Nutrition management for postmenopausal women with PCOS

Polycystic ovary syndrome (PCOS) is an endocrine disorder associated with metabolic dysfunction, menstrual irregularities, hyperandrogenism, insulin resistance, and decreased fertility (Grassi, 2014; Puurunen et al., 2011). Glucose intolerance tends to be more apparent in women with PCOS and often “occurs earlier than expected compared to the general population” (Gambineri, et al., 2012; Grassi, 2014). Elevated abdominal adiposity contribute to greater incidence of insulin resistance, type 2 diabetes, dyslipidemia, and cardiovascular disease. The risk of developing heart disease and type 2 diabetes are potentially increased five-fold in postmenopausal women with PCOS (Boudreaux et al., 2006; Grassi, 2014). Dietary and lifestyle interventions for prevention (e.g., nutritional deficiencies), early diagnosis and treatment (e.g. impaired glucose tolerance) and management are important for improving outcomes.

Optimal management of PCOS requires lifestyle modification often in combination with pharmacologic therapy (e.g., insulin-sensitizing medications such as metformin) (Grassi, 2014). Diet and lifestyle intervention studies that led to moderate weight loss (roughly 5 to 10 percent of total body weight) “have shown beneficial effects on the endocrine, metabolic and reproductive profile” (Crosignani, et al., 2003; Grassi, 2014; Kiddy et al., 1992; Panidis et al., 2008; Thomson, et al., 2008). Common nutritional interventions used for PCOS include calorie restriction, glycemic index and glycemic load modification, and moderate dietary carbohydrate reduction with reasonable increases in protein (improves glucose tolerance and assists with weight loss). Diets that deliver 40% or more of its calories as protein appear to result in “greater weight loss and body fat” (Grassi, 2014). Diets that incorporates fiber-rich foods, red wine, and omega-3 fat also prove to be of benefit – decreases the inflammation (C-reactive protein) and other metabolic abnormalities that often accompany PCOS (Grassi, 2014). Effective drugs and dietary supplements currently available for older women with PCOS include myo-inositol, D-chiro-inositol, oral magnesium supplements, alpha-lipoic acid, vitamin D, omega-3 fatty acid supplementation, cinnamon, and licorice root (Armamani et al., 2007; Costantino et al, 2009; Grassi, 2014; Masharani et al., 2010; Rashidi, 2009).

While nutritional interventions and various supplements are certainly effective in aging women with PCOS, potential barriers to weight management have to be considered. The challenges dietitians often face when counseling PCOS patients are summarized in the article written by Angela Grassi, MS, RDN, LDN, founder of the PCOS Nutrition Center.

References
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Boudreaux, M., Talbott, E., Kip K., Brooks, M., &Witchel., S. (2006). Risk of T2DM and impaired fasting glucose among PCOS subjects: Results of an 8-year follow-up. Current Diabetes Reports 6 (1), 77-83
 

Costantino, D., Minozzi, G., Minozzi, E., & Guaraldi, C. (2009). Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: A double-blind trial. European Review for Medical and Pharmacological Sciences 13 (2), 105-110.
 

Crosignani, P., Colombo, M., Vegetti, W., Somigliana, E., Gessati, A., & Ragni, G. (2003). Overweight and obese anovulatory patients with polycystic ovaries: Parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum. Reprod. 18 (9), 1928-1932. doi: 10.1093/humrep/deg367

Gambineri A., Patton, L., Altieri, P, et al., (2012). Polycystic ovary syndrome is a risk factor for type 2 diabetes: Results from a long-term prospective study. Diabetes 61 (9), 2369-2374. doi: 10.2337/db11-1360.

Grassi, A. (2014). PCOS in aging women – Beyond hormones and hot flashes. Today’s Dietitian 16 (2), 40. Retrieved from: http://www.todaysdietitian.com/newarchives/020314p40.shtml

Kiddy, D., Hammilton-Fairley, D., Bush, A., Short, F., Anyaoku, V., Reed, M., & Franks, S. (1992). Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clinical Endocrinology (Oxf) 36 (1), 105-111.

Masharani, U., Gjerde, C., Evans, J., Youngren, J., & Goldfine, I., Effects of controlled-release alpha lipoic acid in lean, nondiabetic patients with polycystic ovary syndrome. J Diabetes Sci Technol. 4(2), 359-364

Panidis, D., Farmakiotis, D., Rousso, D., Kourtis, A., Katsikis, I., & Krassas, G. (2008). Obesity weight loss, and the polycystic ovary syndrome: Effect of treatment with diet and orlistat for 24 weeks on insulin resistance and androgen levels. Fertility and Sterility 89 (4), 899-906. doi: http://dx.doi.org/10.1016/j.fertnstert.2007.04.043

Puurunen, J. Piltonen, T., Morin-Papunen., L, et al. (2011). Unfavorable hormonal, metabolic, and inflammatory alterations persist after menopause in women with PCOS. The Journal of Clinical Endocrinoly and Metabolism 96 (6), 1827-1834. doi: 10.1210/jc.2011-0039.

Rashidi, B., Haghollahi, F., Shariat, M., & Zayerii, F. (2009). The effects of calcium-vitamin D and metformin on polycystic ovary syndrome: a pilot study. Taiwan J Obstet Gynecol. 48 (2), 142-147.

Thomson, R., Buckley, J., Noakes, M., Clifton, P., Norman, R., & Brinkworth, G. (2008). The effect of a hypocaloric diet with and without exercise training on body composition cardiometabolic risk profile, and reproductive function in overweight and obese women with polycystic ovary syndrome. The Journal of Clinical of Endocrinology and Metabolism 93(9), 3373-3380. doi: 10.1210/jc.2008-0751

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