From the Guidelines
Lifestyle modification, including a balanced diet and regular exercise, is the first-line treatment for Polycystic Ovary Syndrome (PCOS) management, as it improves insulin sensitivity, reduces symptoms, and has been shown to be effective in multicomponent lifestyle interventions 1.
Key Recommendations
- Weight loss through a balanced diet and regular exercise is crucial for improving insulin sensitivity and reducing symptoms of PCOS 1.
- A multicomponent lifestyle intervention, including diet, exercise, and behavioral strategies, is central to PCOS management, with a focus on weight and healthy lifestyle behaviors 1.
- No specific diet is recommended, but a balanced diet and healthy eating habits are essential for managing PCOS symptoms 1.
- Exercise is an effective component of lifestyle intervention, and its benefits include weight gain prevention and improved insulin sensitivity 1.
Medications and Treatment
Medications commonly prescribed for PCOS management include:
- Combined hormonal contraceptives (like birth control pills) to regulate periods and reduce excess hair growth.
- Metformin (500-2000 mg daily) to improve insulin sensitivity.
- Anti-androgens like spironolactone (25-200 mg daily) for addressing hirsutism and acne.
- Ovulation induction medications such as clomiphene citrate or letrozole for women trying to conceive.
Ongoing Management
PCOS requires ongoing management as it increases risks for type 2 diabetes, cardiovascular disease, and endometrial cancer. Regular monitoring with a healthcare provider is essential for adjusting treatment strategies and screening for potential complications. The condition stems from insulin resistance and genetic factors that lead to hormonal imbalances, particularly elevated testosterone levels.
Evidence Quality
The evidence-based recommendations for PCOS management are based on high-quality studies, including the international evidence-based guideline for the assessment and management of PCOS, which followed the Appraisal of Guidelines for Research and Evaluation II and The Grading of Recommendations, Assessment, Development and Evaluation framework 1.
From the Research
Definition and Prevalence of PCOS
- Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine disorders among reproductive-aged women, characterized by hyperandrogenism, anovulation, and polycystic ovaries 2.
- PCOS affects the life quality of women by disturbing their physiology and psychology in reproductive age, and may also be associated with other morbidities like diabetes and hypertension 3.
Lifestyle Interventions for PCOS Management
- Lifestyle changes, including dietary modifications and physical activity, are suggested as first-line interventions in managing PCOS 2, 3.
- Dietary interventions, such as foods with low glycemic index scores, caloric restrictions, and high-fiber diets, can improve insulin sensitivity and hormonal balance in women with PCOS 2.
- Physical activity, like aerobic and resistance exercise, enhances insulin sensitivity, helps weight loss, and improves metabolic and reproductive outcomes in women with PCOS 2.
- A balanced diet with 40% energy from carbohydrates, 30% from fats, and 30% from protein, along with optimum physical activity, can reduce severe PCOS symptoms and improve metabolic balance 3.
Treatment Options for PCOS
- Hormonal contraceptives, such as ethinyl estradiol and drospirenone, can be used to treat menstrual irregularity and hirsutism in patients with PCOS 4, 5.
- Metformin can be used to regularize menstrual cycles, decrease body mass index, and treat hyperandrogenism in women with PCOS, especially in populations with a high prevalence of insulin resistance 4.
- The effectiveness and acceptability of different lifestyle interventions for women with PCOS can be evaluated through systematic reviews and network meta-analyses 6.