Lifestyle Interventions for Polycystic Ovarian Syndrome Diagnosis

Polycystic ovarian syndrome (PCOS) is the most common problem among women of reproductive age. Symptoms that include menstrual cycle disruption, infertility, masculinization, obesity, and metabolic syndrome can seriously affect quality of life, though the condition’s presentation is unique in every patient. Additionally, the potential for lifestyle interventions to improve PCOS have been studied only rarely in the past.

In October 2013, the Endocrine Society released practice guidelines for the diagnosis and first-line treatment of PCOS. Their recommendations include:

• Hormonal contraceptives for menstrual abnormalities and hirsutism or acne
• Clomiphene for fertility problems
• Metformin, which can also improve menstrual irregularities, for metabolic/glycemic abnormalities

However, those recommendations did not include specific lifestyle interventions, so the authors indicated more investigation is needed. Regardless, most clinicians recommend lifestyle modifications as an initial intervention.

A team of Australian researchers conducted a systematic review evaluating the benefits of lifestyle interventions, including diet and exercise. Their meta-analysis published in the February 2014 issue of Endocrine Connections examined reproductive endocrine profiles in women with PCOS. They included 7 studies that combined exercise and dietary interventions and used sensitivity analyses consisting of exercise-alone intervention groups. Across all studies, comparator groups for the main and sensitivity analyses received usual care.

The authors found women who received lifestyle intervention demonstrated significant improvements in follicle-stimulating hormone (FSH) levels, sex hormone-binding globulin (SHBG), total testosterone (T) levels, free androgen index (FAI) levels, and Ferriman—Gallwey score (FG), a method of evaluating and quantifying hirsutism.

Like most lifestyle meta-analyses, the researchers included various studies that employed different dietary interventions and types and durations of exercise. Although the study’s sample may have been underpowered, it suggested women who receive exercise-alone intervention demonstrate significant improvements in all parameters except FAI compared to usual care.

Improving lifestyle choices may prevent future metabolic, endocrine, psychiatric, and cardiovascular complications, the researchers concluded.