Weight loss interventions for PCOS associated with improved menstrual frequency, review finds
Interventions for weight loss were also linked with significant improvements in glycemic control and hormonal markers among patients with polycystic ovary syndrome (PCOS), according to a systematic review of randomized controlled trials.
Weight loss interventions are associated with improvements in some features of polycystic ovary syndrome (PCOS), such as menstrual frequency, and should be considered as a routine treatment option for people with PCOS, a systematic review concluded.
To quantify the effect of weight loss interventions on clinical features of PCOS, researchers searched for randomized controlled trials comparing the interventions with usual care, which typically consisted of metformin, oral contraceptives, or standard advice. Outcomes included glycemic control measured via the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) and fasting insulin and glucose levels, along with hormonal markers including the free androgen index (FAI) and other sex hormones. Additional outcomes included menstrual frequency, hirsutism, and PCOS-related quality of life. Findings were published by Annals of Internal Medicine on Nov. 5.
A total of 29 comparisons from 26 studies with 1,529 participants were included; 13, 12, and four comparisons were judged as having high, some, or low risk of bias, respectively. Twelve trials tested behavioral interventions, nine used glucagon-like peptide-1 (GLP-1) receptor agonists, and eight used other weight loss medications.
Interventions were associated with significantly greater improvements in HOMA-IR (mean difference, −0.45; 95% CI, −0.75 to −0.15), FAI (mean difference, −2.03; 95% CI, −3.0 to −1.07), and menstrual frequency (mean difference, 2.64 menses per year; 95% CI, 0.65 to 4.63). Average difference in weight change was −3.78 kg (95% CI, −4.61 to −2.94 kg) greater with the interventions. Researchers found no evidence that the interventions were associated with clinically or statistically significant improvements in hirsutism, quality of life, or other sex hormones. They cautioned this may be due to the limited power of available data.
The main limitation to the study is that there was high statistical heterogeneity in interventions, comparators, and outcomes that was largely unexplained by sensitivity and subgroup analyses.
The review is the first to the authors' knowledge to show a clinically significant improvement in menstrual frequency with weight loss interventions, they said.
“Clinicians may use these findings to counsel women with PCOS on the expected improvements in PCOS markers after weight loss and direct patients toward interventions, though our findings may not extend to all weight loss interventions especially if they target specific metabolic pathways,” the researchers concluded.