changing diet ,eating habits,regular exercise yoga aerobics swimming can help in weight loss.Psychological counselling helps in managing stress.Life style modifications are first linee management of adolescent pcos

1. Role of life style modifications in
PCOD
Poonam Loomba,M.D
Loomba Hospital and IVF Centre Ambala Cantt.
loombapoonam@gmail.com

2. Obesity / PCOS / Infertility
• Obesity has substantial effects on manifestations
of PCOS.
• 35-50% of women with PCOS are obese.
• 50% of overweight women have PCOS.
• Obesity plays a significant role in determining the
severity of clinical manifestations and metabolic
disorder.
• Significant increase in infertility and menstrual
irregularities seen with BMI > 30 kg/m2

3. Central obesity is strongly
indicated as a cause of
insulin resistance,
The prevalence of obesity is
reaching epidemic
proportions in many
developed countries, and in
particular adolescent
women.
It worsens both the
metabolic and endocrine
profiles in PCOS and may
decrease the response to
treatment.

6. Is it that simple?

7. Components of life style
• Sedentary life
• Eating habits
• Weight gain
• Stress
• Depression
S
E
WS
D

8. Management
• Clinician
• Dietician
• Exercise specialist
• Psychologist
• Councellor

9. Modificattions
• Diet
• Exercise
• Weight Loss
• Behavioral Changes
• Smoking cessation

10. Portion control
• It is generally
recommended to
spread the calories
throughout the day by
having 5-6 small meals.
• This keeps the
metabolism humming
and reduce cravings for
sweets and starches.
(Very common among
women with PCOS)

11. Optimal meal patterns
 Consume breakfast within 1 hr of walking
 Snack 2 -3 hr later
 Eat lunch 2 hr later
 Another snack 2 – 3 hr later
 Dinner 2 hr later

12. Foods to eat
Lots of leafy green
vegetables.
Focus on whole foods
and sources of protein
like fish, eggs and
chicken breast.
Spices like turmeric,
cinnamon, fenugreek,
and ginger, that are
anti-inflammatory and
believed to help with
insulin resistance.

13. Fruits
• Fruits low in fructose
and rich in fibre are
best
• Grapefruits,
Clementines, Lime,
Lemon, Raspberries,
Blackberries ,Oranges
Strawberries,Pineapple
Blueberries and
honeydew melon

14. Good fats
• Healthy fats mean foods
like avocado, salmon,
mackerel, sardines,
butter, and olive oil (free
range or organic if
possible).
• Increasing healthy fats in
your diet is a great way to
keep you satiated, and
can help your body
absorb vitamins A, D, E, K
and help with healthy
female hormone levels.

15. Split Carbs, Proteins, Fats
• Try a macronutrient split of around 20
percent complex carbs, 40 percent protein and
40 percent fat but switch it around and get
constant feedback from them as to whether
it's working or not.
• Cholesterol should be less than 300 mg daily
• Use low fat cooking methods: baking, broiling,
grilling, boiling, rather than breading, frying
• Use liquid vegetable oil

16. Flaxseed (Alsi)
• For balancing hormones use Flaxseed which is
rich in fibre and Omega 3. Eat two
tablespoons per day on salads, or sprinkled
on porridge or in smoothies.

17. Say NO to
• White pasta
• White rice
Anything super-processed
(including processed meats).
• Fruit drinks and smoothies
• Whole milk
• Excess of Tea Coffee
• Sugar

18. Minerals
• Good dietary sources of chromium include
onions, romaine lettuce, tomatoes, whole
grains, and potatoes. Chromium promotes
weight loss due to its ability to help control
cravings. •
• Chromium is a component of the glucose
tolerance factor (GTF) which helps maintain
normal blood glucose levels by making insulin
more efficient.

19. Zinc
• • Zinc can exert beneficial effects on at least two
common conditions associated with PCOS:
Acne and Obesity
• Eat Plenty of Foods That Contain Magnesium •
Research indicates that there is a strong link
between magnesium deficiency and insulin
resistance associated with PCOS. • Magnesium
appears to be the most common micronutrient
found to be depleted in insulin resistant people
and diabetes patients.

20. Calcium and Vit D
Calcium plays an important role in egg
maturation and follicle development in the
ovaries.
• Vitamin D is essential for promoting calcium
absorption from food in the intestines. •
In addition, low levels of vitamin D and have been
associated with other problems related to PCOS,
including infertility, weight gain, and insulin
resistance.

