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

5. 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
Age (years)
Long-term health
Precocious puberty
Reproductive disorder
Metabolic syndrome

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

8. 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

9. SMALL CHANGES MAKE A BIG DIFFERENCE

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

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

12. Low fat
High
carbs
Raised insulin

14. Dietary Modifications
Low carbohydrates
High fiber
Unsaturated fats

15. 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

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

17. 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

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

19. 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

20. Exercise
Exercise Exercise
Exercise

21. 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.

22. Exercise
Cardiotraining
CVD
Weight
Strength training
calorie
High BMR

23. Get started
Zumba
Pilates
Yoga
Aerobics
Cycling
Walking
Swimming

24. Effects Improves insulin sensitivity frequency of ovulation
cholesterol
body composition

25. META-aNALYSIS
Lifestyle modifications versus metformin plus lifestyle modifications

26. 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.

27. 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:

28. 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: , 1999

29. 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