KANYA MAHA VIDYALAYA

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Post Graduate Diploma in Nutrition & Dietetics

Diet Therapy & Applied Nutrition

CASE STUDY
POLYCYSTIC OVARIAN SYNDROME

Submitted by : Submitted to :
Harmanpreet kaur. Ms. Kuljinder kaur
Roll no : 237576
Introduction
PCOS a significant public health problem and is one of the
commonest hormonal disturbances affecting women of
reproductive age.
The condition affects an estimated 8–13% of women of
reproductive age, and up to 70% of cases are undiagnosed.
The prevalence of PCOS is higher among some ethnicities
and these groups often experience more complications.
Polycystic ovary syndrome (PCOS) is a hormonal
imbalance that occurs when ovaries (the organ that
produces and releases eggs) create excess hormones.
In PCOS, ovaries produce unusually high levels of
hormones called androgens. This causes reproductive
hormones to become imbalanced.
As a result, people with PCOS often have irregular
menstrual cycles, missed periods and unpredictable
ovulation.
Small follicle cysts (fluid-filled sacs with immature eggs)
may be visible on ovaries on ultrasound due to lack of
ovulation (anovulation).
PCOS is one of the most common causes of infertility in
women and people assigned female at birth (AFAB). It can
also increase risk of other health conditions.
Aetiology & Pathophysiology
The aetiology of polycystic ovary syndrome is poorly understood, and is thought to be multifactorial in
origin.
The two most common hormonal abnormalities present in PCOS are:

EXCESS LUTEINISING HORMONE (LH) I N S U L I N R E S I S T A N C E

- produced by the anterior pituitary
gland in response to increased GnRH
pulse frequency.
- This stimulates ovarian production
of androgens.
- resulting in high levels of insulin secretion.
- This suppresses hepatic production of sex hormone
binding globulin (SHBG), resulting in higher levels
of free circulating androgens

The increased circulating androgens suppress the LH surge (which is required for ovulation to occur).
Having too much androgen interferes with ovulation. This means that eggs don't develop on a regular
basis and aren't released from the follicles where they develop.
Mechanism
PCOS affects the reproductive organs(ovaries) that generate the hormones
progesterone and Oestrogen , which control the menstrual cycle.
Androgens, which are male hormones, are also little produced by the
ovaries.
As a result, every month eggs are released from the ovaries for sperm
fertilization. This process is known as ovulation.
Given that, the two hormones Luteinizing Hormone (LH) and Follicle
Stimulating Hormone (FSH) produced in the pituitary gland control
ovulation.
Consequently, after being induced by FSH to form a follicle, a sac that
houses an egg, the ovary releases a mature egg.
For instance, in the PCOS condition, the ovaries grow an excessive number
of small, fluid-filled sacs. Specifically, “Polycystic” is a medical term that
denotes “several cysts.”
Further, each of these sacs is actually a follicle that houses an immature
egg. Therefore, the eggs are never developed enough to start ovulation.
Most important, Oestrogen, progesterone, Follicle Stimulating Hormone
(FSH), and Luteinizing Hormone (LH) levels are modified by the absence
of ovulation.
Further, progesterone levels are decreased while androgen levels are
higher than usual. Also, extra male hormones disrupt the menstrual cycle
in women with PCOS, resulting in fewer periods than usual.
 Symptoms
male-pattern weight gain,
baldness or hair especially around
thinning the belly.

excessive hair ACNE

on the OR
face or body OILY SKIN

heavy,
long,
intermittent, INFERTILITY
unpredictable or absent
periods
 Investigations
BLOOD TESTS

The main blood tests include testosterone, sex hormone-binding globulin, gonadotrophins and progesterone.
Their reference ranges and typical findings in PCOS are listed below.
 Blood tests can also be used to exclude other differential diagnoses –
such as thyroid stimulating hormone for hypothyroidism,
serum prolactin for hyperprolactinaemia (although a mildly elevated prolactin level can be observed in PCOS).
Women with PCOS are at a increased risk of diabetes.
Consider performing an oral glucose tolerance test – particularly in women with a BMI >30

IMAGING

Typical ultrasound findings are numerous peripheral ovarian follicles (“cysts”), and/or ­ovarian volume >10cm3.

