Polycystic ovarian syndrome and lifestyle interventions

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women in their childbearing age around 18 -25% of women all over the world suffering from this syndrome.

PCOS SYMPTOMS

Women with this PCOS can represent different symptoms, most common are following;

  • Irregular periods
  • Excess facial hair growth (HIRSUTISM)
  • Infertility or difficulty getting pregnant ( because of irregular ovulation or failure to ovulate)
  • Obesity
  • Acne and skin problems like Dermatitis.
  • Depression, anxiety, bipolar disorders and eating disorders.
  • Metabolic syndrome; hypertension, diabetes and coronary artery diseases

How to diagnose PCOS??

This condition should invite early diagnosis and intervention because there is considerable evidence that women with PCOS are at increased risk of
infertility, dysfunctional uterine bleeding, metabolic syndrome, type II diabetes, and cardiovascular disease. A Rotterdam criterion is widely used as a diagnostic assessment for PCOS. It requires two of the following three features;

  • Irregular or skipped periods
  • Anovulation
  • Multiple cysts in ovaries on ultrasound
  • Higher levels of Androgens; either manifested by symptoms like Hirsuitism, Acne or balding or biological evidence like raised levels of Testosterone in their blood tests.

Causes and risk factors;

The exact cause of this syndrome remains elusive however excess androgens production and insulin resistance may cause this syndrome. A Genetic factor is also important as several studies reported an increase incidence among first degree relatives. It is reported by studies that around 50-70% of women with PCOS have insulin resistance meaning their cells are not able to use insulin effectively. To keep body glucose normal, the body tries to pump out the high level of insulin. This hyperinsulinemia is associated with weight gain and increase production of androgen hormone testosterone. Insulin resistance makes it harder to lose weight, that’s why women with PCOS experience this issue.

lifestyle interventions for PCOS management;

According to international PCOS guideline 2018, lifestyle interventions like diet, exercise, behaviour or combined are recommended as first line management for PCOS. Several studies reported the higher prevalence of obesity and overweight in women with PCOS as compared to the general population so these prevention opportunities are particularly relevant for the management of PCOS symptoms.

How the intervention might work

Lifestyle intervention is therefore anticipated to work because a reduction in the Body Mass Index (BMI) will be associated with a reduction in insulin resistance, which will, in turn, lead to an improvement in the reproductive and metabolic features of PCOS. Weight loss of as little as 5-10% has been demonstrated to correct oligo anovulation and improve the ability of women with PCOS to conceive.

PCOS nutrition ;

its is frequently asked by women with PCOS that which diet is best for curing their symptoms but unfortunately there is no such miracle diet. Research shows that diet which reduces insulin resistance like some carbs, proteins and healthy fats may help in improving menstrual irregularities and obesity.

➡️choose your carbs wisely as all carbs are not bad… carbohydrates with high fibre content like whole grains, lentils, legume and beans are helpful in reducing weight and risk of type 2 diabetes in women with PCOS.

➡️ Food with a low glycemic index (a ranking system indicate how rapidly blood sugar level rises after eating carbohydrates) may reduce insulin resistance as reported by several studies.

➡️ Protein may helps in cravings, balance hormones levels and aid in weight reduction, examples are lean meat, egg, seafood and plant based proteins. some evidence has suggested the beneficial effect of a diet with higher ratio of protein to carbohydrates.

➡️ Food that reduces inflammation as; tomato, spinach, olive oil, walnuts, almonds, blueberries and strawberries.

Food to avoid;

  • Food high in refined carbs like white bread, Muffins, white pasta
  • sugary drinks like soda and juices as they increase blood sugar levels, which can lead to weight gain and worsen the symptoms of PCOS.
  • Processed food and red meat.

Review the stress in your life;

stress increases cortisol level and this high level is linked with insulin resistance and weight gain. yoga and meditation can reduce stress as reported by studies.

Make sure you are getting enough sleep:

Several studies observed that short sleep duration is significantly associated with metabolic abnormalities, including higher BMI, raised fasting insulin levels, and increased risk of insulin resistance. Make sure you are getting enough and good quality sleep.

Get active;

Regular physical activity may help in reducing insulin resistance. studies have shown that low intensity exercise like walking or cycling reduces levels of cortisol and helps in reducing insulin resistance.

Consider supplements;

certain supplements like vitamin D, Myo inositol may help manage weight and other symptoms of PCOS though there is very little research is available to recommend these supplements for PCOS.

Take-home message;

PCOS is distressing for most of the women due to its symptoms and it is suggested by clinicians and dietitians that life style modification is the first line treatment for overweight and obese women.However due to diversity of symptoms one size does no fit for all. Make healthy food choices and create workout plan that suits your body and your PCOS….

Menopause; how to make it a postive experience.

Menopause is a phase of life in every woman when menstruation stopped naturally, however for some women this process is a time for anxiety and depression. Menopause usually occur at the ages of 45-55 years However, the average age for menopause in the UK is 51 years.

Physiology of Menopause;

Estrogen is a female sex hormone produced by ovaries. This hormone is responsible for secondary sexual characteristics in female ;like breast enlargement, broadening of the pelvis. However, estrogen receptors are also located in brain, skin, blood vessels and bones.

