cancer [8,9].
What are the diagnostic criteria?
In order to diagnose PCOS a multitude of different factors both physiological as well as hereditary have to be evaluated. As part of a consensus workshop in 2003 the so-called Rotterdam Criteria were created to provide a guiding framework for the diagnosis. This framework assumes PCOS is prevalent in case two out of the following three features are met :
- Oligo-ovulation and/or anovulation;
- Hyperandrogenism (clinical or biochemical)
- Polycystic ovaries by ultrasonography
Although the framework already provides a very good approximation, PCOS remains very difficult to diagnose.
What are the available treatment options?
According to the current state of medical science, PCOS can not be cured, but symptoms can be managed effectively when following a personalized treatment plan. Due to the complex nature of PCOS symptoms treatment options vary and should follow a multifold approach . Requiring continuous and consistent management of PCOS, behaviour and lifestyle habits of patients are of great importance and relevance when it comes to lowering the impact and prevalence of disease symptoms . Hence, adherence to a healthy workout routine and a balanced diet lowers the overall risk of long-term health problems significantly and improves fertility and regularity of menstrual cycles . Complementing a lifestyle-centred disease management approach, pharmaceutical treatment options depend on whether the patient plans to conceive. If the patient plans to conceive, and fertility medicines remain ineffective, a surgical procedure called laparoscopic ovarian drilling can be implemented using heat or a laser to destroy the harmful ovarian tissue that is responsible for producing androgens such as testosterone causing infertility . If patients pursue contraceptive measures, hormonal birth control can improve acne, reduce extra hair, lower the risk of endometrial cancer and make menstrual cycles more regular .
As often traditional and well-known treatments do not help all individual patients to deal and live with PCOS, there are more digital solutions to help. Therefore, we will showcase three companies Hertility Health, Veera Health and Allara, which are following a very interesting approach.
Hertility Health is a virtual care platform focused on reproductive and hormonal health. The company helps women effectively detect and understand root causes of their symptoms by providing at-home testing, evidence-based medicine, and educational content. Offering the at-home testing kit, Hertility Health analyzes and defines the hormonal profile of each patient. Based on the actionable insights of the hormonal profile, Hertility Health indicates individualized care pathways in the fields of PCOS care, endometriosis care, egg freezing, and IVF. Moreover, Hertility Health offers both clinical consultations as well as virtual consultations with in-house experts with competencies in reproductive medicine, fertility, PCOS, endometriosis and gynaecology.
Veera Health is a virtual health clinic exclusively for women focused on PCOS and mental health. The platform connects dedicated health coaches with the final patients to set up individualised goals, outline a personalised treatment plan and coordinate appointment booking with health experts going forward. Doing so, the health coaches pursue a holistic treatment approach with experts from the fields of gynaecology, dermatology, fitness and nutritional science to formulate a workout, diet, medical and lifestyle plan.
Allara is a virtual health clinic focused mainly on women’s health and wellness. The platform provides remote online consultation for conditions like PCOS, hair loss, infertility, insulin resistance, facial hair, acne and other hormonal related problems. Allara offers ongoing 1:1 support via video calls and messaging as well as personalised care plans and goal tracking. Patients can book 30-minute video appointments with medical providers specialising in PCOS. Moreover, registered dietitians support in setting up the right nutrition plan for the individual patient. Finally, the platform offers diagnostic testing and e-prescriptions as well.
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 Goodarzi, M. O., & Azziz, R. (2006). Diagnosis, epidemiology, and genetics of the polycystic ovary syndrome. Best Practice & Research Clinical Endocrinology & Metabolism, 20(2), 193–205. https://doi.org/10.1016/j.beem.2006.02.005
 Kahsar-Miller, M. D., Nixon, C., Boots, L. R., Go, R. C., & Azziz, R. (2001). Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS. Fertility and Sterility, 75(1), 53–58. https://doi.org/10.1016/S0015-0282(00)01662-9
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 Menstrual Cycle | Office on Women’s Health. (n.d.). Retrieved November 11, 2021, from https://www.womenshealth.gov/menstrual-cycle
 The Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reproduction, 19(1), 41–47. https://doi.org/10.1093/humrep/deh098
 Napolitano, M., Megna, M., & Monfrecola, G. (2015). Insulin Resistance and Skin Diseases. The Scientific World Journal, 2015, 1–11. https://doi.org/10.1155/2015/479354
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 The Australian Ovarian Cancer Study Group and The Australian National Endometrial Cancer Study Group, Fearnley, E. J., Marquart, L., Spurdle, A. B., Weinstein, P., & Webb, P. M. (2010). Polycystic ovary syndrome increases the risk of endometrial cancer in women aged less than 50 years: An Australian case–control study. Cancer Causes & Control, 21(12), 2303–2308. https://doi.org/10.1007/s10552-010-9658-7
 Barr, S., Hart, K., Reeves, S., Sharp, K., & Jeanes, Y. M. (2011). Habitual dietary intake, eating pattern and physical activity of women with polycystic ovary syndrome. European Journal of Clinical Nutrition, 65(10), 1126–1132. https://doi.org/10.1038/ejcn.2011.81
 Pasquali, R. (2018). Lifestyle Interventions and Natural and Assisted Reproduction in Patients with PCOS. In S. Palomba (Ed.), Infertility in Women with Polycystic Ovary Syndrome (pp. 169–180). Springer International Publishing. https://doi.org/10.1007/978-3-319-45534-1_13
 Mario, F. M., Graff, S. K., & Spritzer, P. M. (2017). Habitual physical activity is associated with improved anthropometric and androgenic profile in PCOS: A cross-sectional study. Journal of Endocrinological Investigation, 40(4), 377–384. https://doi.org/10.1007/s40618-016-0570-1
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 Legro, R. S., Arslanian, S. A., Ehrmann, D. A., Hoeger, K. M., Murad, M. H., Pasquali, R., Welt, C. K., & Endocrine Society. (2013). Diagnosis and treatment of polycystic ovary syndrome: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism, 98(12), 4565–4592. https://doi.org/10.1210/jc.2013-2350
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