From the Guidelines
Polycystic Ovary Syndrome (PCOS) management should prioritize lifestyle modifications, including a balanced diet and regular exercise, as the first-line treatment to improve symptoms and reduce long-term health risks, as recommended by the 2020 international evidence-based guideline 1.
Overview of PCOS
PCOS is a common hormonal disorder affecting women of reproductive age, characterized by irregular periods, excess androgen levels, and polycystic ovaries. The syndrome results from a complex interplay of genetic factors, insulin resistance, and hormonal imbalances, leading to excessive androgen production that disrupts normal ovarian function and metabolism.
Lifestyle Modifications
Lifestyle modifications form the cornerstone of PCOS treatment, with weight loss of 5-10% significantly improving symptoms in overweight women through regular exercise (150 minutes weekly) and a balanced diet 1. A multicomponent lifestyle intervention, including diet, exercise, and behavioral strategies, is central to PCOS management, focusing on weight and healthy lifestyle behaviors.
Pharmacological Interventions
For women seeking pregnancy, ovulation induction medications such as clomiphene citrate (50-150mg daily for 5 days) or letrozole (2.5-7.5mg daily for 5 days) may be prescribed. Metformin (500-2000mg daily) improves insulin sensitivity and may help with weight management and ovulation 1. Anti-androgen medications like spironolactone (25-200mg daily) can address hirsutism and acne but should be avoided during pregnancy due to potential feminization of male fetuses.
Recent Developments
Recent studies have explored the potential utility of anti-obesity pharmacological agents, such as glucagon-like peptide 1 receptor agonists (GLP-1 RAs), orlistat, phentermine, and topiramate, in PCOS management, highlighting their potential to promote weight loss and improve insulin resistance 1.
Key Recommendations
- Lifestyle modifications, including a balanced diet and regular exercise, should be the first-line treatment for PCOS 1.
- Weight loss of 5-10% can significantly improve symptoms in overweight women with PCOS.
- Pharmacological interventions, such as hormonal contraceptives, ovulation induction medications, metformin, and anti-androgen medications, may be prescribed to address specific symptoms and reduce long-term health risks.
- Regular monitoring, including annual screenings for diabetes, lipid abnormalities, and blood pressure, is essential to manage PCOS-related risks.
From the Research
PCOS Overview
- Polycystic ovary syndrome (PCOS) affects 6-7% of reproductive-aged women 2
- Characterized by hyperandrogenism (hirsutism, acne, male-pattern hair loss), oligo-anovulation, and polycystic ovaries on ultrasound 2
- Reproductive and metabolic complications associated with PCOS can be serious, requiring a comprehensive approach to evaluation and treatment 2
Management of PCOS
- Menstrual cycle control is necessary to prevent endometrial hyperplasia, and can be accomplished with hormonal contraception, progesterone therapy, and weight loss (if overweight) 2
- Ovulation induction therapies include weight loss, clomiphene citrate, and/or metformin for women desiring pregnancy 2
- Cosmetic issues such as hirsutism, acne, and male-pattern hair loss can be treated with estrogen-containing hormonal contraceptive agents, antiandrogens, and topical agents 2
- Lifestyle modifications, including dietary changes, physical activity, and behavioral changes, can improve reproductive, anthropometric, metabolic, and psychological outcomes in women with PCOS 3
Lifestyle Interventions
- Dietary interventions such as low glycemic index scores, caloric restrictions, high-fiber, omega three fatty acid-rich diets, ketogenic diets, Mediterranean diets, antioxidant-rich food, and anti-inflammatory diets can improve insulin sensitivity and hormonal balance in women with PCOS 3
- Physical activity, such as aerobic and resistance exercise, enhances insulin sensitivity, helps with weight loss, and improves metabolic and reproductive outcomes in women with PCOS 3
- Behavioral and education modules can improve awareness, adherence, and effectiveness of conventional treatment, and manage mental health issues related to PCOS 3
Pharmacological Therapies
- Metformin therapy can decrease fasting blood sugar and testosterone levels, and lead to significant improvements in clinical manifestations of hyperandrogenism 4
- Addition of low-dose spironolactone to metformin therapy can induce a more marked reduction of clinical and biochemical hyperandrogenism than metformin alone 5
- Metformin plus low-dose spironolactone therapy can restore regular menses, decrease circulating testosterone and Δ-4-androstenedione, and reduce Hirsutism Score (HS) in PCOS patients 5
Dietary and Lifestyle Modifications
- 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 6
- Herbal extracts may show a positive correlation in reducing indicators associated with PCOS 6
- Dietary and lifestyle modifications can effectively manage PCOS, and recommendations for modification of diet and lifestyle activities can positively influence recovery from PCOS 6