Clinical Assessment: Reproductive System

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.

REPRODUCTIVE SYSTEM

Patients with morbid obesity report a decrease in desire, less enjoyment from sexual activity, difficulty with sexual performance and avoidance of sexual encounters.

Overweight and obese women have an increased incidence of dysfunctional uterine bleeding and amenorrhea. Elevated plasma testosterone and androstenedione are frequently found alongside reduced sex hormone binding globulin (SHBG) and increased ratio of estrone to estradiol. The obesity-related increase in androgen production evident in obese women may be due to an increase in ovarian and adrenal production stimulated by insulin, and a consequent reduction in SHBG. Adipose tissue may have a peripheral effect on steroid secretion and serve as a reservoir and site for steroid generation.

Massively obese men may have subnormal plasma testosterone concentrations and reduced SHBG levels. Low levels of testosterone and growth hormone have been associated with increased deposition of abdominal fat. The inverse relationship between plasma testosterone and body weight in obese men may be attributable to increased aroma

tization of androgen precursors to estrogens by adipose tissue, resulting in negative feedback on the hypothalamic-pituitary axis. It is important to note that there is currently no evidence to support the use of testosterone replacement in the treatment of obesity.

PCOS affects one in 10 women and is even more common in the obese population. The strong association between excess weight and PCOS raises the possibility that either obesity is a causal factor for PCOS, or PCOS is a causal factor for obesity. PCOS decreases fertility and is associated with a range of metabolic abnormalities including:

• Insulin resistance/hyperinsulinemia/impaired glucose tolerance/type 2 diabetes

• Dyslipidemia

• Increased estrone:estradiol ratio

• Decreased SHBG

• Increased free steroid concentrations

Symptoms of PCOS may include:

• Oligomenorrhea

• Infertility

• Hirsutism

• Acne, oily skin or dandruff

• Abdominal obesity

• Male pattern baldness

• Skin tags

Treatment of PCOS aims to alleviate symptoms. Oral contraceptives can help to restore regular menses, decrease ovarian testosterone secretion, and clear facial acne. Metformin can improve insulin sensitivity, thereby reducing insulin production and decreasing adrenal androgen production. Metformin can also help restore regular ovulation, decrease abnormal hair growth, reduce body weight, and improve dyslipidemia.

Weight loss is perhaps the best treatment for PCOS, and a 10% weight loss may be sufficient to restore normal ovulation and fertility.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

Members of the Canadian Obesity Network can download Best Weight for free.

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