Polycystic ovarian syndrome
This presentation is the property of its rightful owner.
Sponsored Links
1 / 23

Polycystic Ovarian Syndrome PowerPoint PPT Presentation


  • 60 Views
  • Uploaded on
  • Presentation posted in: General

Polycystic Ovarian Syndrome. Amy Mendez, MPH, RD, LD Registered Dietitian. What is PCOS?. The most common endocrine disorder affecting women of childbearing age 5-20% of reproductive age women. Knochenhauer,et al. J Clin Endocrinol Metab . 1998;83;3078-3082. Presenting problems.

Download Presentation

Polycystic Ovarian Syndrome

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Polycystic ovarian syndrome

Polycystic Ovarian Syndrome

Amy Mendez, MPH, RD, LD

Registered Dietitian


What is pcos

What is PCOS?

  • The most common endocrine disorder affecting women of childbearing age

  • 5-20% of reproductive age women

Knochenhauer,et al. J ClinEndocrinolMetab. 1998;83;3078-3082.


Presenting problems

Presenting problems

  • Oligomenorrhea or Amenorrhea

  • Hyperandogenism side effects

    • Hirsutism

    • Acne

    • Male pattern balding

  • Infertility

  • Obesity/weight gain


Pcos diagnosis

PCOS diagnosis

  • 2003 PCOS Consensus Workshop new diagnostic criteria (need at least 2 of 3)

    • Hyperandrogenism (clinical or serum)

      • Ex: testosterone

    • Chronic Anovulation (avg menses >45 days)

    • PCOS ovaries on ultrasound

  • Exclude other diseases


Long term risks of pcos

Long term risks of PCOS

  • Type 2 DM- 17-45% incidence

  • Dyslipidemia

  • Endometrial Cancer

  • Hypertension -39% incidence

  • MI- risk factors predict 7 fold increase

  • Gestational DM- 17-38% incidence

  • Pregnancy Induced Hypertension- 14% incidence

  • Ovarian Cancer


Polycystic ovarian syndrome

Hyperandrogenism

Insulin Resistance


Unlikely that the insulin resistance is a result of the hyperandrogenism

Unlikely that the insulin resistance is a result of the hyperandrogenism

  • IR remains after BSO

  • Pre-pubertal women with acanthosis nigricans are hyperinsulinemic several years before hyperandrogenism occurs

  • Some women with point mutations in the insulin receptor have been shown to have PCOS

  • Normal men have androgen concentrations 10-30 fold higher than women, yet they do not demonstrate insulin resistance


Elevated insulin levels

Elevated Insulin levels

  • Studies show that women with PCOS have higher insulin levels than obese controls

  • Chang et al, 1983 showed that non-obese PCO pts had higher basal and serum insulin levels than controls


Type 2 diabetes

Type 2 Diabetes

Gambineri et al. Diabetes 53(9), 2353-2358.


Metabolic syndrome atp lll definition

Metabolic Syndrome:ATP lll Definition

Ford ES et al. JAMA. 2002;287:356-359.


Therapies for hyperinsulinemia

Therapies for hyperinsulinemia

  • Weight loss (obese PCOS)

  • Insulin Sensitizers

    • Troglitozone (Rezulin)

    • Metformin (Glucophage)

    • Rosiglitazone (Avandia)

    • Pioglitazone (Actos)

  • Dietary therapies


Dpp benefit of diet exercise or metformin on diabetes prevention in at risk patients

DPP: Benefit of diet + exercise or metformin on diabetes prevention in at-risk patients

N = 3234 with IFG and IGT, without diabetes

40

Placebo

P*

30

Metformin

<0.001

Cumulative

incidence of diabetes

(%)

31%

20

Lifestyle

<0.001

58%

10

0

0

1.0

2.0

3.0

4.0

Years

*vs placebo

IFG = impaired fasting glucose

Diabetes Prevention Program (DPP) Research Group. N Engl J Med. 2002;346:393-403.


Effect of weight loss

Effect of weight loss

  • Diet-induced weight loss of 12.4 kg in 13 obese, insulin-resistant women with PCOS improved:

    • Fasting insulin

    • Peak insulin

    • Insulin AUC

    • Insulin Sensitivity


Dietary composition

Dietary Composition

  • 45 women with PCOS

  • Randomized to:

    • high protein (HP; 40% carb, 30% protein; n=14)

    • Low protein (LP; 55% carb, 15% protein; n=14

  • 12 weeks energy restriction, 4 wk maintenance


High protein vs low protein

High Protein vs Low Protein

  • Improvements seen for both groups:

    • Pregnancies

    • Menstrual cyclicity

    • Lipid profile

    • Insulin resistance

    • Weight

    • Abdominal fat

  • HP group: HDL remained consistent, LP group: HDL dropped during weight loss


Polycystic ovarian syndrome

At this time, no clear evidence that diet composition has significant benefits over the weight loss itself


Reactive hypoglycemia

Reactive Hypoglycemia

  • 64 lean women with PCOS

  • 50% prevalence of reactive hypoglycemia

    • Altuntas, et al. Eur J Obstet Gynecol Reprod Biol 2005

  • Would a low glycemic load diet pattern be effective to reduce post-prandial hyperinsulinemia?

  • Would this dietary pattern reduce “carbohydrate cravings?”


Low glycemic load diet

Low Glycemic Load Diet

A.M. Herriot et al. J Human Nutr Dietetics 2008

  • 88 patients with PCOS referred for nutrition counseling

  • Retrospective audit of records at RD and MD visits

  • Subjective reports of hunger and carbohydrate cravings improved


Polycystic ovarian syndrome

Additional benefits of protective dietary pattern


Polycystic ovarian syndrome

Amy Mendez, MPH, RD, LD

Registered Dietitian

843-876-4795

[email protected]


  • Login