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

Treatment Options for Polycystic Ovary Syndrome (PCOS)

Multicomponent lifestyle intervention including diet, exercise, and behavioral strategies is the first-line management for PCOS, particularly for those with excess weight, to reduce weight, central obesity, and insulin resistance. 1

Lifestyle Management

Dietary Approaches

• No specific diet type has proven superior; focus should be on individual preferences while maintaining a healthy balanced diet 2
• For weight loss, aim for an energy deficit of 30% or 500-750 kcal/day (1,200-1,500 kcal/day) 2
• Avoid unduly restrictive or nutritionally unbalanced diets 2
• Achievable goals such as 5-10% weight loss in those with excess weight yield significant clinical improvements within 6 months 1

Physical Activity Recommendations

• At least 150 minutes/week of moderate intensity physical activity or 75 minutes/week of vigorous intensity activity for prevention of weight gain 2
• For modest weight loss, recommend at least 250 minutes/week of moderate intensity activities 2
• Include muscle-strengthening activities on 2 non-consecutive days/week 2
• Both aerobic and resistance exercises have shown benefits in PCOS 2
• Minimize sedentary, screen, or sitting time 2

Behavioral Strategies

• Implement SMART (specific, measurable, achievable, realistic, timely) goal setting and self-monitoring 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
• Address psychological factors such as anxiety, depression, body image concerns, and disordered eating 1

Pharmacological Management

For Ovulatory Dysfunction

• Clomiphene citrate is indicated for the treatment of ovulatory dysfunction in women with PCOS desiring pregnancy 3
• Treatment should be properly timed in relation to ovulation 3
• Long-term cyclic therapy is not recommended beyond a total of about six cycles 3
• Patients should be carefully evaluated before treatment to exclude pregnancy, ovarian cysts (except in PCOS), abnormal vaginal bleeding, and liver dysfunction 3

For Metabolic Abnormalities

• Metformin may help improve insulin sensitivity and metabolic parameters in women with PCOS 4
• Orlistat may assist with weight loss and improve lipid and glucose metabolism 4

Special Considerations

Monitoring and Follow-up

• Regular monitoring of weight and waist circumference is recommended 2
• Ongoing assessment during weight loss and maintenance is important 1

Ethnic-Specific Considerations

• Ethnic-specific BMI and waist circumference categories need to be considered when optimizing lifestyle and weight 1, 5
• Ethnic groups with PCOS who are at high cardiometabolic risk require greater consideration for lifestyle intervention 1, 5

Benefits Beyond Weight Loss

• Healthy lifestyle may contribute to health and quality of life benefits even in the absence of weight loss 1, 6
• Lifestyle modifications not only improve biochemical, hormonal, and anthropometric parameters but also reduce long-term risks of metabolic and cardiovascular diseases 6

Common Pitfalls and Caveats

• Many women with PCOS describe significant difficulty losing weight; treatment options should be started early to avoid unnecessary delays 7
• Obesity exacerbates PCOS phenotype including infertility and reduces efficacy of fertility treatments 7
• Health professional interactions should be respectful, patient-centered, and considerate of individual preferences and cultural differences 1, 2
• Untreated PCOS can lead to long-term consequences including adverse pregnancy outcomes, increased risk of endometrial cancer, and type 2 diabetes mellitus 4