Treatment Options for Polycystic Ovary Syndrome (PCOS)
Lifestyle management is the first-line treatment for PCOS, with multicomponent interventions including diet, exercise, and behavioral strategies being central to improving metabolic, reproductive, and psychological outcomes. 1, 2
Lifestyle Interventions
Weight Management
- Target 5-10% weight reduction in women with excess weight, which yields significant clinical improvements 1
- Recommended energy deficit of 30% or 500-750 kcal/day (1,200-1,500 kcal/day) 1
- Regular monitoring during weight loss and maintenance phases 1
Dietary Recommendations
- No specific diet has proven superior for PCOS 1, 2
- Follow general healthy eating principles across the life course 1
- Options include:
- Low glycemic index foods
- Mediterranean diet
- Anti-inflammatory diets 2
- Avoid unduly restrictive or nutritionally unbalanced diets 1
- Tailor dietary changes to individual food preferences 1
Physical Activity Recommendations
- For adults (18-64 years):
- Minimum 150 min/week moderate intensity OR
- 75 min/week vigorous intensity exercise
- Include muscle-strengthening activities on 2 non-consecutive days/week 1
- For adolescents:
- At least 60 min/day of moderate to vigorous physical activity 1
- Activity should be performed in at least 10-minute bouts or around 1,000 steps 1
- For weight loss and prevention of weight regain:
- Increase to 250 min/week of moderate-intensity activities OR
- 150 min/week of vigorous intensity 1
Behavioral Strategies
- Implement SMART goal setting (specific, measurable, achievable, realistic, timely) 1
- Use self-monitoring techniques to track progress 1
- Include problem-solving, stimulus control, assertiveness training, slower eating, and relapse prevention strategies 1
- Consider comprehensive behavioral or cognitive behavioral interventions to increase engagement and adherence 1
Special Considerations
Psychological Support
- Address anxiety, depression, body image concerns, and disordered eating 1
- These factors need management to optimize engagement with lifestyle interventions 1
Cultural and Ethnic Considerations
- Consider adolescent and ethnic-specific BMI and waist circumference categories 1
- Ethnic groups with PCOS who are at high cardiometabolic risk require greater consideration for lifestyle intervention 1
Clinical Monitoring
- Regular assessment of weight, metabolic parameters, and reproductive function 2
- Screen for cardiovascular risk factors and diabetes 2
Common Pitfalls to Avoid
- Focusing solely on weight loss rather than overall health benefits
- Implementing overly restrictive diets that are not sustainable
- Neglecting psychological aspects of PCOS management
- Failing to recognize that healthy lifestyle may contribute to health benefits even in the absence of weight loss 1
- Not providing adequate support for lifestyle changes, which can lead to poor adherence
Lifestyle interventions have been shown to improve free androgen index, weight, and BMI in women with PCOS 3. While no specific diet type is superior to another, the key is finding a sustainable approach that works for the individual patient 1.