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Meta-Analysis
. 2019 Mar 28;3(3):CD007506.
doi: 10.1002/14651858.CD007506.pub4.

Lifestyle changes in women with polycystic ovary syndrome

Siew S Lim  1 , Samantha K Hutchison, Emer Van Ryswyk, Robert J Norman, Helena J Teede, Lisa J Moran
Affiliations
Meta-Analysis

Lifestyle changes in women with polycystic ovary syndrome

Siew S Lim et al. Cochrane Database Syst Rev. .

Abstract

Background: Polycystic ovary syndrome (PCOS) affects 8% to 13% of reproductive-aged women and is associated with reproductive and metabolic 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 methods: We searched the Cochrane Gynaecology and Fertility Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, CINAHL and AMED (date of last search March 2018). We also searched controlled trials registries, 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 (RCTs) 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 evidence quality and risk of bias, and extracted data. Our primary outcomes were live birth, miscarriage and pregnancy. We used inverse variance and fixed-effect models in the meta-analyses. We reported dichotomous outcomes as an odds ratio and continuous outcomes as a mean difference (MD) or standardised mean difference (SMD).

Main results: We included 15 studies with 498 participants. Ten studies compared physical activity to minimal dietary and behavioural intervention or no intervention. Five studies compared combined dietary, exercise and behavioural intervention to minimal intervention. One study compared behavioural intervention to minimal intervention. Risk of bias varied: eight studies had adequate sequence generation, seven had adequate clinician or outcome assessor blinding, seven had adequate allocation concealment, six had complete outcome data and six were free of selective reporting. No studies assessed the fertility primary outcomes of live birth or miscarriage. No studies reported the secondary reproductive outcome of menstrual regularity, as defined in this review.Lifestyle intervention may improve a secondary (endocrine) reproductive outcome, the free androgen index (FAI) (MD -1.11, 95% confidence interval (CI) -1.96 to -0.26, 6 RCTs, N = 204, I2 = 71%, low-quality evidence). Lifestyle intervention may reduce weight (kg) (MD -1.68 kg, 95% CI -2.66 to -0.70, 9 RCTs, N = 353, I2 = 47%, low-quality evidence). Lifestyle intervention may reduce body mass index (BMI) (kg/m2) (-0.34 kg/m2, 95% CI -0.68 to -0.01, 12 RCTs, N = 434, I2= 0%, low-quality evidence). We are uncertain of the effect of lifestyle intervention on glucose tolerance (glucose outcomes in oral glucose tolerance test) (mmol/L/minute) (SMD -0.02, 95% CI -0.38 to 0.33, 3 RCTs, N = 121, I2 = 0%, low-quality evidence).

Authors' conclusions: Lifestyle intervention may improve the free androgen index (FAI), weight and BMI in women with PCOS. We are uncertain of the effect of lifestyle intervention on glucose tolerance. There were no studies that looked at the effect of lifestyle intervention on live birth, miscarriage or menstrual regularity. Most studies in this review were of low quality mainly due to high or unclear risk of bias across most domains and high heterogeneity for the FAI outcome.

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Conflict of interest statement

SL received a National Health and Medical Research Council (NHMRC) fellowship in support of this work. SL has received reimbursement from the Endocrine Society of Australia to present at an endocrinology conference.

EVR has nothing to disclose.

SKH received Sabbatical Support from Monash Health in support of this work. SKH currently works as a clinician in an Australian public hospital PCOS clinic. SKH has received travel grants to attend PCOS conferences from the Endocrine Society of Australia, NHMRC, the Australian Diabetes Society and the PCOS International Guideline Development Group from the PCOS Centre for Research Excellence.

HJT receive partial or complete salary funding from NHMRC.

LJM received salary funding from the Heart Foundation of Australia. LJM has received reimbursement from the Heart Foundation of Australia to attend endocrinology and PCOS conferences.

RJN has received grants and honoraria from Schering Plough, Merck Serono and Ferring Pharmaceuticals.

LJM and RJN are previous investigators of studies examining weight loss through dietary intervention on reproductive and metabolic outcomes in polycystic ovary syndrome.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each methodological quality item for each included study.
3
3
Study flow diagram.
4
4
Forest plot of comparison: 1 Lifestyle intervention versus minimal treatment: Combined data, outcome: 1.2 Secondary reproductive outcomes. For SHBG, total testosterone and clinical hyperandrogenism (Ferriman‐Gallwey score), mean change instead of post‐intervention data were used for Mani 2018 and Stener‐Victorin 2009‐2013. For FAI, mean and SD values for Stener‐Victorin 2009‐2013 were calculated from group means and SD for T and SHBG.
5
5
Forest plot of comparison: 1 Lifestyle intervention versus minimal treatment: Combined data, outcome: 1.3 Anthropometric outcomes.
 For weight, BMI and waist circumference, mean change instead of post‐intervention data were used for Mani 2018 and Stener‐Victorin 2009‐2013.
6
6
Forest plot of comparison: 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, outcome: 1.4 Metabolic: oral glucose tolerance test (OGTT) glucose (mmol/L/minute).
1.2
1.2. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 2 Secondary reproductive: endocrine.
1.3
1.3. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 3 Anthropometric.
1.4
1.4. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 4 Metabolic: oral glucose tolerance test (OGTT) glucose (mmol/L/minute).
1.5
1.5. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 5 Metabolic: fasting glucose (mmol/L).
1.6
1.6. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 6 Metabolic: fasting lipids (mmol/L).
1.7
1.7. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 7 Metabolic: fasting insulin (µU/mL).
1.8
1.8. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 8 Metabolic: oral glucose tolerance test (OGTT) insulin (µU/mL/minute).
1.9
1.9. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 9 Quality of life.
1.10
1.10. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 10 Subgroup analyses for SHBG.
1.11
1.11. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 11 Subgroup analyses for FAI.
1.12
1.12. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 12 Subgroup analyses for HDL‐C.
1.13
1.13. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 13 Subgroup analyses for OGTT insulin.
1.14
1.14. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 14 Subgroup analyses for PCOSQ Weight.
1.15
1.15. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 15 Sensitivity analyses for BMI.
1.16
1.16. Analysis
Comparison 1 Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses, Outcome 16 Sensitivity analyses for FAI.
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References to studies awaiting assessment

Gaeini 2012 {published data only}
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References to other published versions of this review

Moran 2011
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