On an ultrasound report, polycystic ovaries (PCO) are typically described as:

Follicle count: At least 12 follicles in each ovary, measuring 2–9 mm in diameter

Ovarian volume: Greater than 10 ml

Enlarged ovaries: Both ovaries are enlarged

Follicle distribution: Peripheral distribution of follicles gives a "string of beads" appearance

Central stroma: Hypoechoic (dark) central stroma

 Differential diagnosis
Other causes of HYPERANDROGENISM
NON-CLASSICAL
CONGENITAL ADRENAL
HYPERPLASIA
inherited disease that affects
the adrenal glands and is
present at birth.
ACROMEGALY
occurs when the body produces too
much growth hormone (GH).
GH decreases sex hormone–
binding globulin
ANDRENOGEN SECRETING
NEOPLASMS
rare ovarian tumours that cause
hyperandrogenism
PROGESTATIONAL AGENTS
hormonal treatments that Regulates
the menstrual cycle, Treating
dysfunctional uterine bleeding,
Contraception etc.
HYPERPROLACTENEMIA
a condition of elevated
prolactin levels in blood .
Prolactin inhibits synthesis of
sex hormone–binding globin,
thereby raising the (unbound)
testosterone
CUSHING SYNDROME
when the body has too
much of the hormone
cortisol for a long time.
Other causes of ANOVULATION

PREMATURE OVARIAN
EXTREME EXERTION FAILURE
RAPID WEIGHT
CHANGES

EATING DISORDER
HYPERTHYROIDISM
HYPOTHYROIDISM
 Treatment
Polycystic ovary syndrome (PCOS) cannot be cured, but
the symptoms can be managed.

LIFESTYLE CHANGES

In overweight women, the symptoms and overall risk of developing long-

term health problems from PCOS can be greatly improved by losing excess
weight.
You can lose weight by exercising regularly and eating a healthy, balanced
diet.
Your diet should include plenty of fruit and vegetables, (at least 5 portions a
day), whole foods (such as wholemeal bread, wholegrain cereals and brown
rice), lean meats, fish and chicken.
 MEDICINES

IRREGULAR OR ABSENT PERIODS

The contraceptive pill may be induced using an intermittent course of progestogen
tablets (which are usually given every 3 to 4 months, but can be given monthly).
FERTILITY PROBLEMS
clomiphene or Letrozole may be the first treatment recommended for women with
PCOS who are trying to get pregnant. Another medicine called metformin may be
recommended.

UNWANTED HAIR GROWTH AND HAIR LOSS

The combined oral contraceptive pill is usually used to treat excessive hair
growth
(hirsutism) and hair loss (alopecia).
A cream called eflornithine can also be used to slow down the growth of
unwanted facial hair.
Anti-androgens may also be offered for excessive
1. cyproterone acetate
2. spironolactone
3. flutamide
4. finasteride
 IVF TREATMENT

If you have PCOS and medicines do not help to get pregnant, in vitro

fertilisation (IVF) treatment works.

This involves eggs being collected from the ovaries and fertilised outside the

womb. The fertilised egg or eggs are then placed back into the womb.

IVF treatment increased the chance of having twins or triplets if you have

PCOS.

SURGERY
A minor surgical procedure called laparoscopic ovarian drilling (LOD)
may be a treatment option for fertility problems associated with PCOS
that do not respond to medicine.
Under general anaesthetic, a small cut is done in Abdomen and a long,
thin microscope called a laparoscope through into your abdomen.
The ovaries will then be surgically treated using heat or a laser to
destroy the tissue that's producing androgens (male hormones).
LOD has been found to lower levels of testosterone and luteinising
hormone (LH), and raise levels of follicle-stimulating hormone (FSH).
This corrects hormone imbalance and can restore the normal function
of your ovaries.
 Dietary Management
low GI carbohydrates and wholegrains
adding protein and fats to low GI carbohydrates
High fibre
Omega-3fats

Foods to eat Foods to avoid

Omega-3 rich fish, such as salmon, baked or broiled Fried foods (French fries, potato chips, corn chips and fried
Olive oil instead of butter or margarine chicken or fish)
Beans and other protein-rich legumes instead of meat
Saturated fats such as butter or margarine
Non-starchy vegetables such as leafy greens (spinach, kale, escarole,
Red meat, including hamburgers, roast beef and steaks,
endive, lettuce, etc.), tomatoes, mushrooms, peppers, broccoli,
processed luncheon meat and hot dogs
cauliflower, snow peas, celery and fennel
Processed snacks: cakes, cookies, candy and pies
Whole grains, such as brown rice, barley, sorghum and others. Breads
Prepared cereal high in sugar, including instant oatmeal, granola
and pastas made with whole grains can help people with PCOS avoid
Sugary beverages such as sodas, teas and sports drinks
spikes in blood sugar.

Whole fruit for dessert. The fiber content in whole fruit helps you feel Alcoholic beverages

full, helps your digestion and slows down the absorption of its sugars Refined flour, white bread, rolls, pizza crust and pasta

into the bloodstream. White rice

 CASE
STUDY
 PATIENT’S PROFILE
PATIENT’S NAME : ARSHDEEP KAUR
AGE : 23
SEX : FEMALE
HEIGHT : 5'6"
WEIGHT : 58 KGS
MARITAL STATUS : UNMARRIED
OCCUPATION : STUDENT

HISTORY OF PREVELANT ILLNESS

Irregular periods since 2 months.

