From the Guidelines
Lifestyle management, including a balanced diet and regular exercise, is the first-line treatment for polycystic ovary syndrome (PCOS), as it can significantly improve symptoms and hormone levels 1. PCOS is a common hormonal disorder affecting women of reproductive age, characterized by irregular periods, excess androgen levels, and polycystic ovaries.
Key Management Strategies
- Lifestyle modifications, including weight loss through regular exercise and a balanced diet, can improve symptoms and hormone levels
- Medications may be prescribed based on specific symptoms, such as:
- Combined hormonal contraceptives to regulate periods and reduce excess hair growth
- Metformin (500-2000 mg daily) to improve insulin sensitivity
- Anti-androgens like spironolactone (25-200 mg daily) to address hirsutism
- Clomiphene citrate or letrozole for fertility treatment
Importance of Regular Monitoring
Regular monitoring is essential, as PCOS increases the risk of:
- Type 2 diabetes
- Cardiovascular disease
- Endometrial cancer The condition results from a combination of genetic factors and insulin resistance, leading to hormonal imbalances that disrupt normal ovarian function.
Recent Evidence on Bariatric Surgery
A recent systematic review and meta-analysis found that bariatric surgery can improve anthropometric, metabolic, and reproductive outcomes in women with PCOS 1.
Pharmacological Agents for Weight Loss
Anti-obesity pharmacological agents, such as glucagon-like peptide 1 receptor agonists, may be considered as an adjunct to lifestyle management for weight loss in PCOS 1.
Hirsutism Treatment
Treatment for hirsutism in PCOS often involves a combination of medical interventions, including oral contraceptives, antiandrogen drugs, and insulin-sensitizing agents 1.
From the Research
Definition and Prevalence of PCOS
- Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine disorders among reproductive-aged women, affecting approximately 10% of women attending gynaecology clinics 2.
- It is characterized by hyperandrogenism, anovulation, and polycystic ovaries 3, 4, 5.
Symptoms and Associated Risks
- PCOS is associated with symptoms such as hirsutism, infertility, acne, weight gain, type 2 diabetes, cardiovascular disease (CVD), and endometrial hyperplasia 2.
- Women with PCOS are at a higher risk of developing metabolic and cardiovascular diseases 3, 4.
Lifestyle Interventions for PCOS Management
- Lifestyle changes, including dietary modifications and physical activity, are suggested as first-line interventions in managing PCOS 3, 4.
- Dietary interventions such as foods with 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, can enhance insulin sensitivity, help with weight loss, and improve metabolic and reproductive outcomes in women with PCOS 3.
Medical Treatments for PCOS
- Combined oral contraceptive (COC) therapy, including ethinylestradiol/drospirenone combination, can provide clinical improvement in symptoms such as excessive hair growth, unpredictable menses, acne, and weight gain 5.
- Metformin can improve hirsutism and menstrual frequency in women with PCOS, and may also improve insulin sensitivity when combined with ethinyl estradiol-drospirenone 2, 6.