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Polycystic Ovarian Syndrome

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

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  1. Polycystic Ovarian Syndrome Amy Mendez, MPH, RD, LD Registered Dietitian

  2. 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.

  3. Presenting problems • Oligomenorrhea or Amenorrhea • Hyperandogenism side effects • Hirsutism • Acne • Male pattern balding • Infertility • Obesity/weight gain

  4. 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

  5. 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

  6. Hyperandrogenism Insulin Resistance

  7. 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

  8. 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

  9. Type 2 Diabetes Gambineri et al. Diabetes 53(9), 2353-2358.

  10. Metabolic Syndrome:ATP lll Definition Ford ES et al. JAMA. 2002;287:356-359.

  11. Therapies for hyperinsulinemia • Weight loss (obese PCOS) • Insulin Sensitizers • Troglitozone (Rezulin) • Metformin (Glucophage) • Rosiglitazone (Avandia) • Pioglitazone (Actos) • Dietary therapies

  12. 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.

  13. 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

  14. 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

  15. 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

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

  17. 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?”

  18. 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

  19. Additional benefits of protective dietary pattern

  20. Amy Mendez, MPH, RD, LD Registered Dietitian 843-876-4795 mendeza@musc.edu

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