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

Management of Polycystic Ovary Syndrome (PCOS)

Lifestyle interventions including dietary modifications, regular physical activity, and behavioral strategies should be the first-line management approach for all women with PCOS, with particular emphasis on weight management for those with excess weight. 1

Lifestyle Management Framework

Weight Management

• A 5-10% weight loss goal should be set for women with PCOS who have excess weight, as this can significantly improve clinical outcomes 1, 2
• Weight management should be monitored regularly with appropriate BMI and waist circumference measurements, considering ethnic-specific categories when applicable 1, 2
• For weight loss, an energy deficit of 30% or 500-750 kcal/day (1,200-1,500 kcal/day) is recommended, tailored to individual energy requirements 1

Dietary Recommendations

• No specific diet type is superior for PCOS; balanced dietary approaches should be individualized based on preferences and cultural considerations 1
• General healthy eating principles should be followed across the life course 1
• Flexible and individual approaches to reducing energy intake are important, avoiding overly restrictive or nutritionally unbalanced diets 1

Physical Activity Guidelines

• 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 physical activity, including muscle and bone strengthening exercises 3 times weekly 1
• For greater health benefits and modest weight loss: 250 minutes/week of moderate intensity or 150 minutes/week of vigorous intensity activity 1
• Minimize sedentary time and incorporate activity into daily routines 1

Behavioral Strategies

• Implement SMART (specific, measurable, achievable, realistic, timely) goal setting and self-monitoring techniques 1
• Include behavioral strategies such as goal-setting, self-monitoring, stimulus control, problem-solving, assertiveness training, slower eating, reinforcing changes, and relapse prevention 1
• Consider comprehensive behavioral or cognitive behavioral interventions to increase engagement and adherence 1
• Fitness tracking devices can be used to support active lifestyles and minimize sedentary behaviors 1

Psychological Considerations

• Address psychological factors including anxiety, depression, body image concerns, and disordered eating to optimize engagement with lifestyle interventions 1, 2
• Ensure health professional interactions are respectful, patient-centered, and culturally sensitive 1
• Consider personal sensitivities and potential weight-related stigma in all communications 1

Special Populations

• Ethnic groups with PCOS who are at high cardiometabolic risk require greater consideration for lifestyle interventions 1, 2
• Use adolescent and ethnic-specific BMI and waist circumference categories when optimizing lifestyle and weight 1

Implementation Considerations

• Healthy lifestyle may contribute to health and quality of life benefits even in the absence of weight loss 1
• Self-monitoring, including with fitness tracking devices, can promote active lifestyles 1
• When assessing weight, be mindful of potential stigma, negative body image, and self-esteem issues 1
• Prevention of weight gain is particularly important from adolescence 1
• Where complex issues arise, referral to suitably trained allied health professionals should be considered 1

Common Pitfalls and Caveats

• Avoid focusing solely on weight loss as the measure of success; emphasize overall health improvements 1, 3
• Recognize that no specific diet type is superior for PCOS; avoid promoting fad or restrictive diets 1, 4
• Don't overlook psychological factors that may impede adherence to lifestyle changes 1, 2
• Ensure lifestyle advice is culturally appropriate and considers individual preferences 1
• Remember that benefits of lifestyle modification can occur independent of significant weight loss 3