Lifestyle management in polycystic ovary syndrome - beyond diet and physical activity

Abstract

Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with reproductive, metabolic and psychological consequences. Weight and lifestyle (diet, physical activity and behavioural) management are first-line therapy in international evidence-based guidelines for PCOS. While these recommend following population-level diet and physical activity guidelines, there is ongoing interest and research in the potential benefit of including psychological and sleep interventions, as well as a range of traditional, complimentary and integrative medicine (TCIM) approaches, for optimal management of PCOS. There is limited evidence to recommend a specific diet composition for PCOS with approaches including modifying protein, carbohydrate or fat quality or quantity generally having similar effects on the presentations of PCOS. With regards to physical activity, promising evidence supports the provision of vigorous aerobic exercise, which has been shown to improve body composition, cardiorespiratory fitness and insulin resistance. Psychological and sleep interventions are also important considerations, with women displaying poor emotional wellbeing and higher rates of clinical and subclinical sleep disturbance, potentially limiting their ability to make positive lifestyle change. While optimising sleep and emotional wellbeing may aid symptom management in PCOS, research exploring the efficacy of clinical interventions is lacking. Uptake of TCIM approaches, in particular supplement and herbal medicine use, by women with PCOS is growing. However, there is currently insufficient evidence to support integration into routine clinical practice. Research investigating inositol supplementation have produced the most promising findings, showing improved metabolic profiles and reduced hyperandrogenism. Findings for other supplements, herbal medicines, acupuncture and yoga is so far inconsistent, and to reduce heterogeneity more research in specific PCOS populations, (e.g. defined age and BMI ranges) and consistent approaches to intervention delivery, duration and comparators are needed. While there are a range of lifestyle components in addition to population-recommendations for diet and physical activity of potential benefit in PCOS, robust clinical trials are warranted to expand the relatively limited evidence-base regarding holistic lifestyle management. With consumer interest in holistic healthcare rising, healthcare providers will be required to broaden their knowledge pertaining to how these therapies can be safely and appropriately utilised as adjuncts to conventional medical management.

Keywords: Polycystic ovary syndrome; cognitive behavioural therapy; complementary medicine; diet; guideline; physical activity; quality of life; sleep.

Fig. 1

Viewing lifestyle modifications through a whole person or holistic care lens. The key features of whole person or holistic care listed in the centre of the figure have been adapted from Thomas et al. [20]. ‘Recognises individual personhood’ relates to focusing on the unique needs of the person rather than the disease. ‘Importance of therapeutic relationship’ emphasises patient autonomy and responsibility. ‘Acknowledges humanity of the doctor’ considers the doctors’ ability to self-reflect on how they engage in the care of the patient. ‘Health as more than absence of disease’ incorporates the mental, emotional, physical, environmental and social needs of the patient. ‘Employs a range of treatment modalities’ promotes continuity of care across health disciplines, and while it may include traditional, complementary and integrative medicine (TCIM), TCIM is not holistic if used in isolation and without adequate integration into conventional healthcare