PCO - PCOS, what is it?

PCO is the abbreviation of polycystic ovaries.

In this condition, an extreme volume of immature eggs form in the ovaries. PCO ovaries are therefore larger than normal ovaries and have a characteristic appearance when viewed through an ultrasound scan, as the immature eggs in the follicles are placed at the edge instead of being evenly distributed in the ovary.

PCO can be accompanied by certain symptoms following which the condition is referred to as PCOS – Polycystic Ovarian Syndrome. The principle features of this syndrome are that the female – in addition to the characteristic ovaries – has an increased amount of male sex hormone (androgen/testosterone) compared to other females. This may lead to increased facial and body hair (hirsutism), but the hair at the top of the head may also be thin together with a receding hairline. There will often be a tendency to acne. Furthermore, ovulation is rare or lacking, which causes menstrual disturbances resulting in fertility problems.

Many women with PCOS also suffer from overweight (80%) which due to the increased androgen concentration presents as male fat distribution, the so-called ”apple shape” where they particularly store the fat around the midline waist and abdomen, whereas the thighs are relatively thin.

PCOS is also associated with reduced insulin sensitivity in the muscular tissue. Insulin is a hormone produced in the pancreas, making glucose invade the tissue. When insulin sensitivity in the muscular tissue is reduced, the need for glucose to the muscles increases. The body will try to compensate for this by increasing the secretion of insulin as well as sugar. The reduced insulin sensitivity and the increased insulin production increase the risk of developing type 2 diabetes in the long run.

The reduced insulin sensitivity (insulin resistance) also disturbs the balance of fat metabolism in the blood and enhances the risk of cardiovascular diseases.

Many women with PCOS experience an increased urge for sugar (candy and chocolate), fatigue, drowsiness, lack of satiety, sleeping problems, mood swings and head ache.

Some think that PCO/PCOS is hereditary, but the development of overweight, combined with too little exercise, are clearly predisposing factors.

How is PCOS treated?

The most effective treatment of PCOS is a change in diet, weight loss and exercise. Metformin as a supplement regulates insulin sensitivity and consequently the other imbalances. Metformin acts by decreasing absorption of glucose from the gastrointestinal tract, enhancing peripheral glucose uptake in the cells and by suppressing new production of glucose in the liver.

Approximately 20% of the women with PCO have a normal weight, and for this group of people, exercise to strengthen insulin sensitivity and Metformin are the best treatments available.

Metformin may have transient side effect such as nausea, abdominal pain, diarrhoea and metal taste which are reduced when taken together with main meals and slowly escalating the dose (eg 500 mg/week). Normally, an initial dose of 500mg x 2 are given at meals, increasing at 1 week’s interval to 1g x 2 daily. Since Metformin sometimes may have an inhibitory effect on Vitamin B uptake from the gastrointestinal tract, it is recommended that women in Metformin treatment who plan to become pregnant – or who are pregnant – take extra folic acid (Folinsyre or Folimet) ie 5 mg daily (prescription), in addition to Apovit or GraVitamin.

As a ”PCO- diet” we recommend that you eat protein-rich foods such as fish and meat, raw vegetables and beans and at the same avoid sugar and carbohydrates contained in, among others, bread, pasta, cakes, soft drinks and candy.

Irrespective of weight, all females with PCOS may benefit from exercise, ie at least half an hour’s strenuous exercise (fast running, spinning or step) or one hour’s light exercise (jogging, quick walk, normal bicycling, swimming) during the day.


When do I stop taking Metformin when I become pregnant?

 We recommend that you stop taking Metformin in gestation week 7-8, which is when we perform a pregnancy scan. Metformin treatment will be resumed when breast-feeding of the infant has stopped.

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