Noted 4 kgs weight gain.
Hardness in pelvic region and increased belly fat .
Sexually inactive.
Breakouts on face , chest and back.
Excessive hair growth on face , neck , chest.
Dark patches in underarms.
Unbearable pain during menstrual cycle.
 SUBJECTIVE

1. Patient’s Family history:

No genetic history of pcos, diabetes, insulin resistance.
2. Surgical history:
Patient denies any surgical procedures.
3. Social history:
Patient is a student.
Doesn’t drink.
Denies use of tobacco or any recreational drugs.
Exercises 1 hour 2-3 times a week.
Eats a moderately healthy diet.
4. Medications :
No medications.
5. Allery:
No known drug or food allergy.
 REVIEW OF SYSTEMS
1. General :
Patient states a 4kg weight gain.
2. Skin :
Breakouts on back and face, Unwanted hair on face and chest.
3. Gastro intestinal:
Presence of constipation , bloating .
4. Genito-urinary :
Presence of white fluid , vaginal itching .

PHYSICAL EXAMINATION
1. Neck:
No thyroid enlargement.
2. Category :
Normal (BMI found to be 21.4)

DIAGNOSIS
1. Urine hCG (human chorionic gonadotropin) / Pregnancy test :
Negative
2. TSH & Prolactin levels : (normal to mild elevated in pcos)
Normal
3. Hormone levels:
LH:FSH ratio 3:1 (normal 2:1) , testosterone is mildly elevated.
4.Fasting glucose:
Normal
 4 hou r dietary
2
recall
As analysed from the 24 hour dietary recall method , the patient is

taking:

ENERGY : 1878 Kcal

CARBOHYDRAYES : 307.91 g

PROTEIN : 75.11 g

FAT : 51 g

Early MID- EVENING

Breakfast LUNCH DINNER
morning MORNING SNACK

Almonds - Raagi Cheela - 1 Banana shake Moong Dal Moong Dal Moong Dal
10 Tea - 1 cup - 1 glass -1 bowl namkeen - 1 - 1 bowl
Banana - 2 Chapati bowl Rice veg
- 2 Tea -1 pulao -
Salad cup Salad
-
DIETARY
MODIFICATIONS
From the dietary recall method, it was observed that the patient was
taking moderate healthy diet. Some modifications are made since the
patient was unaware about the low GI foods and was taking high GI
foods daily and in more than recommended amounts.

DIETARY CALCULATIONS :

Ideal body weight : 62 Kg

Calories needed :1860 Kcal
DIET PLAN (This plan can be followed on alternative days with the meal option provided)

Early MID- EVENING

Breakfast LUNCH DINNER
morning MORNING SNACK

Almonds - 3 Idli Boiled chana- Brown rice - 1 1 Cup light tea+ poha Chapati -2
10 + 1 cup cup / Chapati -2 1 cup +
Banana - 2 Sambar 1/2 cup OR + Dal - 1/2 cup
OR
Dal - 1/2 cup
+ Green tea 1 cup tea+ + 2 biscuits +
+
Green chutney/ OR Paneer bhurji - 1/2 OR Paneer bhurji - 1/2
Tomato Chutney Seasonal fruit cup Paneer veggies cup
OR + sandwich OR
Methi Parantha 2 1/2 cup low fat Soya chunks curry
curd. 1/2
+ OR
1 tbs green cup
Veg pulav rice 1 cup +
chutney. OR + Salad
Besan cheela -2 1/2 cup Soya
+ Chunk curry
1 tbs green +
chutney. 1/2 cup Butter Milk
 Conclusion
It is a common condition that affects women of reproductive age and has multiple components, including reproductive,
metabolic
and cardiovascular.
Women with PCOS have an increased risk of developing hypertension and cardiovascular disease. They are also more
likely to develop certain serious health problems, including type 2 diabetes, high blood pressure, problems with the heart
and blood vessels, and uterine cancer.
Treatment of PCOS is limited to management of signs and symptoms since the etiology of the disorder is unknown. Some
reasonable preventative therapies include diet, exercise, and oral contraceptives.
Screening for hypertension, abnormal lipid profiles , insulin resistance, and reproductive disorders including cancer
should also be the mainstay of care for women with PCOS.
Eating healthy fats, lean proteins, whole grains, and plenty of fresh fruits and vegetables may help reduce the risk of PCOS
or manage its symptoms.
Meanwhile, it is best to avoid highly processed foods and those containing high levels of fat, added sugar, and salt.