1. Presented by Marita Radloff, Nutrition student at the University of Alabama & Dani Lebovitz MS, RD, CSSD, LD, CDE, Robins AFB Dietitian

2.  What is PCOS?  Signs and Symptoms  Diagnosis  Causes  Complications  Treatment  Diet  Exercise  Final Thoughts  Questions

3.  Polycystic means “many cysts”  Small, pearl-sized clusters of cysts in the ovaries Fluid-filled follicles containing eggs are premature  Follicles containing the eggs build up in the ovaries  Polycystic Ovary Syndrome is the most common endocrine disorder in females  5-10% of reproductive-age women have PCOS  High levels of androgens (male hormones such as testosterone) are released from the ovary  Androgens interfere with ovulation and normal body regulation

4. Heavy, irregular or absent menstrual cycles Infertility Excessive abdominal weight (WH ratio >35 inches) Intense carbohydrate cravings Hair loss from the head Acne (on the face, chest, and back) Sleep apnea Skin tags Darkened patches of skin (around the neck, groin, underarms, or in folds) High blood pressure High cholesterol High triglycerides Depression Anxiety Decreased sex drive Type 2 Diabetes Pelvic Pain Male pattern hair growth (face, chest, back, lower abdomen, fingers, and toes)

5.  PCOS is responsible for 70% of infertility issues in women who have difficulty ovulating  Androgens affect ovulation and egg development  “String of Pearls” or polycystic ovaries lead to irregular or infrequent periods

6.  Difficult to diagnosis; less than 50% of those with PCOS know they have it  Doctors will look at:  A family history of PCOS  Unusual menstrual cycles Periods lasting 40+ days Very heavy periods Absent periods  Ultrasounds for “String of Pearls” on ovaries  Two or more signs or symptoms of PCOS

7.  Exact cause unknown  Genetics  Exposure to androgens in the womb

8.  Early detection is key since PCOS is known as a “Silent Killer”  Elevated low density lipoprotein (LDL) “lousy cholesterol”  Low high density lipoprotein (HDL) cholesterol “healthy cholesterol”  High triglycerides (fat circulating in the blood)  Elevated blood pressure above 140/90mmHg  Cardiovascular disease 4 to 7 times higher in women with PCOS than women of the same age without PCOS

9.  Increased risk for endometrial cancer  Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone  Progesterone responsible for shedding uterine lining  Overtime, the uterine lining becomes thick and can lead to cancer  Increased risk for breast and ovarian cancer  Studies have shown that women with PCOS have double the risk for developing ovarian cancer

10.  Sleep apnea Most common cause of sleep disorders Brief interruptions during sleep Cause snoring and fragmented sleep When left untreated, can lead to an increased risk of heart disease and stroke o Anxiety and depression o Early detection and treatment is key to avoid chronic diseases later in life!

11.  Diabetes  Insulin resistance  Insulin is a hormone in the body that regulates blood sugar by bringing sugar (glucose) into the cells for energy  Some women with PCOS have insulin resistance, where the amount of insulin needed for energy uptake has been disrupted – this can lead to Type II Diabetes  About 30% of women with PCOS have some type of insulin resistance  Increases the likelihood of the weight gain cycle

12.  Women with PCOS tend to have higher rates of:  Miscarriage  Gestational diabetes  Preeclampsia (pregnancy induced high blood pressure)  Premature delivery  Cesarean section delivery  Neonatal care

13.  Control all of your symptoms, not just one, to reduce chronic disease risk  Get tested for diabetes regularly  Symptoms of PCOS can be improved with diet, exercise, and quitting smoking  Studies have shown that a moderate weight loss of 5-7% of total body weight may significantly improve symptoms

14.  Women with PCOS crave more carbohydrates  Could lead to binge eating and weight gain  What are carbohydrates?  Foods that breakdown into sugar in the body Breads, cereals, rice, pasta, fruits, starchy vegetables Whole grains (complex carbohydrates vs. refined grains (simple carbohydrates)  Choose whole-grains over refined grains  Think fiber! Reduces cholesterol Keeps you feeling fuller longer

15.  Try to make more meals plant-based  A plant-based diet is rich in fruits, vegetables, nuts, legumes and whole grains Limit animal products: Butter Meat  More vitamins, minerals and fiber that help reduce cholesterol and blood pressure  Lower in calories  Take longer to chew: add to full feeling  Start slow: Make one meal or snack a week with no animal products

16.  Eat foods rich in Omega-3 Fatty Acids  Omega-3s lower cholesterol and triglycerides  Foods rich in Omega-3s: Walnuts Egg yolks Flaxseeds Chia seeds Canola oil Fatty Fish (especially salmon and tuna)  These are higher in fat and calories, so eat in moderation

17.  Vitamin D is found in almost every cell and tissue in the body  Helps to regulate menstrual cycles  Decreases insulin resistance  RDA: 600 IU, but some studies suggest 2000 IU  Food sources: Milk, yogurt, cheese, egg yolks, swordfish, salmon, tuna in water, fortified orange juice, and many ready to eat cereals  Take a supplement or get short 10-15 minutes of sunscreen-free sun exposure

18.  Being physically makes a difference!  Regulate menstrual cycles  Decrease risk of diabetes and heart disease  Helps with weight management  Women with PCOS who exercise 3 times/week have:  Improved ovulation rates  Better insulin sensitivity  Lose more inches around their waist than those who just cut calories

19.  Recommended 30-60 minutes 5 days a week  Strength training 2-3 times per week  Increases metabolism and promotes muscle growth  Tips to be more physically active:  Schedule your day around exercise; if it’s the other way around, it might not get done!  Spread out exercise in 10 to 15 minute increments instead of all at once  Use exercise equipment or body weight exercises while watching TV or during commercials  Take the dog on longer walks, use the stairs, park further from store entrances  Wear a pedometer and aim for 10,000 steps per day!

20.  PCOS is not curable, but is treatable  Take steps to stay as healthy as possible  Proper nutrition and exercise help to manage symptoms and reduce risk of chronic diseases  Regularly check blood sugar, cholesterol, and blood pressure  Early diagnosis, proper treatment, and lifestyle changes can manage or reverse symptoms

22.  References  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938 041/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938 041/  http://www.pcosfoundation.org/PCOS-Education- trifold.pdf http://www.pcosfoundation.org/PCOS-Education- trifold.pdf  http://www.pcosnutrition.com/index.php?pID=28 http://www.pcosnutrition.com/index.php?pID=28  http://www.pcosnutrition.com/_files/live/Understan ding_insulin_resistance.pdf http://www.pcosnutrition.com/_files/live/Understan ding_insulin_resistance.pdf  http://www.hormone.org/diseases-and- conditions/womens-health/polycystic-ovary- syndrome http://www.hormone.org/diseases-and- conditions/womens-health/polycystic-ovary- syndrome  http://www.womenshealth.gov/publications/our- publications/fact-sheet/polycystic-ovary- syndrome.html http://www.womenshealth.gov/publications/our- publications/fact-sheet/polycystic-ovary- syndrome.html