ANOVULACION CRONICA PDF

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Rev Chil Nutr Vol. Fernanda Rodrigues de O. Polycystic ovary syndrome PCOS is one of the most common endocrine disorders among women at reproductive age. Its classical form is characterized by menstrual irregularities, chronic anovulation, infertility, and hyperandrogenism. The prevalence of obesity is high among women with POS and anovulaciob causes have not been fully clarified.

The specific effects of diet composition on POS have been little explored. It has been suggested that po-lyunsaturated fatty acids may improve insulin sensitivity and that high-protein diets may potentiate weight loss and improve reproductive function.

However, current evidence is insufficient to determine the optimum composition of a diet for POS patients. The dietary conduct should focus on weight loss to be achieved with nutritionally complete and balanced diets.

The syndrome was first defined in by Stein and Leven-thal cronifa on the observation of a set of symptoms such as amenorrhea, hirsutism and obesity in women whose ovaries were enlarged and contained multiple follicular cysts 2. However, reference to the influence of obesity on menstruation had been observed as early as in the writings of Hippocrates.

Evaluación Clínica de Síndrome de Anovulacion Crónica

In his assay about “the influence of climate, water supply and health situation”, he described women with altered reproductive function as follows: The uterus is unable to receive semen and the women menstruate little and in an infrequent manner” 3.

The PCOS is a syndrome and, as such, it’s necessary use more than a single diagnostic criterion for clinical diagnosis. In accordance with the consensus of Rotterdamthe most widely accepted for the diagnosis of PCOS, it’s necessary the presence of at least two of the three features: Moreover, it’s necessary the exclusion of other medical conditions that cause irregular menstrual cycles and androgen excess such congenital adrenal hyperplasia, Cushing’s syndrome, hyperprolactinemia or ovarian neoplasm 4.

It’s important to consider that the diagnostic criteria for PCOS have not been fully standardized due to the intrinsic characteristics of the syndromes, whose symptoms are highly heterogeneous.

The disorder also is a strong independent risk factor for the development of impaired glucose tolerance cronjca type II diabetes 8,9 and includes various characteristics of metabolic syndrome such as obesity, abdominal obesity and insulin resistance IRthus being strongly related to a higher risk of developing cardiovascular diseases In view of the interfaces existing between PCOS, obesity and nutrition, the objective of the present study was to explore aspects cornica to the possible causes of the high prevalence of obesity among women with PCOS and to the role of diet composition in the treatment of this disease.

There are strong evidences indicating the familiar aggregation in PCOS, suggesting that genetic factors play a important role in the development of this syndrome 11, Studies of families with PCOS anovulacon have evidences of heritability of hyperandrogenaemia and hyperinsulinaemia, and first-degree relatives of women with Anovulacioh present increase incidence of features such oligomenorrhea, polycystic ovaries and androgen excess, beyond the metabolic alterations such insulin resistance type II diabetes and lipid abnormalities 13, Therefore, familial history, indicating the genetic risk, must be considered as an important risk factor for the development of PCOS.

However, anovulqcion heterogeneity of phenotypic features in different and within the same families underscores the importance of the environmental contribution in the manifestation of this syndrome 11,12especially of obesity. The prevalence of obesity is high in all studies of women with PCOS and obese women with PCOS have higher rates of hirsutism and greater irregularities of the menstrual cycle than eutrophic women with the same disease A study was conducted on premenopausal overweight and obese Spanish women in order to assess the presence of PCOS and its characteristics.

Of the women who participated in the study, The prevalence of this syndrome among these overweight Spanish women was significantly higher than croonica women of adequate weight, being approximately 5.

This value was significantly higher than that for the general population 16with a predominance of the phenotype croica abdominal obesity associated with hyperandrogenic state, IR and compensatory hyperinsulinaemia The causes of the increased prevalence of obesity in PCOS have not been fully elucidated in the literature.

Some authors suggest that there may be abnormalities in energy expenditure, especially in postprandial thermo-genesis Robinson et al showed that there was no difference in resting energy expenditure but that the PCOS group had a reduced postprandial thermogen-esis KJ compared to a control group matched for body weight, with an estimated weight gain of 1.

