Polycystic Ovarian Syndrome
2014-12-01
If you find yourself consistently having irregular or
absent menstrual periods, from once in 2 months up to half a year, while
carrying excessive body weight, hear growth, blood androgens, also called ‘male
hormones, as well as disorders in blood sugar and lipid, you are at risk of
Polycystic Ovarian Syndrome (PCOS).
PCOS has been characterized as one of the most prevalent
endocrine and metabolic disorders amongst female. Locally,, 1 to 2 in
every 10-20 females will develop PCOS
during their reproductive age and it does not usually come to light till they
encounter issues in fertility. Females diagnosed with PCOS usually share at
least 2 of the following sings:
1. Irregularity
or absence of menstrual cycle
2. High
androgen levels, leading to
● Hirsutism,
excessive hair growth throughout different body parts such as chin, chest and
abdominal area
● High
testosterone level in blood
3. Existence
of multiple immature follicle cysts, less than 8mm in diameter each, within
ovaries under Ultrasound examination
What exactly causes the disease? Well, there is no
consensus yet, but mounting evidence evidence has shown that PCOS is associated
with hormonal disorders and its heredity nature. It could also be
weight-related, given that 40-60% of female with PCOS are overweight or obese.
Despite the lack of well-established cause, insulin resistance
plays a crucial role during the course of PCOS. Insulin is a regulatory hormone,
produced and secreted by pancreas, performing various via acting on our body
cells, such as coordinating carbohydrates and fat metabolism. When cells become
insulin resistant, they cannot respond and react as adequately to insulin as normal
cells do to carry out functions like taking up sugar from the blood. Pancreas
then needs to work harder to secret more insulin against the resistance of the cells
in response to the high blood sugar level. As a result, it is surprising for
PCOS sufferers with insulin resistant to be hyperinsulinemic (excess insulin present
in the blood). Both insulin resistance and compensatory hyperinsulinemia can
occur in healthy weight females with PCOS, but are particularly evident amongst
overweight sufferers.
How does too much insulin relate to PCOS? Excessive
insulin overstimulates the production of androgens in ovaries. Normally, the
actions of and organs produced by ovaries are well-regulated by estrogen, but
such androgen overproduction forms the culprit of PCOS symptoms. Including
erratic menstrual cycle via interfering the maturation of ovum in ovaries, and hirsutism
via overstimulation of androgens-sensitive hair follicles especially around the
face body parts like chest.
Does PCOS matter?
Thanks to insulin resistance, numerous research
studies have indicated that females with PCOS, no matter how old and heavy they
are, are 3-5 times more prone to several major chronic diseases including metabolic
syndrome, Type 2 Diabetes and cardiovascular diseases. Being overweight or obese,
of course, is part of the blame. Whine greater BMI for PCOS sufferers was associated
with menstrual irregularity, abdominal fat deposit is found to exacerbate body
cells insulin resistance and subsequent physiological and metabolic issues. That
leaves the overweight PCOS sufferers more likely to develop hypertension,
non-alcohol fatty liver disease, sleep apnea other than those conditions
mentioned. Moreover , too much luteinizing hormone, one of the hormones normally
produced as part of menstrual cycle, in PCOS sufferers will further stimulate
estrogen and androgens production leading to extensive thickening of the
endometrial lining , the innermost layer of uterus, which heightens the risk of
endometrial cancer.
How do healthy diet and active lifestyle kick in?
Menstrual irregularity or absence
For quick-fix combination of oral contraceptives is
usually prescribed for those 15-20% PCOS sufferers experiencing erratic
menstrual cycle. Metformin is also clinically proven to be effective in
restoring in restoring the hormonal balance and regularity of the cycle. In the
long run, enjoying a healthy diet and active lifestyle is the key as they help
maintain your healthy weight which keeps irregular menses at bay.
Overweight or obesity
Convincing evidence suggests 5% of overall weight
reduction is beneficial for irregular menses and insulin resistance as well as fertility
rate. Where to start? Making small achievable dietary changes aiming at
lowering fat, sugar and salt intake, moderate portions, limited dine out occasions or alcohol abstinence
together with regular physical activities world give you a great start in
managing your weight to improve PCOS management.
Insulin resistance
Insulin resistance is common to 40-70% of healthy weight PCOS sufferers and characterized
by:
● High
fasting blood sugar and insulin levels
● High
glycated hemoglobin level(HbA1c)
● High blood
sugar level after meal
● Impaired
glucose tolerance
● High
blood lipids levels
Enjoying moderate portions of carbohydrates and
fat, swapping refined or simple carbohydrates such as sugary food and beverage,
white bread for complex carbohydrates with lower glycemic index such as brown
rice, whole wheat bread and soba will help modulate blood sugar level. The
reduction of and organ levels over long term can help restore regular menstrual
cycle and better manage hirsutism. For further enquiry or advice. Feel free to
consult dietitian/nutritionist.
Reference:
Barr S, Reeves S, Sharp K & Jeans Y. (2010)
Efficacy of a low-glycemic index diet in women with polycystic ovary syndrome. Proceedings
of the Nutrition Society 69: E404
Barr S, Hart K, Reeves S, Sharp K & Jeans Y.
(2011) Habitual dietary intake., eating pattern and physical activity of women
with polycystic ovary syndrome. European Journal of Clinical Nutrition 65:
1126-1132
Diamanti-Kandarakis E. Christakou CD, Kandaraki E
& Economou FN, (2010) Metformin: an old medication of new fashion: evolving
new molecular mechanisms and clinical implications in polycystic ovary syndrome.
Eur J Endocrinol 162(2): 193-212
Lam PM. Ma RCM. Cheung LP, Chow CC, Chan JCN & Haines CJ. (2005) Polycystic ovarian syndrome in Hong Kong Chinese women: patient characteristics and diagnostic and diagnostic criteria. Hong Kong Med J 11:336-41
The British Dietetic Association The food fact sheet: Polycystic Ovary Syndrome , http://www.bda.uk.com/foodfacts/pocs Retrieved from 12th Dec, 2014
330 Tips provided by: Ms Grace Lam (Senior Dietitian - Centre for Nutritional Studies, School of Public Health and Primary Care, Faculty of Medicine, CUHK)
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