PCOS

Polycystic Ovarian Syndrome Treatment in Delhi

PCOS is considered as the most common endocrine disorder amongst reproductive age women. It has gained a great deal of public attention over the last few decades, as this is reflected in over 1,500,000 internet sites dedicated to the syndrome. and is characterized by a chronic course, with features that suggest varying combinations of reproductive functional deficits (such as ovulatory dysfunction or PCO morphology) and androgen excess (such as acne and hirsutism).

• Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in  women ,with an estimated prevalence range between 2 and 20%. In australia prevalence is 8.7% and in  Turkey it is 6.1%,  in Iran its 7% and in  north America  it is  4to8%.  Mexican –american women have a higher prevalence ,reportedly as high as 13%

• In india PCOS is reported among 9% of adolescents ). Among india women 15-35 yers of age evaluated at a rural gynecology clinic ,13% presented with menstrual irregularities, half of wich were found to have PCOS, estimating the prevalence to be around 6.5%

• Dermatologic manifestations commonly experienced by women with PCOS include hirsutism, acne vulgaris,andandogenic alopecia or female hair loss, and are attributed to androgen excess.

• Combined hormonal contraceptive pill and anti-androgen agents are commonly utilized as treatment options for women with features of androgen excess.

• Cosmetic therapies may also be hepful in women who either cannot tolerate or whose symptoms are not adequately responsive to hormonal treatments.

Managing PCOS-Related Infertility

• PCOS accounts for approximately 80%of women with ovulatory infertility.

• Lifestyle modiifaction with caloric restriction and physical exercise should be considered as first-line intervention when managing infertile women with an overweight/obese PCOS phenotype.

• Clomiphene citrate (CC) remains the first –line treatment for ovulation induction in anovulatory women with PCOS, although armatase inhibitors have shown promise as an alternative method for ovulation induction.

• Gonadotropin was use is an option for CC –resistant and CC-failure patients, although treatment-related risks of ovarian hyperstimulation and multiple pregnancies may be exaggerated in the PCOS population .Now armatase inhibitors is the first line of treatment.

• In vitro fertilization (IVF) is a reasonable option for women with PCOS who have additional factor for infertility (tubal occlusion,male factors) or for those who have failed prior treatment with CC or gonadotropins.

• In theory, in vitro maturations (IVM) is a potentially useful strategy for the managmrnt of PCOS –related infertility ; in reality however, the reported pregnancy rates with IVF are significantly lower than seen with conventional IVM. More research is needed before IVM can be offered as a reliable treatment option for women with PCOS.

Role of Lifestyle and Diet in the Management of

Polycystic Ovarian Syndrome

• Diet therapy is without question one of the most important and effective management strategy for polycystic ovarian syndrome (PCOS).

• The health benefit of weight loss in overweight and obese women with POCS is well documented.

• While there is much debate about the optimal balnce of macronutrients that would be uniformly beneficial to women with POCS, evidence supports that the type and amount of dietary carbohydrates are important for a woman with PCOS.

• A diet moderate in low glycemic index carbohydrates, low in saturated fat and sodium, and high in fibre from whole grain, fruits, and vegetables can improve short-and long –term symptoms of PCOS, as well as decrease the risk of chronic diseases associated with insulin resistance.

• Regular execise must be encouraged and incorporated in the management paradigm of PCOS.

Putting It All Together

Sample Menu Plans for PCOS

1,200-1,400-cal Sample Menu

Breakfast	Lunch
• 1¼ cup of strawberries • 1 plain nonfat Greek yogurt • ½ cup high-fiber cereal • 6 walnuts	• 3 oz of grilled chicken  • 2 cups of Romaine lettue with 1 cup of assorted nonstarchy vegetables  • 1 tablespoon of olive oil  • 1 tablespoon of balsamic vinegar • 1 small orange
Dinner	Snack
• 3 oz of grilled salmon • 1 cup of green beans with 2 teaspoons butter • 1 cup of cooked wild rice • 1 cup of 1% milk	• 1 oz of low-fat cheese ( • 1 whole grain granola bar • Total: 1,350 cal, g of carbohydrates (35% total calories), 25 g of fiber (100 % of need), • 52 g of fat (36 % of total calories), and 108 g of protein (32 % of total calories).

Exercise Recommendations 

The Physical Activity Guidelines for Americans supports the recommendation that physical activity should be no less than 150 min total per week of moderate-intensity exercise. Activities such as brisk walking,water aerobics, ballroom and line dancing , general gardening, tennis (Doubles), or sports in wich one catches and throws (baseball, softball, volleyball) are all considered to reflect moderately intense physical activity. When exercising moderately, an individual should be able to talk but not sing. If the individual chooses to increase the intensity of exercise (while decreasing the duration), recommendations are for 75 min total per week. Vigorous-intensity activities include race walking, aerobic dance,biking faster than 10 miles an hour, hiking uphill, heavy gardening, jumping rope, martial arts (such as karate), jogging, running, swimming fast laps, tennis (singles), and any sport that involves a significant amount of running (basketball,soccer,field hockey).During vigorous activity,an individual should not be able to say more than a few words before breathing deeply. Activities that strengthen the muscles, improve balance, and preserve bone, such as weight training, using resistance bands, weight-bearing- aerobics, and heavy gardening, are recommended to be included 2 or more days per week.