What is Polycystic Ovary Syndrome (PCOS)?

From the Guidelines

Polycystic ovary syndrome (PCOS) management should prioritize lifestyle modifications, including weight loss through diet and exercise, as the first-line treatment to improve symptoms and reduce the risk of associated metabolic and reproductive complications. PCOS is a complex disorder affecting women of reproductive age, characterized by irregular periods, excess androgen levels, and small fluid-filled follicles in the ovaries 1. The current understanding of PCOS pathophysiology suggests that insulin resistance plays a crucial role in many symptoms, and lifestyle modification or weight loss can improve these symptoms 1.

Key Recommendations

• Lifestyle modifications, such as weight loss through diet and exercise, are recommended as the first-line treatment for PCOS 1.
• Medications, including combined hormonal contraceptives, metformin, anti-androgens, and fertility medications, may be prescribed to manage specific symptoms 1.
• Bariatric surgery may be considered as an adjunct therapy for PCOS in patients with excess weight, as it has been shown to improve anthropometric, metabolic, and reproductive outcomes 1.

Considerations

• PCOS increases the risk of type 2 diabetes, heart disease, and endometrial cancer, making ongoing management and regular follow-up with healthcare providers essential 1.
• The condition stems from insulin resistance and genetic factors that lead to hormonal imbalances, particularly elevated testosterone levels 1.
• A systematic review and meta-analysis found that bariatric surgery can improve outcomes in women with PCOS, including hirsutism, menstrual regularity, and fertility 1.

Treatment Approach

• A comprehensive treatment approach should prioritize lifestyle modifications and consider the individual's specific symptoms and needs. This may include a combination of diet, exercise, and medications to manage symptoms and reduce the risk of associated complications 1.

From the Research

Definition and Symptoms of Polycystic Ovary Syndrome (PCOS)

• PCOS is one of the most prevalent endocrine disorders among reproductive-aged women, characterized by hyperandrogenism, anovulation, and polycystic ovaries 2.
• The condition worsens the life quality of women by disturbing their physiology and psychology in reproductive age, and may also be associated with other morbidities like diabetes and hypertension 3.

Lifestyle Modifications for PCOS Management

• Lifestyle changes are suggested as first-line interventions in managing PCOS, including dietary changes, physical activity, and behavioral changes 2, 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 improve insulin sensitivity and hormonal balance in women with PCOS 2.
• Physical activity, like aerobic and resistance exercise, enhances insulin sensitivity, helps weight loss, and improves metabolic and reproductive outcomes in women with PCOS 2.
• A balanced diet with 40% energy from carbohydrates, 30% from fats, and 30% from protein with optimum physical activity could reduce severe PCOS symptoms and improve metabolic balance 3.

Treatment and Management of PCOS

• Lifestyle modification is the best initial management for obese PCOS patients seeking pregnancy, and insulin sensitizing agents seem to have an important role in treating insulin resistance 5.
• Oral contraceptives are first-line therapy for menstrual irregularities and dermatologic complications such as hirsutism and acne in patients who do not want to become pregnant 6.
• Letrozole is first-line therapy for ovulation induction in patients who want to become pregnant, and metformin added to lifestyle management is first-line therapy for patients with metabolic complications such as insulin resistance 6.

Importance of Lifestyle Modifications in PCOS

• Lifestyle modification is widely considered to be the cornerstone of PCOS treatment, but there is a significant gap in knowledge and a lack of evidence-based guidance for lifestyle modification 4.
• Health professionals should develop effective action plans utilizing the available evidence to provide comprehensive care for women with PCOS 4.