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There also seems to be a lower postprandial response of the gastrointestinal hormones responsible for the control of food intake. After a meal is started, both the presence of nutrients in the intestine and the anovulacoin response to eating lead snovulacion suppression of ghrelin which results in a change in appetite.

Additional factors such as leptin, adiponectin, cholecystokinin, peptide YY, fat-free mass and androgens may play a role in the regulation of energy homeostasis, of anovuladion and of ghrelin concentration Reduced basal ghrelin levels have been detected in women with cronicaa weight and PCOS Pagotto et al reported that obese women with PCOS have significantly lower ghrelin levels than obese women without the pathology The reduction in the postprandial levels of ghrelin is lower in obese than in lean persons and in obese patients with PCOS than in obese women without PCOS A common finding reported in the literature is the negative correlation existing between insulin resistance and plasma ghrelin concentrations 26,27, Schofl et al detected similar ghrelin concentrations in insulin-sensitive women with PCOS and in healthy controls and significantly reduced levels in women with PCOS and IR, suggesting a connection between insulin sensitivity and ghrelin There is a study suggesting that the primary association would be between ghrelin and androgens rather than between ghrelin and insulin The change in ghrelin concentrations is seen as an important consequence of obesity and may influence the regulation of body weight by impairing the stimulus to end eating, affecting the size of the meal consumed.

Moran et al observed that women with PCOS had lower satiety and greater postprandial hunger after a test meal, suggesting that they had fewer defenses against overeating and greater difficulty in ending a meal than controls without this syndrome The importance of the relationship between obesity and PCOS is reflected on the recommendations for the treatment of this syndrome, whose main objective is the reduction of weight and of abdominal fat in order to normalize serum androgen levels, to reduce insulin resistance and to restore reproductive function.

Short-term weight loss has been successful in reducing insulin resistance and restoring ovulation and fertility 1,10,31,32resulting in strong recommendations of care with weight among women with PCOS The main focus of dietary studies on women with PCOS is on the effect of energy restriction on weight loss. The specific effect of diet composition in PCOS have only recently started to receive more attention.

The role of diet composition in infertility is still little explored, but current evidence suggests that dietary factors influence insulin sensitivity, play an important role in the etiology of some forms of infertility Experimental evidence suggests that polyunsatu-rated fatty acids PUFA improve insulin sensitivity in peripheral tissues and reduce insulin secretion by the pancreas.

PPAR-y is a transcriptional gene that regulates metabolism whose activity is directly modulated by dietary lipids Unsaturated fatty acids may bind to PPAR-y, but their effects differ according to cis or trans isomers 37, A high intake of unsaturated cis fatty acids is associated with lower concentrations of inflammatory markers and a lower risk of type II diabetes mellitus, in addition to an improvement of the endocrine and metabolic characteristics of women with PCOS.

In order to assess the relation between the dietary intake of some nutrients and fertility, a prospective cohort study was conducted on The results showed that fat intake and total cholesterol were not related to ovulatory infertility anovulacikn that there was a positive association between the intake of trans fatty acids and the risk of infertility.

It was concluded that unsaturated trans fatty acids can increase the risk of ovulatory infertility when consumed in place of carbohydrates or of unsaturated fatty acids MUFA and PUFA The results showed a significant reduction in body znovulacion, in free fatty acid levels and in total cholesterol and an increase in plasma levels of linoleic acid and alpha-linolenic acid. anovulxcion

¿Qué es la anovulación?

In addition, there was a significant increase in fasting glycemia and in the area under the curve for glucose during the oral glucose tolerance test, with no change in insulin. However, despite the improvements observed, there still is insufficient scientific evidence to recommend the intake of dietary PUFA supplements, especially in insulin-resistant populations The subjects consumed 3 types of diets rich in MUFA, poor in carbohydrates, and standardeach for only 16 days, with a 3 week interval between diets.

Fasting insulin levels were lower in the carbohydrate-poor diet compared to the standard diet and the insulin response to an acute glucose dose was lower in the carbohydrate-poor diet than in the MUFA-rich diet.

