What is the recommended treatment for Polycystic Ovary Syndrome (PCOS)?

Recommended Treatment for PCOS

The recommended treatment for Polycystic Ovary Syndrome (PCOS) should begin with lifestyle interventions, including a balanced dietary approach with an energy deficit of 30% or 500-750 kcal/day and regular physical activity of at least 60 minutes daily, followed by pharmacological interventions such as metformin or combined oral contraceptives when necessary. 1

Lifestyle Interventions as First-Line Treatment

Dietary Recommendations

• Create an energy deficit of 30% or 500-750 kcal/day (1,200-1,500 kcal/day) 1
• Focus on:
  • Low glycemic index foods
  • Anti-inflammatory diet patterns
  • Adequate magnesium and zinc intake
  • Limiting calories from fat to 25-30%
  • Limiting saturated fat to <7%
  • Avoiding trans fats 1

The specific macronutrient composition is less important than achieving an overall caloric deficit. Evidence shows that no single diet type has selective advantages over others, and emphasis should be placed on individual preferences and cultural needs 2. A target of 5-10% weight reduction can yield significant clinical improvements, and health benefits can occur even without significant weight loss 1.

Physical Activity Recommendations

• At least 60 minutes of moderate to vigorous activity daily 1
• Include weight training 3 times per week 1
• Combine both aerobic and resistance exercises for optimal results 2

Physical activity improves insulin sensitivity and can benefit PCOS symptoms independent of significant weight loss 2. Regular moderate-intensity exercise shows greater metabolic benefits over longer durations (24 weeks versus 12 weeks) 2.

Pharmacological Interventions

When lifestyle modifications alone are insufficient, pharmacological interventions should be considered:

For Insulin Resistance

• Metformin: Start with 500 mg/day and gradually increase as tolerated 1
  • Improves insulin sensitivity
  • Reduces hyperandrogenism
  • May help with weight management

For Menstrual Irregularities and Hyperandrogenism

• Combined Oral Contraceptives (COCs): First-line treatment for menstrual irregularities and acne 1
  • Regulates menstrual cycles
  • Reduces androgen levels
  • Improves acne and hirsutism

For Persistent Hirsutism

• Anti-androgens (e.g., spironolactone): Consider for patients resistant to first-line treatments 1
• Topical treatments (e.g., eflornithine cream): Can be used for facial hirsutism 1

Monitoring and Follow-up

Regular monitoring is essential to evaluate treatment effectiveness:

• Evaluate menstrual cycles every 3-6 months 1
• Screen for cardiovascular risk factors, including dyslipidemia 1
• Assess metabolic parameters annually 1
• Monitor BMI and waist-hip ratio to evaluate central obesity 1
• Screen for anxiety and depression 1

Important Considerations and Pitfalls

1. Avoid focusing solely on weight: Health benefits can occur with lifestyle modifications even without significant weight loss 1, 3.

2. Don't overlook psychological factors: Address anxiety, depression, and body image concerns as part of comprehensive treatment 1.

3. Beware of one-size-fits-all approaches: Treatment should consider cultural, socioeconomic, and ethnic differences 1.

4. Don't delay treatment: Early intervention can prevent long-term metabolic and reproductive complications 4.

5. Avoid neglecting long-term risks: PCOS increases risk for metabolic syndrome, type 2 diabetes, and cardiovascular disease, requiring ongoing monitoring 3.

The evidence strongly supports that a comprehensive approach addressing both lifestyle and pharmacological interventions provides the best outcomes for women with PCOS, with lifestyle modifications forming the foundation of treatment.