Management Options for Polycystic Ovary Syndrome (PCOS)
The first-line treatment for PCOS management is a multicomponent lifestyle intervention including diet, exercise, and behavioral strategies, particularly for patients with excess weight. 1, 2, 3
Lifestyle Interventions
Dietary Recommendations
- A balanced dietary approach with an energy deficit of 30% or 500-750 kcal/day (1,200-1,500 kcal/day) is recommended for weight loss, considering individual energy requirements, body weight, and physical activity levels 1, 3
- No specific diet type has proven superior for women with PCOS; focus should be on individual preferences and cultural needs while maintaining nutritional balance 1, 3, 4
- Low-glycemic index foods with high fiber intake are generally preferred for patients with hyperinsulinemia 4
- Avoid unduly restrictive or nutritionally unbalanced diets 3
Physical Activity Recommendations
- Adults should engage in a minimum of 150 minutes/week of moderate-intensity physical activity or 75 minutes/week of vigorous intensity (or equivalent combination) for prevention of weight gain and health maintenance 1, 3
- For weight loss and greater health benefits, increase to at least 250 minutes/week of moderate-intensity activities or 150 minutes/week of vigorous intensity 1, 3
- Include muscle-strengthening activities on 2 non-consecutive days/week 3
- Both aerobic and resistance exercises improve insulin sensitivity and metabolic outcomes in PCOS 1, 5
- Examples of moderate-intensity activities include brisk walking, cycling (8-15 km/h), low-impact aerobics, and yoga; vigorous-intensity activities include jogging/running, high-impact aerobics, and competitive sports 1
Behavioral Strategies
- Implement SMART (specific, measurable, achievable, realistic, timely) goal setting and self-monitoring to achieve realistic lifestyle goals 1, 3
- Include behavioral strategies such as goal-setting, self-monitoring, stimulus control, problem-solving, assertiveness training, slower eating, reinforcing changes, and relapse prevention 1, 3
- Address psychological factors such as anxiety, depression, body image concerns, and disordered eating 2, 3
Monitoring and Goals
- Aim for achievable goals of 5-10% weight loss in those with excess weight, which can yield significant clinical improvements 1, 2, 3
- Regular monitoring of weight and waist circumference is essential during weight loss and maintenance 1, 3
- For ethnic groups with high cardiometabolic risk, use ethnic-specific BMI and waist circumference categories 2, 3
Medical Management Options
Pharmacological Interventions
- Clomiphene citrate may be used for ovulation induction in women seeking pregnancy, but requires careful monitoring due to potential side effects 6
- Common side effects of clomiphene include visual disturbances, ovarian hyperstimulation syndrome (OHSS), and multiple pregnancy 6
- OHSS warning signs include abdominal pain and distention, nausea, vomiting, diarrhea, and weight gain 6
Special Considerations and Pitfalls
Important Caveats
- Healthy lifestyle may contribute to health and quality of life benefits even in the absence of weight loss 1, 3
- Weight gain over time is significantly greater in women with PCOS than in unaffected women, making early intervention crucial 1
- Central obesity increases over time in PCOS, with a progressive increase in waist-to-hip ratio between ages 20-45 years 1
- Health professional interactions should avoid weight-related stigma, which can negatively impact engagement with treatment 1, 3
- Prolonged use of clomiphene citrate may increase the risk of borderline or invasive ovarian tumors 6
- Women with PCOS who are unusually sensitive to gonadotropin may have an exaggerated response to usual doses of clomiphene citrate 6