Polycystic ovarian syndrome (signs ,symptoms and training)

Polycystic ovarian syndrome 

Definition: 

PCOS is a disorder of chronically abnormal ovarian function and hyperandrogenism (abnormally elevated androgen levels) ( imbalance of reproductive hormones) . It affects 5-10% of women of reproductive age between 15 and 44 years old.

PCOS affects a woman’s ovaries, the reproductive organs that produce estrogen and progesterone (hormones that regulate the menstrual cycle). In addition to a small amount of androgens.

Normally:

• The ovaries release eggs to be fertilized by a man’s sperm. The release of an egg each month is called ovulation which is controlled by Follicle-stimulating hormone (FSH) and luteinizing hormone (LH). 

• FSH stimulates the ovary to produce a follicle — a sac that contains an egg — and then LH triggers the ovary to release a mature egg.

In PCOS,

• Many small, fluid-filled sacs grow inside the ovaries. The word “polycystic” means “many cysts.” These sacs are actually follicles, each one containing an immature egg. The eggs never mature enough to trigger ovulation. 
• The lack of ovulation alters levels of estrogen, progesterone, FSH, and LH. Estrogen and progesterone levels are lower than usual, while androgen levels are higher than usual. 
• Extra male hormones disrupt the menstrual cycle, so women with PCOS get fewer periods than usual.

Causes of PCOs: 

The exact cause of PCOS is unknown 

• High levels of androgens: Women with PCOS have more androgens than normal. Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne, two signs of PCOS.
• High levels of insulin: Many women with PCOS have insulin resistance, especially those who have overweight or obesity, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). 
• Insulin resistance can lead to type 2 diabetes and might increase androgen production causing difficulty with ovulation
• Low-grade inflammation. This term is used to describe white blood cells' production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems.
• Heredity. Research suggests that certain genes might be linked to PCOS.
• Increase LH level LH (normal LH/FSH ratio is 1:1 in PCOS it is 2:1 or 3:1).

Signs and symptoms: 

A diagnosis of PCOS is made when you experience at least two of these signs:

1. Irregular periods. Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods. Some women with PCOS stop having menstrual periods
2. Excess androgen. Elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne (face, chest, and upper back) and malepattern baldness (hair loss on the scalp)
3. Polycystic ovaries. Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly leading to infertility.
4. Weight gain or difficulty losing weight (80 percent of women with PCOS are overweight or obese)
5. Darkening of skin, particularly along neck creases, in the groin, and underneath breasts
6. Headaches. Hormone changes can trigger headaches in some women

Complications:

• Infertility 
• Gestational diabetes or pregnancy-induced high blood pressure 
• Miscarriage or premature birth 
• Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver 
• Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease Type 2 diabetes or prediabetes

Cont. complications:  

• Sleep apnea 
• Depression, anxiety and eating disorders 
• Abnormal uterine bleeding 
• Cancer of the uterine lining (endometrial cancer) 
• Endometrial cancer: during ovulation, the uterine lining sheds. If you don’t ovulate every month, the lining can build up. A thickened uterine lining can increase your risk for endometrial cancer.

 Diagnosis:

There is no single test to diagnose PCOS. 

• Physical exam: measure your blood pressure, body mass index (BMI), and waist size. look for extra hair on your face, chest or back, acne, or skin discoloration, any hair loss or signs of other health conditions (such as an enlarged thyroid gland). 
• Pelvic exam: pelvic exam for signs of extra male hormones (for example, an enlarged clitoris) and if your ovaries are enlarged or swollen. 
• Pelvic ultrasound (sonogram): applied to examine ovaries for cysts and check the endometrium. 
• Blood tests: check for higher-than-normal levels of androgen, cholesterol, insulin and triglyceride levels to evaluate your risk for related conditions like heart disease and diabetes in addition to thyroid diseases.

Medical Treatment :

Metformin 

Metformin is a drug used to treat type 2 diabetes. It also treats PCOS by improving insulin levels. 

