AYURVED FOR WOMEN'S HEALTH

Over weight- 25- 30

Obese - > 30

Central or peripheral obesity is usually divided at waist to hip ratios.

IMPORTANCE OF ADIPOSE TISSUE AS AN ENDOCRINE ORGAN

It is an important site of active steroid production and

metabolism.

It is able to convert

•Androgens to estrogens which is called as Aromatase activity,

•Estradiol to estrone,

•Dehydroepiandrosterone to androstenedione.

Aromatisation is found in:

Bones

Hypothalamus

Liver

Muscles

Kidney

Adipose tissue of breast, abdomen and Omentum.

•In hyper androgenic obesity such as PCOS, increased production of androgens are associated with menstrual

irregularities.

•The amount of androstenidione converted to estrone varies depending on the total body weight.

Other mechanisms that influence the adipose tissue as an endocrine organ are:

vMetabolism of estrogen to 2hydroxy estrogen.

vThe storage of steroid hormones in fat.

vThe effects of adiposity in insulin secretion from the pancreas and hence levels of SHBG decrease.

What causes weight related menstrual problems ?

There are two sources of estrogen in the body:

•Ovary and Adrenal gland.

The ovary produces estrogen, while the adrenal gland makes androstenedione. These hormones are a normal part of

the ovulation process.

If there is an exorbitant amount of fat cells present, they will turn the adrenal androstenedione into another form of

estrogen called estrone. In significantly overweight, the steady input of estrone will interfere with the normal cycle of

ovaries. This will undoubtedly cause menstrual irregularities, and thus decrease the chances of conception.

Infertile, Anovulatory Obese women have

•Higher plasma androgens,

•Hyper insulinemia,

•High L.H concentration,

•Lower SHBG.

So the possibilities are-

Increased estrogen production from peripheral tissues leading to a disorder of hypothalamo pituitary ovarian axis.

And insulin resistance is common in anovulatory women, insulin in turn can induce androgen secretion from an ovary

that is polycystic or genetically prone to excess androgen production

Pathology:

Causes of Androgen excess- By the Action on Ovary

Increased LH stimulation

Decreased Aromatization

Increased Insulin

Increased Androstenidione and Testosterone

Increased IGF-1

Enzyme dysregulation(P450C17)

Obesity leads to Increased Insulin level as well as Increased Insulin resistance which in turn act on ovaries and Liver.

Thelevels of SHBG and IGFBP-1 are dicreased, along with ovary these will help for excessive Androgen production.

These androgens undergo Aromatization to produce excessive Estrogens resulting in to a tonic hyper-estrogenic state which

increases the pituitary sensitivity to GnRH resulting in menstrual abnormalities.

Role of Leptin

•It is the product of ob gene, a protein produced in fat cells, that signals the magnitude of the energy stores to the brain

and has significant effects on the reproductive system of rodents.

women with normal periods, 45% of amenorrhea patients were obese while 9.13% of women with normal cycles were

over weight.

Hartz et al- 26,638 women were studied. They noted that anovulation was strongly associated with obesity. Grossly

obese woman had a rate of menstrual disturbance 3.1 times more frequent than women in normal weight range.

problems. Women who were overweight at 23 years (B.M.I 23.9-28.6 k.g/m2) were 1.32 times more likely and if obese

(>28.6 k.g/m2) 1.75 times more likely to have menstrual difficulties.

PCOS, 70% had menstrual disturbances and only 22% had normal menstrual cycle if their B.M.I was over 30 k.g/m2

Obesity and overweight do contribute to a significant proportion of menstrual dysfunction, there is little in literature to

separate predisposing or associated features such as PCOS from so called simple obesity, although there are

suggestions that women with polycystic ovaries suffer more from weight related menstrual dysfunction than those with

normal ovaries.

Thus, by the above explained etiopathology; 3 types of menstrual disturbances are found in obese women.

Amenorrhea

Oligomenorrhea

D.U.B

TREATMENT

In the absence of therapeutic modalities of proven efficacy, therapy is directed towards correction of the risk factors for

menstrual abnormalities& conception.

Patient counselling,

•Weight reduction – First line of treatment, BMI <>

•Correction of biochemical abnormality,

EFFECTS OF WEIGHT LOSS ON MENSTRUATION

There were several reports that indicated that weight loss induces menstrual regulation in women with obesity and

anovulation.

Bakes and Whitworth were the first to show a reduction in plasma androgens with dieting and associated return of

menses. These endocrine and clinical observations have been confirmed by several studies. E.g.

Kiddy et al, Pettigrew- revisited dietary manipulation of patients with obesity and PCOS showing that strict calorie

restriction with a subsequent 5% or greater weight loss led to changes in insulin, IGF, SHBG and menstruation.

Menstrual regularity and hirsutism improved with some spontaneous pregnancies occurring.

There have been several studies confirming that weight loss improves clinical and biochemical parameters that are

disordered due to weight problems.

Clark and colleagues in Adelaide, have shown that menstrual regularity and pregnancy can be restored by exercise and

dietary advice without an emphasis on low calories. More than 90% of obese oligomenorrhea patients showed a

dramatic improvement in menstrual patterns with a high spontaneous conception rate and lower miscarriage rate.

Several studies have reported that surgically induced wt loss are successful in restoring menstruation and pregnancy,

but these operations may have significant morbidity

CONCLUSION

Overweight and obesity in women are associated with high long term morbidity and mortality.

Those who deal with reproductive problems in the area of menstruation and fertility should take other points into consideration and discuss the long term implications of obesity as well as short term reproductive problems

Assessment of glucose intolerance and hyperlipidemia should be standard for all overweight and obese women.

Central adiposity is associated with menstrual disorders and infertility.

Dietary restraint and exercise are the corner stone of management.