Polycystic ovarian syndrome Can lifestyle modifications help?? Dr Saloni Assistant Professor, Deptt...
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Polycystic ovarian syndrome
Can lifestyle modifications help??
Dr SaloniAssistant Professor, Deptt of OBGBPSGMC for Women, Khanpur Kalan
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Life-long condition
0 10 20 30 40 50 60 70
? IUGR
? Pronounced adrenarche
Menstrual irregularities
Hirsutism
Infertility, miscarriageGestational hypertensionGestational diabetes
Hypercholesterolaemia
DiabetesHypertension
Coronary heart disease
Age (years)Long-term health
Precocious puberty
Reproductive disorder
Metabolic syndrome
Cancer (uterine;; ? breast)
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Weight increase
Inherited defects in insulin actions
Insulin receptordisorders
Insulin increase
SHBG decreases
IGFBP-1decrease
Theca (IGF-II,?IGF-I(
Pathophysiology
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LH and IGF-I effect
on theca cells
Cytochrome p-450c 17-alpha activity
Androgen secretion
Non-obese Obese
IGFBP-I
IGF-I
Insulin resistance
Hyperinsulinemia
SHBG
LH GH
PCOD
Different hormone
concentrations in obese and
non-obese PCO patients
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SMALL CHANGES MAKE A BIG DIFFERENCE
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LIFESTYLE MODIFICATIONS
Weight reduction includes a combination of caloric restriction, increased physical activity and behaviour modification.
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Dietary Modifications
Carbohydrate: 55% Protein: 15% Fat: 30% (<10% from saturated fat)
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Low fat
Highcarbs
Raised insulin
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Dietary Modifications
• Low carbohydrates
• High fiber
• Unsaturated fats
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Examples of Soluble Fiber:Oat branOatmealBeansPeasRice branBarleyCitrus fruitsStrawberries Apple Pulp
Examples of Insoluble Fiber:Whole wheat breadsWheat cerealsWheat branCabbageBeetsCarrotsBrussels’ SproutsTurnipsCauliflowerApple skin
Pennington Biomedical Research Center
fiber
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Dietary Modifications
Small may be more frequent meals
Balanced meals
Smaller plates
Resist urge
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Healthy Living Guidelines
Pennington Biomedical Research Center
Minimize whole fat dairy products, such as butter and whole milk
Cholesterol should be less than 300 mg daily
Use low fat cooking methods: baking, broiling, grilling, boiling, rather than breading, frying
Use liquid vegetable oil
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Effects
Weight loss of even 5-10% will help reduce insulin resistance and your androgen levels
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Lifestyle Modification Weight loss (5-10% over 6 months) is effective in
re-establishing ovarian function in >50% of obese PCOS womenStudy Weight loss Outcomes1995 6.3 kg 12 out of 13 + ovulations
11 out of 13 + pregnantHollman 1996 5.6 kg 80% ovulation rate
29% pregnancyandrostenedione, insulintestosterone, estradiol
Huber-Buckholz 1999
6.3 kg (2-5% loss)
9 out of 15 + ovulations2 out of 15 + pregnant
Hoeger 2004 6.8% loss 30% increased ovulation Decreased hirsutism score
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Exercise
Exercise Exercise
Exercise
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Be Physically Active21
Helps lose/ maintain weight 30 minutes of moderate level activity on
most days of week Use stairs instead of elevator, get off bus 2
stops early, Park your car at far end
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Exercise
Cardiotraining
CVD
Weight
Strength training
calorie
High BMR
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Get started
Zumba Pilates Yoga Aerobics Cycling Walking Swimming
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Effects
Improves insulin sensitivity frequency of ovulation cholesterol body composition
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META-aNALYSIS
Lifestyle modifications versus metformin plus lifestyle modifications
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Similar improvements in menstrual cyclicity Significant weight loss, greater with metformin Androgen levels decreased - metformin group Glucose and insulin levels unchanged Lipid levels unaltered either Spontaneous pregnancy rates similar
Hum Reprod. 2006;21:80-89.
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Lifestyle changes (intensive exercise with a goal of ≥ 150 min/week of activity) resulting in weight loss reduced the risk of type 2 diabetes.
N Engl J Med. 2002;346:393-403.
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another
Lifestyle modifications without rapid weight loss lead to a reduction of central fat and insulin sensitivity which restores ovulation in overweight infertile women with PCOS
J Clin Endocrinol metab 84:1470-1474, 1999
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Try to -
Follow a healthy eating pattern.
Be Active Not Smoke Control Your Weight
29
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