LONG TERM WEIGHT
MANAGEMENT TO PROMOTE
REPRODUCTIVE HEALTH IN
OVER WEIGHT/OBEASE
WOMEN WITH POLYCYSTIC
OVARIAN SYNDROME.
DR.PREMA.H.S,
INTRODUCTION
• Obesity in women induces a range of comorbidities like irregular menstrual cycle,
anovulatory infertility, hirsutism, acne,
hyperinsulinemia, dyslipidemia and
hyperandrogenism. These are said to
constitute the polycystic ovarian syndrome
• PCOS is an excellent example of a
syndrome for which early recognition and
intervention of • Weight control
• Diet modification
• Life style changes
• Prevent or delay the development of further
problems.
• Hence long-term holistic interest is needed
to correct the reproductive health of the
affected women.
Objectives
• To evaluate the somatic status of the obese
women with PCOS.
• To evaluate the relationship between obesity
and PCOS.
• Planning and evaluating the wt. management in
reversal of the condition
SELECTION OF SUBJECTS
•
subjects having a BMI greater than 25
with the clinical manifestation of menstrual
irregularities, were selected.
•
While selecting the subjects it was found
out that some of them are with or with out
hirsutism,
acne,
dyslipidemia,
hyprerinsulinemia with PCOS.
DEVELOPMENT OF TOOLS
•
•
•
•
Personal data
Anthropometrical measurements
Co-morbidites associated with obese PCOS
Dietary pattern,food preferences and food
frequency
• Health practices
• Physical activities
• Behavioral pattern
METHODOLOGY
• Assessment of somatic state of obesity
through anthropometrics- Ht. Wt. MUAC.
SFT. W&H
• Assessment of body composition by bioelectrical impendence
• Bio-chemical assessment of serum Hb,
RBS, PPBS,serum insulin & lipid profile.
• Assessment of presence of ovarian cysts by
ultra sound scanning (pelvic or TVS).
• Initially dietary counseling was given to all
the subjects in the presence of their family
members.
• Dietary modification was aimed to provide
hypo caloric diet with 12 to 15 % of fat.
• Assessment of effective wt. reduction
through anthropometrics i.e. wt, skin fold
thick ness, MAC, W&H Measurements was
done periodically.
• Assessment of presence of ovarian cysts and
size of the ovaries were checked by ultra
sound scanning at a specific period.
RESULTS
• A loss of an average of 10 kg over a period
of 5 months
• Reduced ovarian size and the disappearance
of or reduction of cysts in both the ovaries
or in a single ovary.
• Subjects showing on an average a reduction
of 10kg body wt., were found to have
regular menstrual cycles.
• While the subjects losing, on an average, 2
kg body wt. still continue to show menstrual
irregularities.
• As assessed by bio-electrical impedance
body compositions suggest reduced fat %
with elevated TBW & FFM.
• The improvement of WHR.
• Three of the married subjects conceived
spontaneously
without
any
medical
intervention
• These findings suggest that the wt. reduction
through dietary modification have a role in
the improvement of reproductive health of
obese women with PCOS.
Normal uterus with bilateral polycystic
ovaries.
Left ovary measured
3.1x1.7x2.9 cm(volume 7.6 cc)
Right ovary measured
2.5x1.6x3.1 cm(volume 6.2 cc)
Findings are suggestive of a very early intra-uterine
gestation of about 5+ weeks. Both ovaries appeared
normal and Corpus-luteum was seen in the right
ovary.
3.1x1.2x2.0
(volume 3.7 cc)
3.0x2.1x3.6 cm
(Corpus-luteum –
1.8x1.5x1.8 cm)
Bilateral polycystic ovaries with slight decrease in
size since last scan done.
Before wt. loss 3.7x2.2 cm
After wt. loss 3.4x1.7 cm
Before wt. loss 3.8x2.0 cm
After wt. loss 3.1x1.7 cm
Size of the ovary before and after
the dietary treatment
Right ovary
(cm)
Left ovary
(cm)
Total loss of
volume (cm)
Before
After
Before
After
After treatment
4.0× 2.1
2.0 ×1.9
4.0× 2.3
3.5× 1.8
7.5
3.6 ×2.0
2.5× 1.7
3.0 ×2.2
2.6 ×1.6
5.39
4.8 ×1.1
2.6× 1.0
4.8× 1.1
1.8× 0.6
6.88
4.4 ×2.0× 2.7
3.4× 1.2× 1.5
3.4 ×1.9 ×2.1
1.8× 0.2× 2.0
6.84
3.0× 2.4
1.1× 1.6
2.6× 2.2
1.6×0.5
6.72
4.3×2.4
1.9× 0.5
5.0×2.8
2.9×1.3
19.6
Average wt. Loss of the
respondents.
Avg wt. Loss (kg) in
1st reading 3.2±1.6
2nd reading 1.7±0.98
3rd reading 1.45±0.69
4th reading 1.6±0.94
total period 8.05±2.84
Average reduction of WHR of
the respondents.
Avg reduction WHR
1st reading
0.006±0.016
2nd reading
0.003±0.021
3rd reading
0.007±0.021
4th reading
0.013±0.019
total period
0.029±0.033
Average reduction of fat % of the
respondents
Avg reduction in fat%
1st reading
0.994±0.495
2nd reading
0.667±0.488
3rd reading
0.489±0.295
4th reading
0.750±0.470
total period
2.852±1.202
CONCLUSION
• Obesity appears to be a major cause for the
development/progression of PCOS. Hence
effective wt. Management among PCOS cases
is imperative to restore the normal menstrual
cycles