  • Estrogen is instrumented with VitaminD, calcium and other hormones to effectively breakdown and rebuild bone.
  • Estrogen has antiaging effects as it promotes collegen formation which is essential for skin elasticity.
  • Estrogen plays an important role in blood clotting. It also, relax, smooth and dilates blood vessels so blood flow increases.

Symptoms of Menopause;

As there is shift of hormones like estrogen and progesteron ,women may experience different symptoms like hot flushes,weight gain and psychologicl issues. Estrogen production gradually decreases so these symptomst appears slowly .

  • Hot flushes;most common symptom, around 75% women reported hot flushes .it is warmth sensation over face and upper body along with sweating and increased heart rate.
  • Psychological problems like depression and anxiety are common during this phase of life. As estrogen has an important role in serotonin production, modifying the production and the effects of endorphins, the “feel-good” chemicals in the brain. Estrogen also protects nerves from damage and possibly stimulating nerve growth.
  • Weight gain; Low levels of estrogen cause muscle wasting and fat deposition in postmenopausal women which may result in weight gain.
  • Bone loss /osteoporosis ;The bones of the female skeleton depend on oestrogen to maintain their strength and resistance. Low levels of estrogen increase bone turnover and this results in severe reduction of bone density. Postmenopausal women are more likely to get fractures as reported by some studies.
  • vaginal dryness; cessation of estrogen production buy ovaries may result in vaginal atrophy(thinning of walls) and dryness.

How to manage symptoms of Menopause naturally;

Menopause is a natural phenomena and there are healthful, natural ways to manage the change it can bring. Life style interventions like diet,physical activity, and good sleep can minimize the symptoms of Menopause.

Diet; Diet play an important role in overall health in every phase of life. similarly Menopause symptoms can be reduced or minimized by taking balanced healthy diet consist of varied food groups.

  • Fresh fruits and vegeatbles; Fruits and vegetables are the source of vitamins, minerals and fibre. several vegetables like spinch argula and kala are loaded with mineals like calcium, magnesium,Zinc, iodine and folate.
  • vitamin D rich food ; As bone become week and fragile which may increases chance of fracture in postmenopause women. Food rich in vitamin D like dairy products,low fat yogurts and salmon may hepful .
  • Eat your phytoestrogens ;These are plant derived chemicals, mimic the action of human oestrogen and may help in reducing severity of hot flushes, and mood swings in some women. Foods like soyabeans, lentils and chickpeas are a rich source of isoflavin( one of Phytoestrogen).
  • Low sodium die; Avoid added salt as sodium increases calcium loss via the kidney. snack food,canned food and meat has high sodium content. Try to incorporate grains, vegetables, fruits and beans in your diet as they are low in sodium.

Moove your foot Exercise is another important pillar of a healthy life. Regular daily activities like walking and aerobic exercise are helpful in maintaining healthy weight, boots mood and improve blood circulation.  A review of studies correlates the greatest likelihood to reduce symptoms of menopause with women who have the greatest physical fitness.

Diverse Hands Holding The Word Exercise

Sleep well ; During this phase, women experience insomina (lack of sleep) or disturb sleeping habits.To overcome this issue, follow a regular sleep including weekends, block out all light sources and sleep in a cool environment to promote healthy sleep habits.

Stop smoking; women who smoke might reach menopause earlier then who never smoke. Giving up smoking may reduce the risk of other complication like cardiovascular disease, cancer and osteoporosis.

”Menopause is definitely a time of choice and should really be about finding out what you really want. It is time to take charge and shape the remaining chapters of your life.”

Eating for two in Pregnancy; Myth or Fact:

Pregnancy is a time when women believe that they need an extra amount of food for themselves and growing fetus. According to a survey conducted by the National Charity Partnership (NCP),1 in 3 pregnant women still believes that they should consume 300 or more calories every day.           

But studies have shown that this myth has harmful effects on the mother as well as baby health. Eating too many calories means excess weight gain which can be detrimental for both mother and baby.

There are no official guidelines for weight gain during pregnancy in UK, but according to the US Institute of Medicine (IOM) recommendation:

Pregnancy complication for overweight or obese women

  • Gestational diabetes
  • Preeclampsia or high blood pressure
  • Increased risk of Miscarriages
  • Cesarean section

Being overweight or obese causes a problem for baby:

  • Large for gestational age
  • Premature birth
  • Birth defects
  • Risk of type 2 diabetes, heart diseases and obesity later in life.

According to NICE guidance: A pregnant women normally need to have 2,000 calories per day, as energy intakes do not change in the first 6 months of pregnancy.  However, women should require 200 extra calories per day in their last trimester.  These extra 200 calories can be

Take home message; 

Moderation is key; Eat varied diet comprises of all food groups.

  • Fruits and vegetable should be taken in plenty as they are a good source of fibre and vitamin.
  • Choose healthy carbohydrates like whole- grain cereals, bread.
  • Proteins either in the form of meat, eggs or plant based like pulses.
  •  Eat two portions of fish as it is an excellent way to get omega 3 fatty acids.
  • Choose healthy snacks.
  • Avoid salt laden and sugary food.   

Moderate light exercise during pregnancy is also helpful for preventing excess weight gain.

‘‘Listen to your body, but only when you know its intentions are sound.’’