Polycystic Ovary Syndrome

What is polycystic ovary syndrome (PCOS)?

PCOS is a condition with many follicles in the ovaries (cysts). The follicles are 2-9 mm, which are stopped in their development.

PCOS is accompanied by endocrine disorders, often resulting in missing or sparse menstruation and may cause difficulty in achieving pregnancy ( infertility ). The body creates too many male hormones. This can prove by abnormal hair growth on face and body (hirsutism) and acne ( acne ).

65% of women with PCOS are overweight , while 35% of women with PCOS have normal weight.

The abnormal hair growth, hirsutism, affecting approximately 70% of women with PCOS. For many, the most troublesome the unwanted facial hair – on the upper lip, chin party and temples. Others may have increased hairiness around the nipples, between the breasts, inner thighs, from the pubic bone up to the belly button at the bottom of the stomach.

All women have no body hair, but hair growth is becoming more powerful by PCOS and also becomes more apparent if one parent has abundant hair growth, as well as being more evident than brunettes.

Acne affects most young people, but worsen in girls with PCOS and may continue for several years.

About 20% can have deep voice pitch, and in severe cases can be enlarged clitoris, and there may be a general male appearance (virilization) and body type.

It is estimated that 2 of 3 women with PCOS are overweight. The fat accumulates mainly around the waist. Most are normal weight until they get menstruation. The weight gain is usually from about 15 years of age to the beginning of the 20s.

Menstruation Forstyrrelser consists entirely absent menstruation (amenorrhea) in 50%, and bleeding disorders in 30%, with some only have a few periods a year. About 20% will have normal menstrual period.

How common is PCOS?

PCOS affects approximately 5-10% of women of fertile age. More are overweight today and maybe there is therefore also more who have PCOS.

What causes PCOS?

It is estimated today with that PCOS is a partially hereditary disease. It is not certain that others in the family have been diagnosed with PCOS, but in many families found an increased incidence of diabetes and other conditions that may be associated with PCOS.

The tendency to get PCOS is innate – and you can not change it. How the disease behaves depends on living conditions and lifestyles. Maybe there are conditions in fetal life and in childhood that influence how PCOS appears. In children and adults will PCOS aggravated by obesity, improper diet and lack of physical activity.

There is a relationship between PCOS and diabetes.

There is a relationship between the hormone disturbances seen in PCOS and the body movement of sugar. It is believed that PCOS can be explained by a decreased insulin sensitivity of body tissues – also called insulin resistance. At a decreased insulin sensitivity is impaired ability to absorb sugar in muscle and fat tissue from the bloodstream. This will cause the body increases the release of the hormone insulin from the pancreas. As long as there released a normal amount of insulin, blood sugar remains normal. If there is not enough insulin is formed, developed type 2 diabetes.

A decrease in insulin sensitivity, increasing the amount of insulin may explain many of the endocrine changes seen in PCOS. To form more of the male sex hormones in the ovaries, and it disturbs the overall hormones (FSH and LH), which regulates the menstrual cycle. There will be periods of ovulation and thereby periods of inactivity or infrequent menstrual periods.

There is no longer the normal variations in the level of estrogen (female hormone) during a menstrual cycle, but the constant high amounts. Estrogens are also formed in the fatty tissue, and this happens in particular of obesity, which worsens the condition.

The changes hormone stimulates the secretion of frigøringshormonet LH from the pituitary gland in the brain. A high LH contributes to the formation of small cysts in the ovaries, and increase the level of male sex hormones. Hormonal disturbance in turn leads to lack of ovulation, irregular bleeding, hair growth and infertility.

An important part of the clinical picture of PCOS is that over the years may be changes in the blood, called metabolic changes . This applies to changes in glucose metabolism, which causes an increased risk for diabetes ( diabetes) . In addition, many high cholesterol and high blood pressure . All these conditions are risk factors for cardiovascular disease later in life. In addition to treating the symptoms of PCOS, it is very important to try to prevent the risk of cardiovascular disease and diabetes in the future.

What are the symptoms of PCOS?

Missing or scanty menstrual periods ,  infertility  abnormal hair growth on face and body (hirsutism) and acne ( acne ). In rare cases, the voice become deep and there can be klitorisforstørrelse.

65% of women with PCOS are overweight , while 35% of women with PCOS have normal weight.

What symptoms should you pay particular attention to?

If the symptoms occur over very short time.

How is it diagnosed?

The case history will usually be quite typical. A general examination and gynecological examination is still needed to exclude other causes of symptoms. Gynecological examination is usually normal, and it is usually not possible for the doctor to feel the small ovarian cysts. The ultrasound of the ovaries can confirm the many follicles, but the study can also be normal, even if you have PCOS.

Conversely, it is not uncommon for women who do not have PCOS also have many follicles. The study will also help to exclude the possibility that the tumor is in the ovary.

In most cases, the doctor will take blood samples. Normally, to measure the male hormones and possible. take other hormone tests. In many cases it may be appropriate to control blood sugar, fats and cholesterol.

What does it mean to have PCOS?

It can be very stressful to have a visible disease PCOS with acne and excess body hair, and it may be of little comfort that it is often more visible to the girl herself – than the surroundings. Unwanted hair growth may have negative influence on yourself, especially among teenage girls, which is in the midst of a process in which they are developing their own identity. Overweight, reduced possibility of pregnancy and an increased risk of disease later in life helps to aggravate the negative thoughts.