21. B Vitamins
• The B vitamins in sunflower seeds can help beat PCOS symptoms. •
• Vitamin B2 helps convert dietary fat, protein and carbohydrates into
energy.
• Vitamin B3 helps maintain normal blood sugar levels.
• • Vitamins B5 helps with weight loss due to its ability to control fat
metabolism. •
• Vitamin B6 plays a critical role in maintaining a woman’s hormonal
balance and fertility. It is also needed for proper absorption of zinc in the
intestines. •
• In addition, vitamins B2, B3, and B6 are essential for normal thyroid
function and metabolism, and can thus help reduce excess body weight.

22. Exercise and Yoga
• Walking
• Workouts
• Aerobics
• Swimming
• Zumba
• Cycling
• Yoga

23. • Improvement in body
composition
• Reduction in BMI ,WHR
• Reduction in body fat
mass and percentage.
• Improving insulin
sensitivity of skeletal
muscles.
• To prevent the
progression to T2DM
• Decrease dependence on
medications.
• Enhance adipose tissue
lipolysis
• Improve depression

24. Getting started
If you’ve never done any sort of exercise before its best
to consult an Accredited Exercise physiologist in
regards to a program suited to you.
If you have ongoing major health concerns seek a GP
clearance before commencing any sort of exercise.
Start off with 15-20 minute walks to build tolerance 2-3
times a week.
Also add in whole body resistance exercises for 20-30
minutes 2-3 times a week.
If your local area has group classes for those at risk of
T2DM or Diabetes classes it would be a great
introduction to exercise!

25. Evidence
•
• Exercise itself improves this on many levels such as improving
insulin sensitivity of skeletal muscles . Our skeletal muscles
accounts for 75-95% of our body, hence commencing in exercise
maintains insulin sensitivity.
• Research has shown that a single bout of prolonged aerobic
exercise (30-60mins) can lower glucose levels and stimulate
translocation and glucose transport activity in an insulin resistant
skeletal muscle. Studies have also shown that sedentary individuals
who engaged in resistance exercise at moderate intensity has
improved their insulin sensitivity by 48%!

26. Yoga
• Yoga relieves stress – stress
has severe negative impact on
PCOS High cortisol levels show
itself in the form of
testosterone which, in turn
promotes weight gain.
• Yoga promotes weight loss
:relaxing yoga that promotes
calorie burn in the body by
pumping up the metabolism
• Yoga increases fertility: yoga
poses helps to enhance blood
supply to the brain which in
turn aids to restore hormonal
balance.
• Yoga improves
gastrointestinal balance

27. Different Asanas
• Badhakonasana or
Butterfly pose is a simple
and easy to do yoga pose
that works wonderfully
for natural PCOS
treatment. This asana
helps to open up the
pelvic region and
promote relaxation which
in turn helps to reduce
stress and relieve
discomfort related to
menstruation.

28. Reclining butterfly
• Supta Badhakonasana
(Reclining Butterfly Pose)
• This is one of the best
yoga poses for PCOS
that’s even more
beneficial than the classic
Butterfly pose. This pose
has to be practiced laying
down which makes it
extremely relaxing.

29. Bhujangasana: Cobra pose
• This posture exerts
soothing pressure on the
stomach and aids to
stimulate the functions of
the ovary. It also helps in
better digestion and
reducing stress. But it’s
best not the hold this
posture for more than 30
seconds at a time.

30. Naukasana: Boat pose
• It is the best type of
yoga for weight
loss that helps to
achieve a perfectly flat
abdomen.

31. Dhanurasana: Bow pose
It helps to stimulate the
functions of the
reproductive organs,
relieves menstrual
discomfort and
normalizes the
menstrual cycles.

32. Superman pose
This specific yoga pose
works for developing a
toned abdomen. It also
helps to promote blood
circulation to the
reproductive organs

33. Cat and cow pose
• Relaxes pelvic organs
and improves
circulation to ovaries.

34. Balasana: Child’s pose
It brings about
relaxation by soothing
the Central Nervous
System.

35. Mill churning pose
• The movements involved
in this exercise helps
modify the functions of
the endocrine gland,
thereby facilitating
optimum hormonal
secretion, and it also
massages the uterus,
reproductive organs, liver,
kidneys, and pancreas.

36. Wide legged forward movement
This particular yoga
posture works the hips
and lower back by
flexing the muscles
within turn increase
energy and facilitates
blood circulation to
the ovaries.

