PCO or PCOS?

Poly Cystic Ovaries (PCO) PCO is an indication that there are more ovarian follicles (ovaries) than usual. This is seen in an ultrasound scan where you find over 12 ovaries and a slightly enlarged ovary. PCO is very common and occurs in 20-25% of all women of childbearing age.

Diagnosis

PCO is diagnosed with an ultrasound and is best done by ultrasound scanning through the vagina

Poly Cystic Ovarian Syndrome (PCOS)

The difference between PCO and PCOS is that PCOS is associated with the production of too many male sex hormones from the ovaries and therefore often causes an imbalance. To diagnose PCOS, you must have at least 2 of these 3 symptoms:

  • One or both ovaries must be polycystic.
  • Long menstrual cycles of more than 35 days - or complete absence of menstruation.
  • Signs of male sex hormone overproduction, either assessed by increased hair growth or by blood test analyzes.

It should be excluded that there may be another hormone disorder, e.g. elevated prolactin. Measurement of the pituitary hormones FSH, LH and prolactin as well as the measurement of the sex hormones estrogen, progesterone and AMH should be included in the examination. In some cases, the content of male hormones (androgens) is also measured.

Other causes of elevated male sex hormone should be ruled out.

PCO occurs at almost the same frequency worldwide, in approximately 20-25% of women of childbearing age. PCOS varies in frequency depending on ethnic background and is found in the western world at approximately 10%.

Women with PCOS most often have symptoms such as bleeding disorders, infertility, overweight, hair problems or acne.

Symptoms of PCOS
  • Bleeding disorders - most often long intervals, but short intervals can be seen. 
  • Lack of ovulation
  • Infertility (infertility)
  • Tendency to acne and hair in unwanted places (face, abdomen, inside of thighs). The extent of hair loss depends on the person's sensitivity to male sex hormone in, among other things. hair roots.
  • Approx. 50% of women with PCOS are overweight. Weight gain often aggravates PCOS, and weight loss can better the symptoms.

Risk of diabetes
Overweight people with PCOS have an increased risk of developing diabetes

Diabetes is more frequently seen in overweight and PCOS women. The condition can be improved / avoided by weight normalization.

Cardiovascular diseases also occur more frequently, and treatment targets the risk factors (cholesterol, smoking, exercise, weight).

Cervical cancer is seen with fairly low frequency in women before menopause. Overweight with PCOS and lack of menstruation have an increased risk of developing uterine mucosa. The treatment is aimed at normalizing the bleeding pattern so that regular mucosal rejection is achieved during menstruation. It can be done with birth control pills during periods when the woman does not want to get pregnant.

Bleeding disorders in PCOS

Bleeding disorders are a frequent symptom of PCOS. It may be due to lack of ovulation, interfering with the sex hormones and affecting the lining of the uterus.

The degree of bleeding disorder can vary throughout life and especially in weight change. Therefore, women with bleeding disorders are divided into two groups - the slim and the obese:

The slim PCOS girls have

  • Often a low estrogen level. Normally, the elevated male sex hormone is converted to estrogen in adipose tissue, but it is sparse in the lean girls.
  • Often a thin uterine mucosa by ultrasound scanning.
  • Very long intervals between or completely absent menstruation. In some cases the intervals are very short.
  • No increased risk of diabetes or cardiovascular disease.

The overweight PCOS girls have

  • Often, a significant conversion of androgens to estrogens in the adipose tissue, thereby increasing the total amount of estrogen.
  • Often a thick mucosa in the uterus by ultrasound scanning.
  • Often bleeding at long or irregular intervals, but rarely stops completely during menstruation.
  • Increased risk of diabetes and cardiovascular disease.
Disturbed regulation

In women with PCOS, the normal regulation of the menstrual cycle is disturbed. The menstrual cycle often becomes very long or stops completely. The ovaries also produce too many male sex hormones.

When the menstrual cycle stops, eggs do not mature, making it very difficult to conceive.

The reason why the cycle stops and the ovaries produce too much male hormone is not known for sure. In some cases, overweight may occur, but PCOS is also seen in perfectly normal women.

In women with PCOS, there is often a high concentration of the hormone LH and a relatively low amount of FSH. LH helps make the ovaries produce more male hormone.

Women with PCOS also sometimes have a changed metabolism with a degree of "insulin resistance". It may be reminiscent of a lighter degree of type 2 diabetes ("old-man diabetes").

Overweight women with PCOS can, in many cases, get the cycle started again by losing about 10% in weight.

Since the metabolism of diabetes may be reminiscent of diabetes, it can also help women with PCOS to eat properly if they have diabetes. That is, avoid sugar and white bread and other "easily transferable carbohydrates". Instead, one should eat coarser breads and pastas and protein-containing foods.

Metformin - a type of medication used for type 2 diabetes - can also improve sugar turnover and, in some cases, make the cycle more normal in women with PCOS.

The role of insulin

PCOS is also characterized in that the metabolism and fat metabolism are affected. Women with PCOS have reduced sensitivity to insulin ("insulin resistance").

Insulin resistance causes the cells in the body to have difficulty absorbing sugar. When the cells detect that the sugar is too low, a signal is sent demanding to increase blood sugar. This releases more insulin and sugar into the blood so that the sugar can be absorbed by the cells. The increased sugar level in the blood leads to increased formation of adipose tissue and thereby overweight. The overweight is often retained as the increased amount of insulin prevents the breakdown of adipose tissue.

In some cases, treatment with the drug metformin may be attempted in women with PCOS. Metformin tends to improve insulin resistance and can sometimes make the cycle more normal and increase the chance of pregnancy.

PCOS can cause diabetes due to high blood sugar. It is the variant type-2 diabetes, also called "old man diabetes". However, it is only in overweight PCOS women that there is a risk of developing diabetes

Treatment of PCOS

Women with PCOS may have difficulty obtaining a pregnancy. We have good experience with an individual assessment and subsequent treatment of the women. The woman's bleeding pattern is important for the choice of treatment strategy.

Stimulation of women with irregular bleeding

Most women with irregular bleeding can be stimulated with daily injections of low doses of the egg maturation hormone FSH.

Stimulation of women without bleeding

As a rule, menstrual bleeding is first induced with a short-term treatment with a progesterone (Provera) or with a single cycle of birth control pills. Women who do not have bleeding most often require treatment with very gentle doses of FSH.

Weight loss of approx. 5-10% of the body weight itself can produce spontaneous ovulation and pregnancy in approx. 20-60%. Read more about dietitian treatment here.

Other forms of infertility treatment, such as insemination therapy (IUI), test tube therapy (IVF and ICSI) may become relevant if stimulation FSH does not produce the desired pregnancy.