Polycystic ovarian syndrome Can lifestyle modifications help?? Dr Saloni Assistant Professor, Deptt of OBG BPSGMC for Women, Khanpur Kalan

Life-long condition Hypercholesterolaemia ? Pronounced adrenarche Cancer (uterine;; ? breast) Hirsutism Hypercholesterolaemia Menstrual irregularities Diabetes Hypertension ? Pronounced adrenarche Infertility, miscarriage Gestational hypertension Gestational diabetes Coronary heart disease ? IUGR 0 10 20 30 40 50 60 70 Age (years) Long-term health Precocious puberty Reproductive disorder Metabolic syndrome

Pathophysiology Weight increase SHBG decreases Insulin increase Inherited defects in insulin actions IGFBP-1 decrease Insulin receptor disorders Theca (IGF-II, ?IGF-I)

Different hormone concentrations in obese and non-obese PCO patients 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

SMALL CHANGES MAKE A BIG DIFFERENCE

LIFESTYLE MODIFICATIONS Weight reduction includes a combination of caloric restriction, increased physical activity and behaviour modification.

Dietary Modifications Carbohydrate: 55% Protein: 15% Fat: 30% (<10% from saturated fat)

Low fat High carbs Raised insulin

Dietary Modifications Low carbohydrates High fiber Unsaturated fats

fiber Examples of Insoluble Fiber: Whole wheat breads Wheat cereals Wheat bran Cabbage Beets Carrots Brussels’ Sprouts Turnips Cauliflower Apple skin Examples of Soluble Fiber: Oat bran Oatmeal Beans Peas Rice bran Barley Citrus fruits Strawberries Apple Pulp Fiber is either soluble or insoluble. When eaten regularly, fiber has been shown to lower blood cholesterol and may help to decrease the risk of diabetes and colorectal cancer. It is recommended that we consume more raw vegetables and fresh fruit, including the skins when appropriate. This is because the skins are packed with both valuable nutrients and fiber. Some examples of soluble fiber include : oat bran, oatmeal, beans, peas, rice bran, barley, citrus fruits, strawberries, and apple pulp. Some examples of insoluble fiber include: whole wheat breads, wheat cereals, wheat bran, cabbage, beets, carrots, Brussels’ sprouts, turnips, cauliflower, and apple skin. Cooking vegetables can decrease fiber content, and skins are a good source of fiber. Pennington Biomedical Research Center

Dietary Modifications Small may be more frequent meals Balanced meals Smaller plates Resist urge

Healthy Living Guidelines 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 Dairy Recommendation: It is recommended that you minimize your intake of whole fat dairy products, such as butter and whole milk or 2% full fat dairy products. Cholesterol Recommendations: Your overall intake of cholesterol should be less than 300 mg daily. It is said that egg whites do not contain cholesterol, and they are a good source of protein. You can substitute 2 egg whites for each egg yolk in many recipes that call for eggs. Also, organ meats, such as liver and heart, are very high in cholesterol. Dietary Substitutions: Prepare fish by baking, broiling, grilling, or boiling, rather than breading and frying. You should use liquid vegetable oil and soft margarine in place of hard margarine or shortening. Pennington Biomedical Research Center

Effects Weight loss of even 5-10% will help reduce insulin resistance and your androgen levels

Lifestyle Modification Weight loss (5-10% over 6 months) is effective in re-establishing ovarian function in >50% of obese PCOS women Study Weight loss Outcomes 1995 6.3 kg 12 out of 13 + ovulations 11 out of 13 + pregnant Hollman 1996 5.6 kg 80% ovulation rate 29% pregnancy androstenedione, insulin testosterone, estradiol Huber-Buckholz 1999 6.3 kg (2-5% loss) 9 out of 15 + ovulations 2 out of 15 + pregnant Hoeger 2004 6.8% loss 30% increased ovulation Decreased hirsutism score

Exercise Exercise Exercise Exercise

Be Physically Active 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 Physical activity not only helps control your blood pressure, it also helps you manage your weight, strengthen your heart and manage your stress level. A healthy weight, a strong heart and general emotional health are all good for your blood pressure.

Exercise Cardiotraining CVD Weight Strength training calorie High BMR

Get started Zumba Pilates Yoga Aerobics Cycling Walking Swimming

Effects Improves insulin sensitivity frequency of ovulation cholesterol body composition

META-aNALYSIS Lifestyle modifications versus metformin plus lifestyle modifications

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.

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.

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

Try to - Follow a healthy eating pattern. Be Active Not Smoke Control Your Weight And try to stop smoking, control your weight, get more active and take your high blood pressure medicine every day. The best treatment is prevention. Adopt a healthy life by: following a healthy eating pattern. Research as shown that following a healthy eating plan can both reduce the risk of developing high blood pressure and lowering an already elevated blood pressure. Maintain a healthy weight. Be physically active, limit alcohol and quit smoking