Estrogen and Progestin combination 

Taken estrogen and progestin daily can restore a normal hormone balance, regulate ovulation, relieve symptoms like excess hair growth, and protect against endometrial cancer. 

Clomiphene 

Clomiphene (Clomid) is a fertility drug that can help women with PCOS get pregnant. However, it increases the risk for twins and other multiple birth.

Physical therapy treatment: 

Lifestyle modification is a central part of treatment for all manifestations of polycystic ovary syndrome. 

Treatment for PCOS usually starts with lifestyle changes like weight loss, diet, and exercise. 

Losing just 5 to 10 percent of your body weight can help regulate your menstrual cycle and improve PCOS symptoms. Weight loss can also improve cholesterol levels, lower insulin, and reduce heart disease and diabetes risks.

Studies comparing diets for PCOS have found that low-carbohydrate diets are effective for both weight loss and lowering insulin levels. A low glycemic index (low-GI) diet that gets most carbohydrates from fruits, vegetables, and whole grains helps regulate the menstrual cycle better than a regular weight loss diet. 

A few studies have found that 30 minutes of moderate-intensity exercise at least three days a week can help women with PCOS lose weight. 

Losing weight with exercise also improves ovulation and insulin levels. Diet plus exercise helps you lose more weight than either intervention alone and it lowers risks for diabetes and heart disease.

Diet:

Finding the right diet to tackle PCOS is a highly individual and complex process as the underlying cause of PCOS and different hormone levels will vary from woman to woman. 

General PCOS diet guidelines:

- Limit caloric intake to enhance losing weight 

- Eat food high in fibers (fruits, vegetables whole grains and legumes) 

- Eliminate saturated fatty acids and junk food 

- Eat real food rather than processed and refined food 

- Decrease sugar intake 

- Low glycemic index diet 

- Combine protein and carbohydrates as protein helps to regulate the blood sugar spike caused by the carbohydrates. 

- Anti-inflammatory foods (food high in omega-3 fatty acids, tomatoes, Kale, spinach, blueberries and strawberries) 

- Eliminate dairy product (increase inflammatory mediators).

Exercise:  

1- Aerobic exercises: 

Aerobic exercise will help you lose weight, regulate insulin level and improve insulin resistance. 

Parameters 

• 55%–70% VO2 max 
• Time: 30–45 min. Fatigue-free level 
• Progression: 10% VO2 max every 2 weeks

2- Strength training: 

Builds muscle which is important in raising basal metabolic rate so that you burn more calories while at rest and while exercising.

Parameters 

• Frequency: 2–3 days/week for 12–24 weeks 
• Intensity: Initial 60%–70% of 1 repetition maximum 2–3 sets of 8–12 repetition/set. 1 min rest between set. Avoid Valsalva maneuver during lifting 
• Time: 30–45 min. Fatigue-free level 
• Progression: Repetitions or sets can be increased based on the patient tolerance

Cont. exercise: 

3- High Intensity Interval Training (HIIT): 

HIIT is a type of cardio workout that alternates between extremely challenging, fast, high intensity exercise and low-intensity exercise. is especially important for women with PCOS because of the physiological effect it has on insulin sensitivity. 

Several medical studies have found that HIIT workouts are more effective than other forms of exercise at increasing insulin sensitivity. 

It is recommend doing one or two 20-30-minute HIIT workouts each week. Start with warm-up properly and wait at least 24 hours before doing another high intensity workout like HIIT or strength training. 

Combination of different types exercises gives the patient different benefits.

Do's And Dont's 

Do's: 

• Make sure that proper weight is maintained. If you are overweight, reduce it by doing exercises regularly and having a healthy balanced diet. 
• Have adequate sleep. 
• Maintain a record of your menstrual cycle.

Don'ts:

• Do not smoke. 
• Do not consume alcohol. 
• Do not skip meals or sleep. A disciplined lifestyle is key to better health and freedom from PCOS. 
• Avoid Hormonal treatment as far as possible.