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 co-morbidities 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 bio-electrical 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.

Right ovary measured 2.5x1.6x3.1 cm(volume 6.2 cc)

Left ovary measured 3.1x1.7x2.9 cm(volume 7.6 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 cmAfter wt. loss 3.4x1.7 cm

Before wt. loss 3.8x2.0 cmAfter 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.

1st reading 3.2±1.62nd reading 1.7±0.983rd reading 1.45±0.694th reading 1.6±0.94total period 8.05±2.84

Avg wt. Loss (kg) in

Average reduction of WHR of the respondents.

1st reading2nd reading3rd reading4th readingtotal period 0.029±0.033

0.006±0.0160.003±0.0210.007±0.0210.013±0.019

Avg reduction WHR

Average reduction of fat % of the respondents

1st reading2nd reading3rd reading4th readingtotal period

0.750±0.4702.852±1.202

Avg reduction in fat%0.994±0.4950.667±0.4880.489±0.295

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