37. Lotus pose
• This pose helps to
stretch the pelvic region
and also helps to
correct hormonal
imbalance

38. Unmoving observation
• One of the best ways to
alleviate stress is by
practicing Conscious
relaxation through
Nispanda Bhava.This
exercise involves
passive listening which
brings forth mental
peace and relaxation.

39. Corpse pose
This relaxing posture is
beneficial for polycystic
ovary syndrome also
because it helps to relax
the body and mind and
relieve stress and
tension in an effective
manner.

41. Aerobics
• AEROBIC EXERCISE IN WOMEN WITH POLYCYSTIC OVARY SYNDROME IMPROVES
OVARIAN MORPHOLOGY INDEPENDENT OF CHANGES IN BODY COMPOSITION
• Leanne M. Redman, Ph.D.,1 Karen Elkind-Hirsch, Ph.D.,2 and Eric Ravussin, Ph.D.1
• Collectively these studies indicate that a reduction in body weight of at
least 5% leads to significant improvements in menstrual cyclicity, ovulation
and biochemical hyperandrogenism in terms of the reproductive
complaints
• Improved glucose tolerance and reduced risk for cardiovascular disease
• In comparison to dietary restriction (800 kcal/d), aerobic exercise led to a
40% higher rate of ovulation (25% versus 65%, respectively) and greater
improvements in SHBG and testosterone despite less weight loss
• Aerobic exercise resulted in a greater reduction in fasting insulin and
insulin resistance (HOMA-IR) suggesting a possible mechanistic link

42. Stress and Anxiety
• Every study of PCOS has shown a higher risk of
depression, anxiety and worsened quality of
life in this condition.
• Practitioners must investigate the presence of
mental distress and include treatment of this
in the management plan.
• Psychologist can help in counselling.

43. Screening for CVD
• Women with PCOS should be screened for
cardiovascular risk by determination of CVD
risk factors (obesity, lack of physical activity,
cigarette smoking, family history of type II
diabetes, dyslipidaemia, hypertension,
impaired glucose tolerance, type II diabetes)
They should be strongly warned against
smoking.

44. Positive impact of life style changes
 Weight loss (5-10% over 6 months) is effective in
re-establishing ovarian function in > 50% of obese
PCOS women.
 80% ovulation rate 29% pregnancy
 Decreased hirsutism score4
 Reduced insulin resistance
 Improved metabolic features
 Improved reproductive function

45. Research 1
• Metformin and lifestyle modification in
polycystic ovary syndrome: systematic review
and meta-analysis.
• Naderpoor N1, Shorakae S1, de Courten B1, Misso
ML2, Moran LJ3, Teede HJ4.
• Lifestyle + metformin is associated with lower
BMI and subcutaneous adipose tissue and
improved menstruation in women with PCOS
compared with lifestyle ± placebo over 6 months

46. Research 2
• New Therapeutic Approaches in Obesity and
Metabolic Syndrome Associated with Polycystic
Ovary Syndrome.
• Saleem F1, Rizvi SW2.
• Guidelines recommend lifestyle modification,
metformin, hormonal contraceptives (HCs), and
bariatric surgery as the main treatment options in
obese patients with PCOS. Studies are being
conducted to test the efficacy of existing
treatment options as well as to discover new
therapies.

47. Research 3
• Lifestyle changes in women with polycystic
ovary syndrome.
• Moran LJ1, Hutchison SK, Norman RJ, Teede
HJ.
• Author information
• Update in
• Lifestyle changes in women with polycystic
ovary syndrome. [Cochrane Database Syst Rev.
2011]

48. • AUTHORS' CONCLUSIONS:
• Lifestyle intervention improves body
composition, hyperandrogenism (high male
hormones and clinical effects) and insulin
resistance in women with PCOS. There was no
evidence of effect for lifestyle intervention on
improving glucose tolerance or lipid profiles
and no literature assessing clinical
reproductive outcomes, quality of life and
treatment satisfaction.

49. Implement public awareness
• Medical conferences to educate doctors,
paramedics
• PCOS awareness associations in every country
with regular activities
• Good blogs by experts
• Social media postings – targetting next
generation possible by face book , instagram,
whatsapp
• Websites for information

50. • Include healthy eating and exercise part of ANC .
• Screening for PCOS in infertile women
• Teenagers – catch them early before it is too late
Conduct regular talks in schools
• Aerobics ,zumba,exercises in schools
• Visit by dietician and
Counsellors