How does Polycystic Ovary Syndrome (PCOS) affect the plan of care?

PCOS Management Plan of Care

Multicomponent lifestyle intervention including diet, exercise, and behavioral strategies should be the first-line management for all patients with PCOS, especially those with excess weight, to improve metabolic, reproductive, and psychological outcomes. 1

Comprehensive Assessment Components

• Calculate BMI and measure waist circumference to assess central obesity, which exacerbates metabolic, reproductive, and psychological features of PCOS 1, 2
• Consider ethnic-specific BMI and waist circumference categories for high cardiometabolic risk ethnic groups 1, 2
• Evaluate psychological factors including anxiety, depression, body image concerns, and disordered eating which can affect engagement with treatment 1, 2

Lifestyle Management Framework

Weight Management Goals

• Target achievable weight loss of 5-10% in those with excess weight, which yields significant clinical improvements within 6 months 1, 2
• Implement ongoing assessment and monitoring during weight loss and maintenance phases 1
• Focus on weight gain prevention as weight gain is accelerated in PCOS compared to women without PCOS 1

Dietary Interventions

• Recommend a balanced dietary approach with an energy deficit of 30% or 500-750 kcal/day (1,200-1,500 kcal/day) for those needing weight loss 1
• Follow general healthy eating principles for all women with PCOS across the lifespan 1
• Tailor dietary changes to food preferences, allowing for flexibility while avoiding overly restrictive diets 1
• No specific diet type has proven superior for PCOS management - focus on sustainable approaches 1, 3

Physical Activity Recommendations

• For adults (18-64 years): 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: At least 60 minutes/day of moderate to vigorous intensity physical activity, including muscle and bone strengthening activities 3 times weekly 1
• For weight loss: Increase to minimum 250 minutes/week of moderate intensity or 150 minutes/week of vigorous intensity activity 1
• Both aerobic and resistance exercise improve insulin sensitivity and metabolic outcomes 3

Behavioral Strategies

• Implement SMART (specific, measurable, achievable, realistic, timely) goal setting and self-monitoring 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 cognitive behavioral interventions to increase support, engagement, retention, and adherence 1
• Address psychological barriers to lifestyle changes including weight stigma which negatively impacts care quality and mental health 4

Multidisciplinary Approach

• Utilize a multidisciplinary team including dietitian, health psychologist, gynecologist, and endocrinologist for comprehensive care 5, 4
• Ensure health professional interactions are respectful, patient-centered, and culturally sensitive 1
• Consider referral to specialized allied health professionals when complex issues arise 1
• Provide PCOS-specific lifestyle advice rather than generic recommendations 4

Special Considerations

• Prioritize high cardiometabolic risk ethnic groups for more intensive lifestyle intervention 1
• Recognize that healthy lifestyle may contribute to health and quality of life benefits even in the absence of weight loss 1
• Address the common patient perception that lifestyle management is overly focused on weight loss and fertility rather than individual goals 4
• Ensure healthcare providers are adequately educated on PCOS-specific lifestyle management to improve quality of care 4

Monitoring and Follow-up

• Monitor weight, BMI, and waist circumference regularly as part of self-management 1
• Assess improvements in metabolic parameters (insulin resistance, lipid profile) 3, 6
• Evaluate changes in reproductive outcomes (menstrual regularity, ovulation) 6
• Monitor psychological wellbeing throughout the treatment process 1, 4