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Lifestyle interventions may improve BMI, weight and free androgen index in women with PCOS

By Rebecca Jenkins
Adopting a healthy lifestyle may lead to weight loss and reduced male hormone levels in some women with polycystic ovary syndrome (PCOS), a literature review finds.

A Cochrane review of reproductive, anthropometric, metabolic and quality of life outcomes in women with PCOS who made lifestyle changes identified 15 relevant randomised controlled trials with almost 500 participants. However, most were low-quality studies with inconsistent findings and poor reporting of study methods.

Researchers were able to conclude that lifestyle interventions may improve the free androgen index, weight and body mass index in women with PCOS.

There was a mean difference in weight of 1.68 kg for those randomised to a lifestyle intervention compared with minimal treat­ment, the Australian review authors reported.

However, there were no studies looking at live birth, miscarriage or menstrual reg­ularity, and the review gave no clear answers about the effects of healthy lifestyle on glucose tolerance.

‘It is not possible to state from existing research whether the lack of an intervention effect on glucose outcomes is due to the degree of weight loss achieved, to clinical heterogeneity or to the small sample size and moderate study durations available for review,’ they wrote.

Coauthor Professor Robert Norman from the University of Adelaide’s NHMRC Centre for Research Excellence in Polycystic Ovary Syndrome, said it was disappointing there was not more evidence on the effect of lifestyle.

‘I think many patients who have been studied were seeking fertility and were put on fertility treatment as a first option rather than waiting for weight loss to work,’ he told Endocrinology Today.

In practice, doctors often struggle to sell lifestyle changes while patients could see such advice as a delay in treatment.

‘Many will say “I have been told to lose weight all my life. I came for a baby, not to get another weight loss message,” he said.

Yet the lesson from diabetes therapy advice was clear – lifestyle change was essen­tial for optimal results.

‘I think our top priority is to motivate doctors and patients to take this approach seriously and provide the resources they need to achieve their goals,’ he said.

‘We need funded programs and trained staff (dietitians, exercise physiologists, psy­chologists, etc) to achieve this. We will have much better health outcomes this way.’
Cochrane Database Syst Rev 2019; (3): CD007506.