polycystic%20ovarian%20syndrome
POLYCYSTIC OVARIAN SYNDROME
Polycystic ovarian syndrome (PCOS) is the accumulation of underdeveloped follicles in the ovaries due to anovulation. It is is characterized by menstrual abnormalities and clinical or biochemical features of hyperandrogenism.
It results mainly from abnormal steroidogenesis that may be caused by insulin resistance leading to hyperinsulinemia.
There is increased sensitivity to androgens and the majority of women have elevated androgen levels.

Lifestyle Modification

Lifestyle Modification

  • Lifestyle modification is recommended in all PCOS patients
    • Diet modification, exercise and weight loss in obese patients all contribute to reestablishing insulin sensitivity
    • Benefits should be emphasized during preconception counseling 
  • In women with PCOS, excess body fat aggravates insulin resistance and its associated clinical consequences
  • Central obesity and high BMI have a major impact on the development of hyperinsulinemia and hyperandrogenism
  • PCOS patients with normal body habitus should be advised to continue these and to maintain their body weight within the normal range
  • PCOS patients should be informed of and screened for risk factors of cardiovascular disease (CVD): Cigarette smoking, obesity, dyslipidemia, type 2 diabetes mellitus or impaired glucose tolerance, family history of early CVD, hypertension, obstructive sleep apnea and absence of physical activity
  • PCOS patients should also be screened for anxiety and depressive symptoms to ensure adherence to lifestyle changes 
    • If positive, a specialist referral for further assessment and/or treatment may be done

Diet Modification

  • There is no particular food plan that is recommended for PCOS
  • Frequent feedings (4-6x/day) may be helpful to avoid hypoglycemia and hunger
    • Hypoglycemia can lead to cravings and poor food choices
  • To promote weight loss, diet should be modified to an intake of carbohydrates with a low glycemic index, and a reduced intake of fat and simple sugars
    • High-protein diet appears as effective as high-carbohydrate diet, as long as fat and total calories are comparable
  • May consider reducing intake by 500-750 kcal/day taking into consideration the patient’s weight, energy requirements and activity level

Exercise

  • Weight reduction and exercise can help reverse the metabolic problems in PCOS by improving ovarian function and the associated hormonal aberrations
    • Activities of vigorous intensity at 150 minutes/week or moderate intensity at 250 minutes/week together with strengthening of the major muscle groups are encouraged to lose modest weight and to prevent regained weight
  • Decreases risk of diabetes and CVD
  • Improvement in physical fitness and reduction in body fat will assist in resumption of ovulation and increase in fertility especially in anovulatory obese women with PCOS

Weight Reduction

  • Helps lower circulating androgen levels leading to spontaneous resumption of menses
  • Improves insulin resistance in obese patients
  • Associated with improved pregnancy rates and decreased hirsutism, as well as improvements in glucose and lipid levels
  • A 5-10% weight loss in 6 months is considered successful 
    • It is estimated that a loss of 5-10% of body weight can restore reproductive function in 55-100% of PCOS patients within 6 months of weight-reducing program
    • Hirsutism can also improve within 6-9 months of weight loss 

Management for Hirsutism

  • If hirsutism is moderate and localized, it may be treated with hair removal by shaving, laser, electrolysis or depilatory creams
  • In more severe hair growth, alternative methods can be used until androgen-suppressing therapies take effect
  • Treatment is often palliative rather than curative
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