1 / 23

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.

fathia
Télécharger la présentation

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related