Losing weight may help improve menstrual frequency and other symptoms.

• Polycystic ovary syndrome (PCOS) affects approximately one in 10 women.
• Researchers recently found that weight-loss measures can help people with PCOS lose weight and improve blood sugar regulation and hormonal markers.
• This work may be the first to find an association between weight loss interventions and a clinically significant increase in menstrual frequency.
• The study authors suggest that physicians may look at these results to advise PCOS patients on weight loss strategies.

Polycystic ovary syndrome (PCOS)also known as Stein-Leventhal syndrome, affects women of reproductive age. It is the most common endocrine disease and cause of infertility among women.

PCOS has no known cause or cure. Some people with PCOS experience few or no symptoms.

This condition often contributes to irregular or missed ovulation and menstruation. It can also lead to abnormally high androgen levels, which can cause hirsutism.

Overweight or obesity affects more than half of women with PCOS. At least 65% to 80% of people with PCOS also live with insulin resistance.

Additionally, people with PCOS who are overweight tend to have worse medical outcomes than women with PCOS and a healthier weight.

However, company experts Oxford University in the UK found limited data to quantify the impact of weight loss on PCOS symptoms. This deficiency makes it difficult for practitioners to recommend specific weight loss strategies for the treatment of PCOS.

In search of more convincing evidence, scientists examined more than 3,000 scientific studies. They also interviewed dozens of women with PCOS.

Their systematic review found that weight loss interventions contributed to “improvement of some important clinical features of PCOS.”

According to UK clinical guidelines, losing 5% weight can reduce testosterone levels and markers of insulin resistance. Health experts recommend giving overweight women with PCOS advice on lifestyle changes, usually including weight loss through a low-carb diet and exercise.

However, patient and public participation (PPI) consultants in this study shared that, in their experience, support for weight management was insufficient. Evidence also suggests that encouraging weight loss without additional support is in most cases ineffective.

Medical news today discussed this research with a PCOS expert Dr. Ali Chappell, PhD, MS, RDfounder and CEO of Lilli Health, who was not involved in the review.

“When interventions focus on the underlying cause of weight gain—insulin resistance—PCOS symptoms are more likely to improve. Addressing insulin resistance directly is essential to achieving significant improvements in PCOS symptoms, including weight loss,” she explained.

MNT also discussed this study with Alyssa Pacheco, RDPCOS nutritionist Alice, who was also not involved in the study.

“PCOS is characterized by hormonal and metabolic imbalances, insulin resistance, chronic inflammation, estrogen imbalance, high cortisol levels and gut dysbiosis, all of which can make weight loss difficult,” she said.

Pacheco agreed that losing weight can help improve many of the symptoms of PCOS.

“When someone loses weight, they can usually expect improvements in their blood sugar levels, insulin levels, cholesterol levels and testosterone levels. It also usually means they experience fewer food cravings and fatigue, and have more regular periods.
— Alyssa Pacheco, RD

Pacheco also shared that people with PCOS are at a disproportionately higher risk of eating disorders. This, she says, requires greater caution when discussing weight loss measures.

Previous studies suggest that low-carbohydrate interventions or pharmacotherapy may promote weight loss and greater improvements in insulin resistance, glucose, and hemoglobin levels than metformin or no intervention.

However, the Oxford University team noted that no review compared the “full range of weight loss interventions” for the treatment of PCOS.

Moreover, previous studies often lacked data to analyze clinically relevant symptoms and markers for PCOS treatment, including menstrual frequency, hirsutism, and free androgen index (FAI).

The study authors searched major medical databases for randomized controlled trials (RCTs) from inception to June 2024. They focused on RCTs of weight loss interventions in adults diagnosed with PCOS.

• “routine care” metforminoral contraceptives and standard recommendations,
• “minimal intervention” such as weight loss advice without additional support, or
• placebo.

They also analyzed studies that compared low- and high-intensity weight loss methods.

Key findings of the review included symptoms and biological markers of PCOS. They were selected after consultation with doctors experienced in treating PCOS and 36 patients with PCOS.

Included RCTs contained data that allowed calculation of weight change as well as at least one PCOS symptom or biomarker such as fasting insulin, fasting glucose, testosterone, FAI, menstrual frequency, acne, and hirsutism.

The study researchers began with 3,760 studies, narrowing the list to 39. More than 1,500 people contributed data to the primary analysis, and more than 2,300 contributed data to the secondary analysis.

The Oxford University team said: “Our systematic review shows that for women with PCOS, weight loss interventions resulted in improvements in some important clinical features of PCOS.”

They noted a decrease in fasting insulin levels, FAI and HOMA-IRa marker of insulin resistance, as well as an increase in the frequency of menstruation.

“To our knowledge, this is the first review to show a clinically meaningful association of improved menstrual frequency with weight loss interventions, which is an important predictor of subsequent fertility and an important outcome for women,” the team also said.

However, the evidence was unable to establish an association between weight loss interventions and significant changes in fasting glucose, testosterone, hirsutism, and other markers.

MNT asked the experts surveyed which weight loss measures seemed most effective.

Chappell shared that in her experience, insulin-lowering methods are the most effective: “Since insulin resistance underlies all symptoms of PCOS, focusing on lifestyle changes that lower insulin levels helps reverse insulin resistance and results in loss of weight and improvement of other clinical symptoms. . I call it the low insulin lifestyle.”

“The most effective weight loss interventions are those that address the underlying reason why weight loss is difficult to begin with. I recommend eating a balanced diet that includes high-fiber foods, protein and healthy fats—this combination keeps your blood sugar levels more stable and reduces food cravings throughout the day,” Pacheco said. MNT.

“Other lifestyle factors, such as exercise, sleep and stress, may play a large role in insulin resistance and weight loss,” she added.

The study authors acknowledge some limitations of their review.

Chief among these, they noted, is “high statistical heterogeneity in interventions, comparators, and outcomes…”. They hope that a more detailed meta-analysis will allow weight loss methods to be compared.

In addition, most of the studies analyzed lasted less than six months. Thus, the long-term effects of the interventions are unknown.

This review does not reflect recent changes in weight management, such as complete diet changes.

Chappell said the study’s findings highlight the importance of addressing insulin resistance to improve PCOS symptoms.

She also noted that while calorie restriction and other weight-loss measures resulted in moderate weight loss, “they often failed to improve sex hormone levels and associated PCOS symptoms such as hirsutism.”

“Insulin is a major factor in androgen secretion and associated PCOS symptoms that are not affected by calorie restriction alone,” she said.

Overall, the University of Oxford researchers believe their work offers useful guidance for people living with PCOS who are overweight and their healthcare providers: “Weight loss interventions have been associated with improvements in some important features of PCOS and should be considered as a routine treatment option PCOS. people with PCOS.”