Many have only PCOS mild AD and many with PCOS get pregnant by themselves. If there is a need fertility treatment, there are good opportunities to help. The irregular bleeding and elevated male hormones are most pronounced in young, normal condition will improve with age. One can even make much of a diet and ample exercise. If that’s not enough, there are several options for medical treatment.

There are many myths about PCOS – some of the more stubborn is – that women with PCOS have periodically a certain temperament, be easily irascible, have a greater sexual desire and has a particular need for sweets (sugar craving). And some believe that women with PCOS have a harder time losing weight than others. There is not much scientific evidence for these claims, but there are more serious and less serious information and discussion boards on the Internet.

What treatment is there?

For many, the only necessary treatment to lose weight. You can even reduce weight through cost changes and exercise .

Can you go just 2-10% down in weight, it will help normalize menstruation, ovulation can get started and 20-60% achieve pregnancy.

In addition, weight loss strengthen self-esteem, reduce any depression feel and recreate sense of control.

Weight loss will also reduce the risk of cardiovascular diseases. Physical activity is just as important as diet change, therefore also the slim women with PCOS benefit from changes in lifestyle.

Loose weight

Weight loss should not be done quickly. You can start with a strict diet – but it must be followed by a permanent change of lifestyle.

You should base your weight reduction on living a healthy life, where the main action is regular exercise, frequent but small meals – 4-6 times per day, roughly and vegetables and reduce the intake of fat and sugar containing products.

By PCOS should follow the same recommendations about diet and exercise, which applies to patients with type-2 diabetes.

Kosten:

• meal Distribution
  • Regular meal rhythm is recommended. 3-5 hours between each meal fits most
• Choosing foods
  • Choose coarse cereals
  • Eat lots of vegetables
• Caution with sugar and sugary food and drink
  • The intake of rapidly absorbable carbohydrates like milk, fine bakery products, potatoes and sugar should be reduced and replaced with a coarser grain products high in dietary fiber
• Less fat, particularly saturated fat
  • Reduce intake of fatty meat, fatty dairy products and hard margarines
  • Choose lean meats and poultry, half fat and lean dairy products
  • Reduce the intake of “hidden fat” as there are a lot of in chocolate, snacks, cakes, biscuits, desserts
• Increase the proportion of unsaturated fat in the diet
  • Eat more fish and fish foods
  • Use vegetable oils
• energy Consumption
  • Energy reduction of overweight or obesity
• Physical activity
  • Activities, which gives a total energy consumption of at least 1,000 kcal per week (4,2MJ), ie 150 kcal (630 kJ) per day, for example, 30 minutes of fast walking
  • It may be advantageous to increase the activity to 60 minutes a day, if you can make this a priority
• kind of activity
  • Increase everyday activities
    • Go to and from the store
    • Always take the stairs
    • Walk or cycle to work
  • Increase exercise-related activities
    • Walking at a fast pace
    • Trips by bike
    • Swimming, water gymnastics
    • Gymnastics or low-impact aerobics
    • Strength
• Frequency
  • Daily, at least 30 minutes. But the activity may be shared in sequences, for example, 5 to 15 minutes duration – according to a South African study provides short intervals at least as good improvement in glycemic control
  • Focus on activity the frequency and duration rather than intensity

Medical treatment

Choice of medication depends on the purpose of treatment, your genes, your age and your weight.

The pill is the first one to try. The pill will cause the coming menstrual regularity and protects the uterine lining to hormone imbalance.

The pill will also reduce the amount of the male hormone and has effects on both unwanted hair growth, acne and other male features. The pill does not work on the hair already grown up, and it may take eight months or more before there is real power.

In addition gives the pill a safe prevention against unwanted pregnancy. There are few situations where it discourages the pill, but there may be some side effects. You may, in consultation with the doctor find the pill that suits you best.

The use of diabetes medication in tablet form – metformin – enhances the action of insulin and leads to better blood sugar control. Metformin may lower the amount of male hormones that make your periods more regular and increase the chance of getting pregnant.

Metformin place in the treatment of PCOS is highly controversial. Metformin has predominantly effect in obese women with PCOS and have no effect in slimming. The effect on hair growth and male hormones are better at oral contraceptives than for metformin. Metformin is not a slimming composition, but some is lost due to side effects from the stomach and intestine. The most widespread opinion is that metformin may be complementary to a lifestyle change, but should not stand alone.

There is not much knowledge about the effect of metformin during pregnancy, and most recommend that patients stop taking metformin if you become pregnant during treatment with metformin.

Do you have a desire pregnancy, you should be referred to a fertility clinic or specialist. In women with PCOS, the aim is to ensure ovulation of one egg.

By prominent male features and elevated levels of male hormones, other drugs (spironolactone and deksametason) or combination of several substances help to reduce the production of male sex hormone and thus gradually attenuate these features. All of these treatments should be used by a desire pregnancy.

other treatment

If you are plagued by annoying facial hair can be removed by various methods (epilation, electrolysis, laser).

Often you have to pay for these treatments at the beautician.

How is long-term prospects?

The condition is chronic, but the treatment and reduction in weight can reduce a portion of the genes.

Involuntary childlessness is a problem for many, but treatment results are good. As there is also an increased risk of developing diabetes and probably cardiovascular disease, the prognosis also depends on whether you manage to control weight and intake of fats and sugar.

How do I avoid or aggravate PCOS?

Avoid excess weight and make sure to exercise.