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

Treatment Options for Polycystic Ovary Syndrome (PCOS) Symptoms

Lifestyle management is the first-line treatment for PCOS symptoms, with multicomponent interventions including diet, exercise, and behavioral strategies being central to improving morbidity, mortality, and quality of life in women with PCOS. 1

Lifestyle Interventions

Dietary Recommendations

• A variety of balanced dietary approaches can be used to reduce energy intake and induce weight loss in women with PCOS who have overweight or obesity 1, 2
• For weight loss, aim for an energy deficit of 30% or 500-750 kcal/day (1,200-1,500 kcal/day), considering individual energy requirements 1
• No specific diet type has proven superior; focus should be on individual preferences while maintaining nutritional balance 1, 3
• General healthy eating principles should be followed across the life course 1
• Even modest weight loss of 5-10% can yield significant clinical improvements in PCOS symptoms 2, 4

Physical Activity Recommendations

• Recommend at least 150 minutes/week of moderate intensity physical activity or 75 minutes/week of vigorous intensity activity (or equivalent combination) 1
• Include muscle-strengthening activities on 2 non-consecutive days/week 1
• For greater health benefits and modest weight loss, aim for at least 250 minutes/week of moderate intensity activities 1
• Both aerobic and resistance exercises have shown benefits in improving insulin sensitivity and hormonal balance in PCOS 1, 3
• Minimize sedentary, screen, or sitting time 1

Behavioral Strategies

• Implement behavioral techniques such as goal-setting, self-monitoring, stimulus control, problem-solving, assertiveness training, and relapse prevention 1
• Consider comprehensive behavioral or cognitive behavioral interventions to increase engagement and adherence to lifestyle changes 1
• Address psychological factors such as anxiety, depression, body image concerns, and disordered eating that may impact treatment adherence 1, 2

Medical Management Options

For Menstrual Irregularity and Hyperandrogenism

• Combined oral contraceptives can help regulate menstrual cycles and reduce hyperandrogenism symptoms like hirsutism and acne 5
• Clomiphene citrate is indicated for women with PCOS who desire pregnancy and have ovulatory dysfunction 6

For Metabolic Manifestations

• Metformin is recommended for metabolic manifestations such as hyperglycemia and insulin resistance 5
• Lifestyle interventions have been shown to improve insulin sensitivity, which is a key factor in PCOS pathophysiology 3, 7

Special Considerations

• Healthy lifestyle may contribute to health and quality of life benefits even in the absence of weight loss 1, 2
• Ethnic-specific BMI and waist circumference categories should be considered when optimizing lifestyle interventions 1
• Ethnic groups with PCOS who are at high cardiometabolic risk require greater consideration for lifestyle intervention 1
• Regular monitoring of weight and waist circumference is recommended to track progress 2

Common Pitfalls and Caveats

• Avoid unduly restrictive or nutritionally unbalanced diets that may lead to poor adherence and nutritional deficiencies 1
• Do not use clomiphene citrate in patients with ovarian enlargement (except those with PCOS), abnormal vaginal bleeding, or liver dysfunction 6
• Long-term cyclic therapy with clomiphene citrate is not recommended beyond a total of about six cycles 6
• Health professional interactions should be respectful and patient-centered to avoid weight-related stigma that could reduce treatment adherence 1
• Do not overlook the importance of addressing psychological aspects of PCOS, as they significantly impact quality of life and treatment success 1, 8