From the Guidelines
Lifestyle management, including a multicomponent lifestyle intervention with diet, exercise, and behavioral strategies, is the first-line management for polycystic ovary syndrome (PCOS) and should be prioritized to improve symptoms and quality of life. This approach is supported by the most recent and highest quality study, which emphasizes the importance of lifestyle modifications in the management of PCOS 1. The benefits of this approach include improved weight management, reduced risk of chronic diseases such as type 2 diabetes and cardiovascular disease, and enhanced reproductive health.
Key components of lifestyle management for PCOS include:
- A balanced diet that promotes healthy weight and improves insulin sensitivity
- Regular exercise, such as aerobic and resistance training, to improve cardiovascular health and reduce androgen levels
- Behavioral strategies, such as stress management and sleep hygiene, to promote overall well-being
In addition to lifestyle management, medications may be prescribed to address specific symptoms of PCOS, such as:
- Combined hormonal contraceptives to regulate periods and reduce excess hair growth
- Metformin to improve insulin sensitivity and reduce the risk of type 2 diabetes
- Anti-androgens, such as spironolactone, to address hirsutism
- Fertility medications, such as clomiphene citrate or letrozole, to improve ovulation and fertility
Recent studies have also explored the potential benefits of anti-obesity pharmacological agents in the management of PCOS, including glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and other centrally acting medications 1. However, these agents are not currently approved for the treatment of PCOS and require further study to determine their safety and efficacy in this population.
Bariatric surgery may also be considered as a potential adjunct therapy for PCOS in patients with severe obesity, as it has been shown to improve reproductive and metabolic outcomes in this population 1. However, this approach should be carefully considered on a case-by-case basis, taking into account the individual's overall health and medical history.
From the FDA Drug Label
Some patients with polycystic ovary syndrome who are unusually sensitive to gonadotropin may have an exaggerated response to usual doses of clomiphene citrate. Therefore, patients with polycystic ovary syndrome should be started on the lowest recommended dose and shortest treatment duration for the first course of therapy
- Key Points:
- Patients with polycystic ovary syndrome (PCOS) may have an exaggerated response to usual doses of clomiphene citrate.
- These patients should be started on the lowest recommended dose and shortest treatment duration for the first course of therapy 2.
- The goal is to minimize the risk of ovarian hyperstimulation syndrome (OHSS), a potentially serious medical disorder.
- If ovarian enlargement occurs, additional clomiphene citrate therapy should not be given until the ovaries have returned to pretreatment size, and the dosage or duration of the next course should be reduced 2.
From the Research
PCOS Overview
- Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among reproductive-aged women, characterized by hyperandrogenism, anovulation, and polycystic ovaries 3.
- PCOS can worsen the quality of life for women, disturbing their physiology and psychology, and may be associated with other morbidities like diabetes and hypertension 4.
Lifestyle Interventions
- Lifestyle changes, including dietary modifications and physical activity, are suggested as first-line interventions in managing PCOS 3.
- Dietary interventions, such as foods with low glycemic index scores, caloric restrictions, and high-fiber diets, can improve insulin sensitivity and hormonal balance in women with PCOS 3.
- Physical activity, like aerobic and resistance exercise, enhances insulin sensitivity, helps with weight loss, and improves metabolic and reproductive outcomes in women with PCOS 3.
Treatment Options
- Metformin can be effective in regularizing menstrual cycles, decreasing body mass index, and treating hyperandrogenism in women with PCOS, particularly in populations with a high prevalence of insulin resistance 5.
- Combined oral contraceptive (COC) therapy, including ethinyl estradiol and drospirenone, can provide clinical improvement in areas such as excessive hair growth, unpredictable menses, acne, and weight gain 6.
- The addition of metformin to COC therapy may improve insulin sensitivity and decrease waist circumference, fasting insulin, and HOMA-IR in lean women with PCOS 7.
Dietary Recommendations
- A balanced diet with 40% energy from carbohydrates, 30% from fats, and 30% from protein, along with optimum physical activity, can reduce severe PCOS symptoms and improve metabolic balance 4.
- Various herbal extracts have shown a positive correlation in reducing indicators associated with PCOS, and may be considered as part of a comprehensive treatment plan 4.