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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.

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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


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 hyperandrogenism

  • 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 hyperandrogenism

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


Metabolic syndrome atp lll definition
Metabolic Syndrome: hyperandrogenismATP lll Definition

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


Therapies for hyperinsulinemia
Therapies for hyperinsulinemia hyperandrogenism

  • 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 hyperandrogenismon 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 hyperandrogenism

  • 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 hyperandrogenism

  • 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 hyperandrogenism

  • 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


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


Reactive hypoglycemia
Reactive Hypoglycemia significant benefits over the weight loss itself

  • 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 significant benefits over the weight loss itself

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


Additional benefits of protective dietary pattern significant benefits over the weight loss itself


Amy Mendez, MPH, RD, LD significant benefits over the weight loss itself

Registered Dietitian

843-876-4795

[email protected]


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