What are the guidelines for managing Polycystic Ovary Syndrome (PCOS)?

Guidelines for Managing Polycystic Ovary Syndrome (PCOS)

Multicomponent lifestyle intervention, including diet, exercise, and behavioral strategies, should be recommended as first-line treatment for all patients with PCOS, particularly those with excess weight, to improve reproductive, metabolic, and psychological outcomes. 1, 2

Assessment and Risk Evaluation

• Calculate BMI and measure waist circumference to assess central obesity in all PCOS patients 2
• Consider ethnic-specific BMI and waist circumference categories for high cardiometabolic risk ethnic groups 1, 2
• Perform comprehensive metabolic evaluation in women with obesity 2
• Assess psychological factors including anxiety, depression, body image concerns, and disordered eating that may impact treatment adherence 1, 2

Lifestyle Management Approach

Weight Management

• Set achievable weight loss goals of 5-10% in those with excess weight, which can yield significant clinical improvements within 6 months 1, 2
• Implement ongoing assessment and monitoring during weight loss and maintenance phases 1
• Recognize that healthy lifestyle may contribute to health and quality of life benefits even in the absence of weight loss 1

Behavioral Strategies

• Use SMART (specific, measurable, achievable, realistic, timely) goal setting and self-monitoring to enable achievement of realistic lifestyle goals 1
• Include behavioral techniques such as goal-setting, self-monitoring, stimulus control, problem-solving, assertiveness training, slower eating, reinforcing changes, and relapse prevention 1
• Consider comprehensive health behavioral or cognitive behavioral interventions to increase support, engagement, retention, and adherence 1

Dietary Recommendations

• Follow general healthy eating principles for all women with PCOS across the life course 1
• For weight loss in those with excess weight, create an energy deficit of 30% or 500-750 kcal/day (1,200-1,500 kcal/day), considering individual energy requirements, body weight, and physical activity levels 1
• No specific diet type has proven superior - various balanced dietary approaches can be recommended 1, 3
• Tailor dietary changes to food preferences, allowing for a flexible and individual approach while avoiding unduly restrictive and nutritionally unbalanced diets 1

Physical Activity Recommendations

• For adults (18-64 years): Recommend minimum 150 minutes/week of moderate intensity or 75 minutes/week of vigorous intensity physical activity, plus muscle-strengthening activities on 2 non-consecutive days/week 1
• For adolescents: Recommend 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 modest weight loss and prevention of weight regain: Recommend minimum 250 minutes/week of moderate intensity or 150 minutes/week of vigorous intensity activity 1
• Both aerobic and resistance exercise can enhance insulin sensitivity, promote weight loss, and improve metabolic and reproductive outcomes 3, 4

Special Considerations

• Provide respectful, patient-centered care that values individualized preferences and considers cultural, socioeconomic, and ethnic differences 1
• Be aware of personal sensitivities, marginalization, and potential weight-related stigma 1
• Pay special attention to ethnic groups with PCOS who are at high cardiometabolic risk 1
• Consider referral to suitably trained allied health professionals for complex issues 1

Pathophysiology Context

• Insulin resistance plays a key role in PCOS symptoms and is present regardless of BMI 1
• Hyperinsulinemia contributes to hyperandrogenism through effects on the pituitary, liver, and ovaries 1
• Obesity exacerbates insulin resistance, worsening all PCOS symptoms 1, 5