Polycystic%20ovarian%20syndrome Patient Education

• Lifestyle modification is recommended in all PCOS patients
  • Diet modification with healthy eating, regular exercise and weight loss in obese patients all contribute to reestablishing insulin sensitivity and optimizing general health and quality of life  
  • 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
• Goal setting and self-monitoring which are specific, measurable, achievable, realistic and timely (SMART) can help achieve lifestyle goals 
  • All patient interactions should be patient-centered and should consider individualized healthy lifestyle preferences including cultural, socioeconomic and ethnic differences 
  • A respectful and considerate approach should be considered when assessing patient’s weight due to associated negative body image, low self-esteem and/or related stigma
• PCOS patients with normal body habitus should be advised to continue this and to maintain their body weight within the normal range
• PCOS patients should be informed of and screened for risk factors of CVD: Cigarette smoking, obesity, dyslipidemia, type 2 DM or impaired glucose tolerance, insulin resistance, family history of early CVD, subclinical vascular disease, hypertension, metabolic syndrome, OSA, nonalcoholic steatohepatitis 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
• Behavioral strategies including goal-setting, self-monitoring, assertiveness training, problem solving, slower eating, stimulus control, reinforcing changes and relapse prevention can help optimize a healthy lifestyle, weight management and patient’s emotional wellbeing 

Diet Modification

• There is no particular food plan that is recommended for PCOS; it is recommended to follow general healthy eating practices
• 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
  • Vigorous activity at 75 minutes/week or moderate-intensity activity at 150 minutes/week, or a combination of both, together with muscle strengthening on 2 non-consecutive days/week are encouraged to prevent weight gain and to maintain health 
  • Activities of vigorous intensity at 150 minutes/week or moderate intensity at 250 minutes/week, or a combination of both, and strengthening of the major muscle groups on 2 non-consecutive days/week are encouraged to lose modest weight and to prevent regained weight 
  • Physical activity can be incidental or structured; self-monitoring, including use of fitness tracking devices and technologies, could support and promote active lifestyles
• 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

• Associated with improved pregnancy rates and decreased hirsutism, as well as improvements in glucose and lipid levels 
  • Helps lower circulating androgen levels leading to spontaneous resumption of menses
  • Improves insulin resistance in obese patients
• 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
• BMI and waist circumference categories that are adolescent and ethnic-specific should be considered to optimize lifestyle and weight management 
• Anti-obesity medications can be considered with lifestyle intervention as per general population guidelines
  • Consider treatment availability, cost, side effects, contraindications and regulatory status, and avoid pregnancy while on therapy  

Management for Hirsutism

• If hirsutism is moderate and localized, it may be treated with hair removal by shaving, plucking, waxing, bleaching, laser therapy, 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