LONG TERM WEIGHT MANAGEMENT TO PROMOTE REPRODUCTIVE HEALTH IN OVER WEIGHT/OBEASE WOMEN WITH POLYCYSTIC OVARIAN SYNDROME.   DR.PREMA.H.S,

INTRODUCTION Obesity in women induces a range of co-morbidities like irregular menstrual cycle, anovulatory infertility, hirsutism, acne, hyperinsulinemia, dyslipidemia and hyperandrogenism. These are said to constitute the polycystic ovarian syndrome

PCOS is an excellent example of a syndrome for which early recognition and intervention of - Weight control Diet modification Life style changes Prevent or delay the development of further problems. Hence long-term holistic interest is needed to correct the reproductive health of the affected women.

Objectives To evaluate the somatic status of the obese women with PCOS. To evaluate the relationship between obesity and PCOS. Planning and evaluating the wt. management in reversal of the condition  

SELECTION OF SUBJECTS     subjects having a BMI greater than 25 with the clinical manifestation of menstrual irregularities, were selected.     While selecting the subjects it was found out that some of them are with or with out hirsutism, acne, dyslipidemia, hyprerinsulinemia with PCOS.

DEVELOPMENT OF TOOLS Personal data Anthropometrical measurements Co-morbidites associated with obese PCOS Dietary pattern,food preferences and food frequency Health practices Physical activities Behavioral pattern

METHODOLOGY Assessment of somatic state of obesity through anthropometrics- Ht. Wt. MUAC. SFT. W&H Assessment of body composition by bio-electrical impendence Bio-chemical assessment of serum Hb, RBS, PPBS,serum insulin & lipid profile. Assessment of presence of ovarian cysts by ultra sound scanning (pelvic or TVS).

Initially dietary counseling was given to all the subjects in the presence of their family members. Dietary modification was aimed to provide hypo caloric diet with 12 to 15 % of fat. Assessment of effective wt. reduction through anthropometrics i.e. wt, skin fold thick ness, MAC, W&H Measurements was done periodically. Assessment of presence of ovarian cysts and size of the ovaries were checked by ultra sound scanning at a specific period.

RESULTS A loss of an average of 10 kg over a period of 5 months Reduced ovarian size and the disappearance of or reduction of cysts in both the ovaries or in a single ovary. Subjects showing on an average a reduction of 10kg body wt., were found to have regular menstrual cycles. While the subjects losing, on an average, 2 kg body wt. still continue to show menstrual irregularities.

As assessed by bio-electrical impedance body compositions suggest reduced fat % with elevated TBW & FFM. The improvement of WHR. Three of the married subjects conceived spontaneously without any medical intervention These findings suggest that the wt. reduction through dietary modification have a role in the improvement of reproductive health of obese women with PCOS.

Normal uterus with bilateral polycystic ovaries. Right ovary measured 2.5x1.6x3.1 cm(volume 6.2 cc) Left ovary measured 3.1x1.7x2.9 cm(volume 7.6 cc)

Findings are suggestive of a very early intra-uterine gestation of about 5+ weeks. Both ovaries appeared normal and Corpus-luteum was seen in the right ovary. 3.1x1.2x2.0 (volume 3.7 cc) 3.0x2.1x3.6 cm (Corpus-luteum – 1.8x1.5x1.8 cm)

Bilateral polycystic ovaries with slight decrease in size since last scan done. Before wt. loss 3.7x2.2 cm After wt. loss 3.4x1.7 cm Before wt. loss 3.8x2.0 cm After wt. loss 3.1x1.7 cm

Size of the ovary before and after the dietary treatment Right ovary (cm) Left ovary Total loss of volume (cm) Before After After treatment 4.0× 2.1 2.0 ×1.9 4.0× 2.3 3.5× 1.8 7.5 3.6 ×2.0 2.5× 1.7 3.0 ×2.2 2.6 ×1.6 5.39 4.8 ×1.1 2.6× 1.0 4.8× 1.1 1.8× 0.6 6.88 4.4 ×2.0× 2.7 3.4× 1.2× 1.5 3.4 ×1.9 ×2.1 1.8× 0.2× 2.0 6.84 3.0× 2.4 1.1× 1.6 2.6× 2.2 1.6×0.5 6.72 4.3×2.4 1.9× 0.5 5.0×2.8 2.9×1.3 19.6

Average wt. Loss of the respondents.

Average reduction of WHR of the respondents.

Average reduction of fat % of the respondents

CONCLUSION Obesity appears to be a major cause for the development/progression of PCOS. Hence effective wt. Management among PCOS cases is imperative to restore the normal menstrual cycles