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Serum glucose and reproductive hormone levels did not differ between the dietary interventions. This dietary composition may have been of help regarding the better physiological benefits observed.

Dietary strategies for weight loss usually recommend the use of fat-poor diets, which facilitate energy restriction and reduce the risks of cardiovascular diseases. However, over the last few years there has been increased interest in protein-rich and carbohydrate-poor diets for the potentiation of weight loss and also for the improvement ccronica metabolic and reproductive parameters The increased intake of dietary protein as a way of increasing weight loss is based on the greater power of protein to induce satiety compared to carbohydrates and fats, as well as improving insulin sensitivity Clinical studies have provided evidence that ad libitum protein-rich diets generate a greater weight loss in overweight individuals over a period of 6 months than carbohydrate-rich diets.

The main physiological explanation for this findings would be the greater satiety induced by the high protein content of the diet In addition to producing weight loss, these diets seem to have beneficial effects on body composition, on serum lipid levels and on glucose homeostasis. The first group consumed a diet with a 3.

After 10 weeks, weight loss did not differ between groups 6. The women of this same group also reported greater satiety with the protein-rich diet Kasim-Karakas et al evaluated the effects of acute protein administration with those of glucose OGTT challenges anovulcaion hormones related with hunger insulin and ghrelin.

The glucose and the protein drinks were euvolemic and eucaloric. This suggests a prolonged satietogenic effect of protein croonica, providing mechanistic support for increasing protein intake and restricting the simple sugar intake in a PCOS diet These studies demonstrate the benefits of a protein-rich diet regarding body composition, blood lipids, glucose homeostasis, as well as satiety aonvulacion overweight women during the weight loss process.

Similar results were anovluacion in a study conducted on hyperinsulinemic and normoglycemic obese men. The results showed a greater weight loss in the group receiving more dietary protein 8. Serum levels of total cholesterol, triglycerides and LDL-c were significantly reduced in both groups, but a significant reduction in HDL-c occurred only in the group receiving more protein.

Fisiopatología del síndrome de ovario poliquístico

Fasting serum insulin levels were reduced in both groups but reached normal levels only in the group receiving the high-protein diet The increase in the number of pregnancies, the improvement in menstrual cycle, in lipid profile and in insulin resistance and the reduction of body weight 7. These results suggest that the improvements observed in the reproductive, cardiovascular and metabolic parameters can be attributed to the improved insulin resistance and fasting insulinemia a consequence of weight reductionand were independent of diet composition.

There is a strong relation between PCOS and obesity. Therefore, the main objective for the treatment of this syndrome is weight loss, with the intention to anovulcaion or to normalize the hormonal and metabolic alterations.

Current evidence is still insufficient to determine an optimum diet composition for patients crpnica PCOS, especially on a long-term basis, but some directives regarding a anovulavion conduct xronica be inferred.

A modification of life style is the first form of treatment of PCOS, involving weight loss and the regular practice of physical activity.

Weight loss should be achieved by adopting healthier dietary habits and nutritionally complete and balanced diets. The dietary composition should give priority to a low saturated and trans fat content, should be rich in poly- and monounsaturated fats, have a low glycemic index 46anovulaciom be rich in fibers and poor in energy 20,33, There still is no clear position regarding the protein content of the diet, with more consistent results of longer-lasting investigations being needed.

It should be pointed out that no nutritional manipulation maintains its validity in diets strongly deviating from the usual eating habits of each group and that the best diet is the one definitively adopted or used for longer periods of time, permitting more sustainable weight losses.

Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reproduct ; 23 3: Amenorrhoea associated with bilateral polycystic ovaries. Am J Obstet Gy-necol ; Nutrition, insulin and polycystic ovary syndrome. Rev Reproduct ; anovulacon Revised consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome PCOS.

Hum Reproduct ; 19 1: The pathogenic enigma of polycystic ovary syndrome. Arq Bras Edocrinol Metab ; 47 4: Arq Bras Endocrinol Metab ; 50 6: