1Professor of Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt
2Assistant lecturer of Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt
3Professor of Maternal and Newborn Health Nursing, Faculty of Nursing, Menoufia University, Egypt
Background: Obesity increases the risk of sub-fecundity and infertility due to dysfunction in the hypothalamic-pituitary-ovarian axis, low oocyte quality, and reduced endometrial receptivity, and increases the risk of normal-gonadotrophic anovulation. Aim: evaluate the impact of lifestyle modifications on women's BMI and infertility among women with polycystic ovary syndrome. Subjects and Methods: A quasi-experimental design at Beni-Suef University Hospital's gynecological and infertility clinics; a purposive sample of 116 women with polycystic ovary syndrome, overweight, and obesity, was selected. Tools: I: The Arabic-structured interview questionnaire contains personal data; II: anthropometric measures contain body mass index and waist circumference; III: lifestyle and habit characteristics contain nutritional habits and block adult physical activity (PA). Results: It revealed that the anthropometric measures get better for the study group after intervention (60.3%; BMI ≥25.0: overweight and 46.5%; waist circumference ≥88) compared to 29.3%; BMI ≥25.0: overweight and 77.6%; waist circumference ≥88) before intervention, respectively. About 95.1% of BMI ≥30: obesity in the study group had irregular menstrual cycles before intervention. Compared to 94.3% of BMI ≥25: overweight and 100% of BMI 18.5-24.9: normal weight, the study group had a regular cycle after the intervention. There is a positive correlation between anthropometric measures and menstrual cycle regularity (p< 0.01). Also, 87.5%, 83%, and 77.7% of the poor nutrition habits of the study group women experienced hypo-menorrhea, irregular cycles, and oligo-amenorrhea before intervention, compared to 78%, 75.6%, and 83.3% of good habits after intervention. Moreover, 87.5%, 93.6%, and 77.7% of mild physical activity have hypomenorrhea, irregular cycles, and oligoamenorrhea before intervention, compared to 68%, 80%, and 83.3% of moderate physical activity after the intervention. Conclusion: The study shows a positive correlation between anthropometric measures and menstrual cycle regularity and suggests that poor lifestyle habits can lead to irregular cycles and hypomenorrhea. Recommendations: Collaboration among gynecologists, nutritionists, and endocrinal specialists is needed to address women's fecundity-decline-related obesity.
| [1] | World Health Organization. Noncommunicable diseases. (2022). Available online at: https://www.who.int/news-room/fact-sheets/ detail/ noncommunicable-diseases.3-54. |
| [2] | Fitch, A. K., & Bays, H. E. (2022). Obesity definition, diagnosis, bias, standard operating procedures (SOPs), and telehealth: an Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. Obesity Pillars, 1(1), 100-004.View Article PubMed |
| [3] | La Merrill, M. A., Krigbaum, N. Y., Cirillo, P. M., & Cohn, B. A. (2020). Association between maternal exposure to the pesticide dichlorodiphenyltrichloroethane (DDT) and risk of obesity in middle age. International journal of obesity, 44(8), 1723-1732.View Article PubMed |
| [4] | Caiano, L. M., Costanzo, S., Panzera, T., Di Castelnuovo, A., de Gaetano, G., Donati, M. B., & Moli-sani Study Investigators. (2021). Association between body mass index, waist circumference, and relative fat mass with the risk of first unprovoked venous thromboembolism. Nutrition, Metabolism and Cardiovascular Diseases, 31(11), 3122-3130.View Article PubMed |
| [5] | Cena, H., Chiovato, L., & Nappi, R. E. (2020). Obesity, polycystic ovary syndrome, and infertility: a new avenue for GLP-1 receptor agonists. The Journal of Clinical Endocrinology & Metabolism, 105(8), e2695-e2709.View Article PubMed |
| [6] | Phillips, K., Olanrewaju, R. A., & Omole, F. (2023). Infertility: evaluation and management. American Family Physician, 107(6), 623-630. |
| [7] | Mohamed S., Omran A., Ramadan E., Hassan H. (2024). Effect of Body Mass Index on Urinary Incontinence among Menopausal Women. Journal of Women Health Care and Issues, 7(3): 1-6. OI:10.31579/2642-9756/195 |
| [8] | Sheha E., Hassan H., Gamel W. (2018). Association between pre-pregnant overweight and obesity and periodontal disease during pregnancy: a cross sectional study. International Journal of Studies in Nursing, 3(1): 1-21.View Article |
| [9] | Hassan H. (2016). Infertility profile, psychological ramifications and reproductive tract infection among infertile women, in northern Upper Egypt. Journal of Nursing Education and Practice, 6(4): 92-108.View Article |
| [10] | Fichman, V., Costa, R. D. S. S. D., Miglioli, T. C., & Marinheiro, L. P. F. (2020). Association of obesity and anovulatory infertility. Einstein (Sao Paulo), 18(2), 1-11View Article PubMed |
| [11] | Gambineri, A., Laudisio, D., Marocco, C., Radellini, S., Colao, A., Savastano, S., & Obesity Programs of nutrition, Education, Research and Assessment (OPERA) group. (2019). Female infertility: which role for obesity?. International journal of obesity supplements, 9(1), 65-72.View Article PubMed |
| [12] | Alessandra, G., Daniela, L., Chiara, M., Stefano, R., Annamaria, C., & Savastano, S. (2019). Female infertility: which role for obesity?. International Journal of Obesity Supplements, 9(1), 65-72.View Article PubMed |
| [13] | Perakakis, N., Farr, O. M., & Mantzoros, C. S. (2021). Leptin in leanness and obesity: JACC state-of-the-art review. Journal of the American College of Cardiology, 77(6), 745-760.View Article PubMed |
| [14] | Al-yasiry, R. Z., Jwad, M. A., Hasan, M. F., & Alsayigh, H. A. (2022). How obesity affects female fertility. Medical Journal of Babylon, 19(2), 111-114.View Article |
| [15] | Kuryłowicz, A. (2023). Estrogens in Adipose Tissue Physiology and Obesity-Related Dysfunction. Biomedicines, 11(3), 690.View Article PubMed |
| [16] | Volkova, N. I., & Degtyareva, Y. S. (2020). Mechanisms of fertility disorders in obese women. Medical Herald of the South of Russia, 11(3), 15-19.View Article |
| [17] | Hashan, M. R., Gupta, R. D., Day, B., & Al Kibria, G. M. (2020). Differences in prevalence and associated factors of underweight and overweight/obesity according to rural–urban residence strata among women of reproductive age in Bangladesh: evidence from a cross-sectional national survey. BMJ open, 10(2), e034321.View Article PubMed |
| [18] | Ajmal, N., Khan, S. Z., & Shaikh, R. (2019). Polycystic ovary syndrome (PCOS) and genetic predisposition: A review article. European journal of obstetrics & gynecology and reproductive biology: X, 3(1), 10-60.View Article PubMed |
| [19] | Krentowska, A., Łebkowska, A., Jacewicz-Święcka, M., Hryniewicka, J., Leśniewska, M., Adamska, A., & Kowalska, I. (2021). Metabolic syndrome and the risk of cardiovascular complications in young patients with different phenotypes of polycystic ovary syndrome. Endocrine, 72, 400-410.View Article PubMed |
| [20] | Hassan H & Farag D. (2019). The impact of polycystic ovary syndrome on women’s quality of life: Nursing guidelines for its management. Clinical Nursing Studies, 7(3):42-57.View Article |
| [21] | Kadam, P., & Bhalerao, S. (2010). Sample size calculation. International journal of Ayurveda research, 1(1), 55–57.View Article PubMed |
| [22] | Mostafa e, Sayed Ahmed, Mohamed E, Salem, Samir M.) 2012( Effect of Lifestyle Modifications on Polycystic Ovarian Syndrome Symptoms. Journal of American Science 2012; 1( 8)3-7. |
| [23] | Saeedi, V., Nourbakhsh, M., Nourbakhsh, M., Haghighi, L., Kamalzadeh, L., Ezzati Mobasser, S., & Razzaghy‐Azar, M. (2021). Sestrin2 and Beclin1 levels in polycystic ovary syndrome. Journal of Clinical Laboratory Analysis, 35(9), e23957.View Article PubMed |
| [24] | World Health Organization, & World Health Organization. Global Observatory for eHealth. (2006). Building foundations for eHealth: progress of Member States: report of the WHO Global Observatory for eHealth. World Health Organization.1-100 |
| [25] | Marzouk, T., Nabil, H., & Senna, M. (2015). Impact of a lifestyle modification program on menstrual irregularity among overweight or obese women with polycystic ovarian syndrome. Korean Journal of Women Health Nursing, 21(3), 161-170.View Article PubMed |
| [26] | Sternfeld, B., Block, C., Quesenberry Jr, C. P., Block, T. J., Husson, G., Norris, J. C., ... & Block, G. (2009). Improving diet and physical activity with ALIVE: a worksite randomized trial. American journal of preventive medicine, 36(6), 475-483.View Article PubMed |
| [27] | Safaei, M., Sundararajan, E. A., Driss, M., Boulila, W., & Shapi'i, A. (2021). A systematic literature review on obesity: Understanding the causes & consequences of obesity and reviewing various machine learning approaches used to predict obesity. Computers in biology and medicine, 13(6), 1-10.View Article PubMed |
| [28] | Amiri, M., & Tehrani, F. R. (2020). Potential adverse effects of female and male obesity on fertility: a narrative review. International journal of endocrinology and metabolism, 18(3), 1-17.View Article PubMed |
| [29] | Lass, N., Kleber, M., Winkel, K., Wunsch, R., & Reinehr, T. (2011). Effect of lifestyle intervention on features of polycystic ovarian syndrome, metabolic syndrome, and intima-media thickness in obese adolescent girls. The Journal of Clinical Endocrinology & Metabolism, 96(11): 3533-3540.View Article PubMed |
| [30] | Öberg, E. (2022). Effects of Lifestyle Intervention in Overweight Women with Polycystic Ovary Syndrome–Aspects on Reproduction, Metabolism, Psychological Well-Being and Sleep. Karolinska Institutet (Sweden). 22(11):1-18. |
| [31] | Niranjani, S., Bhuvaneswari, G., Hemamalini, M., & Vijayaraghavan, R. (2022). Effectiveness of cinnamon, exercise and counselling on hyper androgenic symptoms and level of anxiety among young girls with Polycystic Ovarian Syndrome. NeuroQuantology, 20(8): 9534. |
| [32] | Benham, J. L., Yamamoto, J. M., Friedenreich, C. M., Rabi, D. M., & Sigal, R. J. (2018). Role of exercise training in polycystic ovary syndrome: a systematic review and meta‐analysis. Clinical obesity, 8(4): 275-284.View Article PubMed |
| [33] | Liu, C., Zhang, L., Zheng, W., Liang, X., Zhang, L., Tian, Z., & Li, G. (2021). Lifestyle intervention for overweight/obese pregnant women with polycystic ovarian syndrome: lessons and challenges. Obesity Facts, 14(4): 405-414.View Article PubMed |
| [34] | Gayathri, K. (2015). A study to assess the effectiveness of lifestyle modification package on knowledge and attitude regarding weight reduction among women with pcos at janet nursing home, Trichy (Doctoral dissertation, Our Lady of Health College of Nursing, Thanjavur) Obstetrics and Gynaecology Nursing 40(20), 113 |
| [35] | Abd Elmenim, S. O., & Emam, A. M. M. (2016). Effect of lifestyle changes on symptoms of polycystic ovarian syndrome in obese girls. IOSR JNHS, 5(3): 1-10. |
| [36] | Turan, V., Mutlu, E. K., Solmaz, U., Ekin, A., Tosun, O., Tosun, G., ... & Malkoc, M. (2015). Benefits of short-term structured exercise in non-overweight women with polycystic ovary syndrome: a prospective randomized controlled study. Journal of physical therapy science, 27(7): 2293-2297.View Article PubMed |
| [37] | Neubronner, S. A., Indran, I. R., Chan, Y. H., Thu, A. W.P., & Yong, E. L. (2021). Effect of body mass index (BMI) on phenotypic features of polycystic ovary syndrome (PCOS) in Singapore women: a prospective cross-sectional study. BMC Women's Health, 21(1): 1-12.View Article PubMed |
| [38] | Taheri, R., Mesbah Ardekani, F., Raeisi Shahraki, H., Heidarzadeh-Esfahani, N., & Hajiahmadi, S. (2020). Nutritional status and anthropometric indices in relation to menstrual disorders: A cross‐sectional study. Journal of Nutrition and Metabolism, 2020(1), 5980685.View Article PubMed |
| [39] | Hassan H., Ahmed W., Ahmed Arafa A. (2019). Physical Activity and Menstrual Disorders Аmong School Girls in Southern Egypt. International Journal of Studies in Nursing, 4(3): 54-59.View Article |
| [40] | Naderpoor N., Shorakae S., de Courten B., Misso ML., Moran LJ., Teede HJ. (2015). Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis. Hum Reprod Update. 2015; 21(5):560–74.View Article PubMed |
| [41] | Moran, L. J., Ranasinha, S., Zoungas, S., McNaughton, S. A., Brown, W. J., & Teede, H. J. (2013). The contribution of diet, physical activity and sedentary behaviour to body mass index in women with and without polycystic ovary syndrome. Human reproduction, 28(8): 2276-2283.View Article PubMed |
| [42] | Albezrah, N. K. A., & Arein, F. R. (2019). Knowledge, attitude, and practice toward weight reduction among polycystic ovary syndrome women at Taif city. Saudi Journal for Health Sciences, 8(2): 112-117.View Article |
| [43] | Thomson, R. L., Buckley, J. D., & Brinkworth, G. D. (2011). Exercise for the treatment and management of overweight women with polycystic ovary syndrome: a review of the literature. Obesity reviews, 12(5): e202-e210.View Article PubMed |
| [44] | Nybacka, Å., Carlström, K., Ståhle, A., Nyrén, S., Hellström, P. M., & Hirschberg, A. L. (2011). Randomized comparison of the influence of dietary management and/or physical exercise on ovarian function and metabolic parameters in overweight women with polycystic ovary syndrome. Fertility and sterility, 96(6): 1508-1513.View Article PubMed |
| [45] | Yesiladali, M., Yazici, M. G., Attar, E., & Kelestimur, F. (2022). Differentiating polycystic ovary syndrome from adrenal disorders. Diagnostics, 12(9), 2045.View Article PubMed |
| [46] | Singh, M., Thirsk, L., Stahlke, S., Venkatesaperumal, R., LoBiondo-Wood, G., & Haber, J. (2021). Nursing research in Canada-E-book: methods, critical appraisal, and utilization. Elsevier Health Sciences,5-22. |
