Lifestyle changes in women with polycystic ovary syndrome

  • Review
  • Intervention

Authors

  • Lisa J Moran,

    Corresponding author
    1. Monash University, The Jean Hailes Clinical Research Unit, School of Public Health and Preventive Medicine, Clayton, Victoria, Australia
    • Lisa J Moran, The Jean Hailes Clinical Research Unit, School of Public Health and Preventive Medicine, Monash University, Locked bag 29, Monash Medical Centre, Clayton Road, Clayton Road, Clayton, Victoria, 3168, Australia. lisa.moran@med.monash.edu.au. lisa.moran@yahoo.com.au.

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  • Samantha K Hutchison,

    1. Monash University, The Jean Hailes Clinical Research Unit, School of Public Health and Preventive Medicine, Clayton, Victoria, Australia
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  • Robert J Norman,

    1. University of Adelaide, Obstetrics & Gynaecology, Robinson Institute, Adelaide, South Australia, Australia
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  • Helena J Teede

    1. Monash University and Diabetes Unit Southern Health, The Jean Hailes Clinical Research Unit, School of Public Health and Preventive Medicine, Clayton, Victoria, Australia
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Abstract

Background

Polycystic ovary syndrome (PCOS) affects 4% to 18% of reproductive-aged women and is associated with reproductive, metabolic and psychological dysfunction. Obesity worsens the presentation of PCOS and weight management (weight loss, maintenance or prevention of excess weight gain) is proposed as an initial treatment strategy, best achieved through lifestyle changes incorporating diet, exercise and behavioural interventions.

Objectives

To assess the effectiveness of lifestyle treatment in improving reproductive, anthropometric (weight and body composition), metabolic and quality of life factors in PCOS.

Search strategy

Electronic databases (Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, CINAHL, AMED), controlled trials register, conference abstracts, relevant journals, reference lists of relevant papers and reviews and grey literature databases, with no language restrictions applied.

Selection criteria

Randomised controlled trials comparing lifestyle treatment (diet, exercise, behavioural or combined treatments) to minimal or no treatment in women with PCOS.

Data collection and analysis

Two authors independently selected trials, assessed methodological quality and risk of bias and extracted data.

Main results

Six studies were included. Three studies compared physical activity to minimal dietary and behavioural advice or no advice. Three studies compared combined dietary, exercise and behavioural interventions to minimal intervention. There were no studies assessing fertility primary outcomes and no data for meta-analysis on ovulation or menstrual regularity. For secondary outcomes, lifestyle intervention provided benefits when compared to minimal treatment for endpoint values for total testosterone (mean difference (MD) -0.27 nmol/L, 95% confidence interval (CI) -0.46 to -0.09, P = 0.004), hirsutism by the Ferriman-Gallwey score (MD -1.19, 95% CI -2.35 to -0.03, P = 0.04), weight (MD -3.47 kg, 95% CI -4.94 to -2.00, P < 0.00001), waist circumference (MD -1.95 cm, 95% CI -3.34 to -0.57, P = 0.006), waist to hip ratio (MD -0.04, 95% CI -0.07 to -0.00, P = 0.02), fasting insulin (MD -2.02 µU/mL, 95% CI -3.28 to -0.77, P = 0.002) and oral glucose tolerance test insulin (standardised mean difference -1.32, 95% CI -1.73 to -0.92, P < 0.00001) and per cent weight change (MD -7.00%, 95% CI -10.1 to -3.90, P < 0.00001). There was no evidence of effect of lifestyle for body mass index, free androgen index, sex hormone binding globulin, glucose or lipids; and no data for quality of life, patient satisfaction or acne.

Authors' conclusions

Lifestyle intervention improves body composition, hyperandrogenism (high male hormones and clinical effects) and insulin resistance in women with PCOS. There was no evidence of effect for lifestyle intervention on improving glucose tolerance or lipid profiles and no literature assessing clinical reproductive outcomes, quality of life and treatment satisfaction.

Plain language summary

The effect of a healthy lifestyle for women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a very common condition affecting 4% to 18% of women. Being overweight worsens all clinical features of PCOS. These clinical features include reproductive manifestations such as reduced frequency of ovulation and irregular menstrual cycles, reduced fertility, polycystic ovaries on ultrasound, and high male hormones such as testosterone which can cause excess facial or body hair growth and acne. PCOS is also associated with metabolic features and diabetes and cardiovascular disease risk factors including high levels of insulin or insulin resistance and abnormal cholesterol levels. PCOS affects quality of life and can worsen anxiety and depression either due to the features of PCOS or due to the diagnosis of a chronic disease. A healthy lifestyle consists of a healthy diet, regular exercise and achieving and maintaining a healthy weight. This review identified six studies with 164 participants that assessed the effects of a healthy lifestyle in women with PCOS. In this review, while some studies reported on fertility, menstrual regularity and ovulation, the findings were reported in a variety of ways and it was not possible to estimate the overall effects of lifestyle on these outcomes. Current evidence suggests that following a healthy lifestyle reduces body weight and abdominal fat, reduces testosterone and improves both hair growth, and improves insulin resistance. There was no evidence that a healthy lifestyle improved cholesterol or glucose levels in women with PCOS.

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