Will Lifestyle Changes Improve Polycystic Ovary Syndrome?
Thursday, September 22, 2011
Polycystic ovary syndrome (PCOS) affects 4% to 18% of reproductive-aged women and is associated with significant reproductive, metabolic and psychological problems.
Obesity, not always, but often, an accompanying problem, worsens the presentation of PCOS. Current treatment guidelines for PCO, therefore, strongly recommend ‘weight management’ (both weight loss and the prevention of excess weight gain) through diet and exercise as an initial treatment strategy.
But how effective are these ‘lifestyle’ strategies and how consistent are the improvements?
This was the topic of a recent review by Lisa Moran and colleagues from Australia, published in the Cochrane Database of Systematic Reviews.
The authors identified six randomised controlled trial (including a total of 165 participants). Three studies compared physical activity to minimal dietary and behavioural advice or no advice; three compared combined dietary, exercise and behavioural interventions to minimal intervention.
Although these interventions resulted in modest weigh loss (~3.5 kg) and significantly reduced testosterone levels and associated male-pattern hair growth (hrisutism) as well as fasting insulin levels, there was no relevant effect on glucose or lipid levels or other cardiovascular risk factors.
Notably, none of these studies examined the impact of these interventions on quality of life, patient satisfaction or reproductive health (a common problem in PCOS). There was also no assessment of depression or anxiety, which have been reported to be commonly associated with PCOS.
Perhaps, as the authors point out, the most important result of this analysis is the apparent paucity of large studies that have addressed this issue – surprising enough, given that as many as 1 in 5 women of reproductive age may present with this problem and PCOS is a major cause of female infertility.
As the authors note:
“This review has identified that there are limited well-designed studies in lifestyle intervention in PCOS that are available to guide clinical practice.”
Given the impact of PCOS on reproductive health, it is most surprising that
“There are no existing RCT data identified in this review to assess whether lifestyle intervention improves reproductive outcomes including fertility, menstrual regularity or ovulation”
The overall conclusion is thus rather sobering:
“With the current evidence, it is not possible to comment on the relative effectiveness or sustainability of different durations or types of lifestyle interventions, or their relative success, in a weight loss or non-weight loss environment or with overweight or non-overweight participants……this indicates a considerable gap in the research literature.”
On other hand, this paucity of data should not be interpreted to show that interventions aimed at weight management do not impact on fertility or reproductive health in overweight and obese women with PCOS. Indeed, there is now accumulating anecdotal evidence that more significant weight loss (as can be achieved with bariatric surgery) may prove most beneficial in women with PCOS both in terms of reducing symptoms as well as in improving chances of conception.
Still, one wonders why a topic of such importance has not received more attention from researchers or funding agencies.
AMS
New York, NY
Moran LJ, Hutchison SK, Norman RJ, & Teede HJ (2011). Lifestyle changes in women with polycystic ovary syndrome. Cochrane database of systematic reviews (Online) (2) PMID: 21328294
Thursday, September 22, 2011
N of one here — but from the get-go, my periods were irregular and I had PCOS symptoms when I was a relatively normal-weight young teen. I think the PCOS came before weight gain, so while weight loss might improve some of the symptoms, the early onset of type 2 diabetes (age 25), and ease with which I gained weight in my early 20s make me think that the PCOS was partly underlying the whole deal. Metformin really seemed to help address everything that was going on for me — which makes me think again that weight and PCOS symptoms were secondary complications, and that there was some primary “thing” that the Metformin treated (and continues to treat).
I am looking for information on what happens to women with PCOS once they enter menopause. Does anyone have any good references?
Thursday, September 22, 2011
Dr. Sharma, did you read yesterday’s Globe and Mail article about fertility specialists considering denying obese women fertility treatment? I found this article shocking on many levels, but was particularly upset by the fact that PCOS, which is associated with both infertility and weight gain, was not mentioned at all, nor was the fact that the vast majority of weight loss efforts end in regaining and in fact adding extra poundage.
This article, in my opinion, was a case of extremely shoddy journalism. The journalist would have benefitted greatly from you input.
Oh, and the comments were, for the mostpart, beyond ignorant and vicious.
We have a long way to go in understanding the whole issue of weight.
Thursday, September 22, 2011
Maybe it’s glib of me to say so, but it’s not so surprising that there’s a paucity of data.
After all, it’s not just that PCOS only afflicts women, but it’s only fat, hairy women to boot.
-FW (with PCOS)
Thursday, September 22, 2011
My PCOS symptoms were very bad when I was a thin young woman. Obesity didn’t happen until after years of unsuccessful fertility treatments ( 20 years ago before the metabolic factors of PCOS were well known). Ten years later I was obese but within 30 days of starting a low carb diet and metformin (before any appreciable weight loss) I had my first (EVER!) ovulatory period and got pregnant six months later. A low carb diet reduces insulin levels and helps PCOS a great deal. Low cal/low fat diet only increase carbohydrate consumption, which serve to increase insulin levels and therefore PCOS can worsen. Low carb is where PCOS studies should focus!
Friday, September 23, 2011
I have a good friend with PCOS. She has trained and climbed the CN Tower stairs twice. She’s still fat, and she still has PCOS. And, she’s sweet, highly ethical and brilliant (first in her graduating class at university!) and would make a wonderful mother, but probably won’t be able to have kids without fertility treatments.
Saturday, September 24, 2011
An exceptionally important area in need of further study, given that women with PCOS have the same underlying pathophysiology as type 2 diabetes – that being insulin resistance. Although the risk of cardiovascular disease in PCOS women is not well established, vascular risk reduction strategies (and knowing what modalities are effective) are certainly important. Thanks for discussing this review, Arya!