What are the treatment options for Polycystic Ovary Syndrome (PCOS)?

Treatment Options for Polycystic Ovary Syndrome (PCOS)

Lifestyle interventions should be the first-line treatment for all women with PCOS, particularly focusing on multicomponent approaches including diet, exercise, and behavioral strategies to reduce weight, central obesity, and insulin resistance. 1

Lifestyle Management

Weight Management

• Achievable weight loss goals of 5-10% in women with excess weight can yield significant clinical improvements and are considered successful weight reduction within 6 months 1
• For those with excess weight, an energy deficit of 30% or 500-750 kcal/day (1,200-1,500 kcal/day) is recommended, considering individual energy requirements, body weight, and physical activity levels 1
• Weight management appears equally effective in PCOS as in the general population but requires ongoing assessment and monitoring 1
• Healthy lifestyle may contribute to health and quality of life benefits even in the absence of weight loss 1

Dietary Recommendations

• No specific diet type has proven superior for PCOS; a variety of balanced dietary approaches can be recommended to reduce energy intake and induce weight loss 1
• General healthy eating principles should be followed for all women with PCOS across the life course 1
• Dietary changes should be tailored to food preferences, allowing for a flexible and individual approach while avoiding unduly restrictive and nutritionally unbalanced diets 1, 2

Physical Activity Recommendations

• For adults (18-64 years): Minimum of 150 minutes/week of moderate intensity physical activity or 75 minutes/week of vigorous intensity, including muscle-strengthening activities on 2 non-consecutive days/week 1
• For adolescents: At least 60 minutes of moderate to vigorous intensity physical activity daily, including muscle and bone strengthening activities at least 3 times weekly 1
• For weight loss and greater health benefits: Minimum of 250 minutes/week of moderate-intensity activities or 150 minutes/week of vigorous intensity 1
• Activity should be performed in at least 10-minute bouts or around 1,000 steps, aiming to achieve at least 30 minutes daily on most days 1

Behavioral Strategies

• Implement SMART (specific, measurable, achievable, realistic, and timely) goal setting and self-monitoring to enable achievement of realistic lifestyle goals 1
• Include behavioral strategies such as goal-setting, self-monitoring, stimulus control, problem-solving, assertiveness training, slower eating, reinforcing changes, and relapse prevention 1, 3
• Consider comprehensive health behavioral or cognitive behavioral interventions to increase support, engagement, retention, adherence, and maintenance of healthy lifestyle 1
• Address psychological factors such as anxiety, depressive symptoms, body image concerns, and disordered eating to optimize engagement and adherence to lifestyle interventions 1, 4

Special Considerations

Ethnic and Age-Specific Considerations

• Adolescent and ethnic-specific BMI and waist circumference categories need consideration when optimizing lifestyle and weight 1
• Ethnic groups with PCOS who are at high cardiometabolic risk require greater consideration for healthy lifestyle intervention 1

Healthcare Approach

• Health professional interactions should be respectful, patient-centered, and value women's individualized healthy lifestyle preferences and cultural, socioeconomic, and ethnic differences 1
• Consider personal sensitivities, marginalization, and potential weight-related stigma when discussing lifestyle changes 1
• Referral to suitably trained allied health professionals should be considered when complex issues arise 1, 4

Benefits of Lifestyle Intervention

• Lifestyle interventions have been shown to improve:
  • Reproductive parameters: reduced total testosterone and hirsutism 1, 5
  • Anthropometric measures: reduced weight, waist circumference, and waist-hip ratio 1, 5
  • Metabolic parameters: improved fasting insulin and oral glucose tolerance test results 1, 3

Common Pitfalls and Caveats

• Many women with PCOS report inadequate support for weight management despite its critical importance in treatment 4
• There is often insufficient referral to dieticians and other specialists who could provide ongoing support 4
• Patients typically see specialists infrequently (e.g., endocrinologists twice yearly), creating gaps in ongoing lifestyle support 4
• Lifestyle changes require consistent reinforcement and monitoring to maintain adherence and effectiveness 1, 6
• Psychological aspects of PCOS (anxiety, depression, body image concerns) may impede successful implementation of lifestyle changes if not addressed 1