INTRODUCTION:

•The reproductive system of women is controlled by the complex interplay of

hormones. An imbalance within these hormones leads to a disorder called
PCOD that affects women in their reproductive age.

•Stein Leventhal syndrome

•The definition includes women who demonstrate two of the
following
characteristics:

i. Chronic anovulation (absence of ovulation)

ii. Chronic hyperandrogenism (elevation of serum testosterone or other
androgens )
iii. Polycystic-appearing ovaries (PCO) on ultrasound PCO are enlarged on both
sides and have a smooth, thick, avascular capsule.
iv. Increased LH with increased LH/FSH ratio.
 ETIOLOGY:
•Excess androgen: Overproduction of androgen
by ovaries causes PCOD and may lead to
hirsutism and acne.

•Excess production of insulin:

Insulin resistance is present
in a majority of cases, withcompensatory

hyperinsulinemia contributing to hyperandrogenism via stimulation of ovarian

androgen secretion. Increased androgen production causes difficulty with
ovulation.

•Heredity: Certain genetic correlation may exist with PCOD in women.

•Presence of low-grade inflammation: Women with PCOD experience a low-

grade inflammation that may stimulate polycystic ovaries to produce androgens.
PATHOPHYSIOLOGY:

Several theories have been proposed to explain the pathogenesis

of PCOS-
1) An alteration in gonadotropin-releasing hormone
secretion
results in increased luteinizing hormone (LH) secretion.

2)An alteration in insulin secretion and insulin action results in

hyperinsulinemia and insulin resistance.

3)A defect in androgen synthesis that results in increased ovarian

androgen production.
LH Secretion:
•LH is secreted in a pulsatile manner.
•Women with PCOD have an increase in both the LH pulse frequency and
amplitude, resulting in increased 24-hour secretion.
•This increase in LH secretion occurs as a result of increased frequency of
hypothalamic gonadotropin-releasing hormone (GnRH) pulses.
•Increased LH, in turn, leads to an increase in androgen production by the theca
cells within the ovary.
Hyperinsulinemia and Insulin Resistance:

•Insulin resistance, defined as reduced glucose response to a given amount of

insulin, is a characteristic metabolic disturbance associated with PCOD.

•30% to 40% of women with PCOD have impaired glucose tolerance, and as
many as 10% develop type 2 diabetes mellitus by the age of 40.

•Insulin acts synergistically with LH to enhance androgen production in the

ovarian theca cells.

•Insulin also decreases hepatic synthesis and secretion of sex hormone-

binding globulin, the hormone that binds testosterone in the circulation, thus
increasing the amount of free testosterone that is biologically available.

•Women with PCOD and hyperinsulinemia have elevated free testosterone,

but the total testosterone concentration may be at the upper range of normal
or only modestly elevated.
SYMPTOMS
:
COMPLICATIONS:
DIAGNOSIS:
For a diagnosis of PCOD to be made; at least two of the following criteria must be
met:
•Irregular or absence of menstrual periods (Oligomenorrhea or amenorrhea)
•High levels of androgen hormones evident in blood test results
•Ultrasound scan with evidence of polycystic ovaries

•Diagnostic criteria:
 MEDICAL NUTRITIONAL THERAPY:
Medical Management:
• Regulation of menstrual cycle
• Promoting ovulation
• Reduction of excessive hair
growth
• Ex. Spironolactone and some
OCPs are prescribed to inhibit
the effects and suppress the
production of androgen
hormones
Lifestyle Modifications:
• Weight loss can lower insulin and androgen
levels and restore ovulation. Just a 5%
reduction in weight can have significant health
benefits.
• Exercise- lowers blood sugar levels and control
body weight, can increase the sensitivity of
insulin-stimulated glucose uptake in skeletal
muscle.
•Avoid smoking and alcohol.
 NUTRITIONAL MANAGEMENT:
GOALS OF THE DIET
•Establish glycemic control
•Management of symptoms
•Improving metabolic and
reproductive
functions

PRINCIPLES OF THE DIET

•A high fiber diet may aid in establishing glycemic control.
•A low GI diet may also aid in establishing menstrual regularity and glycemic
control.
•Limiting the intake of simple sugars and refined carbohydrates, reduction of
saturated and trans fatty acids and attention to possible deficiencies such as
vitamin D, chromium and omega-3.
•Balanced carbohydrate intake throughout the day: Eat three meals with 45 grams/meal
and two to three snacks of 15/20 grams each. Gradually increase intake of high fiber
carbohydrate foods, aiming for 30 to 35 grams/day.

•Try not to let more than four to five hours go between meals/snacks to maintain stable
blood sugars and diminish extreme hunger.

•Emphasize lean protein foods at 15 to 20% of total calories. (1400 kcal = 70 grams protein).

•Consume about 25 to 30% of calories as fat – emphasizing low saturated fat foods and
increased monounsaturated and omega-3 fatty acid. Avoid foods containing trans fats.

•Some phyto-nutrients might improve insulin resistance. Low fat dairy foods; nuts
especially walnuts; orange and leafy green vegetables; carrots, yams and sweet potatoes.

•Vitamin D deficiency has been associated with insulin resistance. Supplementation with
Vitamin D3 may be beneficial.

•B12 absorption may be affected by long term use of metformin. A multivitamin

supplement with B12 may be recommended, especially for strict vegetarians.
 DRUG-NUTRIENT INTERACTION:
Medications Uses Nutrient Interaction Side effects

Combination of Helps stimulate Vitamins Causes Dizziness,

estrogen the growth of B2,B3,B6,B12, deficiency headache, rapid
folic acid, weight gain,
and an egg follicle.
magnesium, swelling of feet and
progesteron zinc,seleniu lower legs, vaginal
e m bleeding.

Synthetic Used to treat Vitamins Causes Weight gain,

progestin amenorrhea B2,B3,B6,B12, deficiency blurry vision,
and infertility. folic acid, fatigue, headaches,
magnesium, breast tenderness,
zinc,seleniu bloating, mood
m swings.
Medications Uses Nutrient Interaction Side effects
Glucophage Helps to control Vitamin B12, Megaloblastic anemia Headache,
and high blood sugar. folic acid and muscle pain, weakness,
Metformin CoQ10 nausea, vomiting, diarrhea,
gas, or stomach pain.

Accutane Reduces the Vitamin A Taking two compounds Dry skin,

amount together could increase itching, rash, dry nose,
of oil released by toxicity nosebleeds, cracks in the
the skin, used to corners of the mouth,
treat severe dry mouth, dry lips.
nodular acne.

Birth control Helps reduce Vitamin B6, Both folic acid and B6 Spotting between periods
pills excessive folic acid, levels may be low, Possible weight gain or fluid
androgen levels Vitamin E and C depression. Vit. C may retention,
in the blood, increase blood levels of Breast swelling,
protects the estrogen.
or tenderness,
uterus by
Nausea or
ensuring regular upset stomach,
ovulation. Mood changes.