Weight loss interventions may improve metabolic and reproductive outcomes in polycystic ovarian syndrome

1. In this systematic review and meta-analysis, weight loss interventions for overweight people with polycystic ovary syndrome were associated with greater reductions in insulin resistance and free androgen index as well as greater increases in menstruation frequency.

2. Weight loss interventions were also linked to greater reductions in fasting insulin with no effect on fasting glucose.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Over half of women with polycystic ovary syndrome (PCOS) are overweight or obese, which has been linked to worse metabolic, hormonal, and reproductive outcomes. Clinical guidelines recommend that these women be encouraged to lose weight, but women often find that advice alone can be unhelpful; furthermore, the effects of weight loss on the full range of symptoms and markers has yet to be well described. This study aimed to assess how weight loss intervention programs affect metabolic, hormonal, and gynecological markers as well as quality of life among women with PCOS. Primary analyses showed that, compared to usual care alone, weight loss intervention resulted in a nearly 4 kilogram reduction in weight and larger reductions in insulin resistance and free androgen index (FAI). Frequency of menstruation was also found to increase to a greater degree among those who received weight loss intervention. Weight loss interventions were linked to larger reductions in fasting insulin, testosterone, and sex hormone-binding globulin (SHBG), but there were no clinically significant changes in fasting glucose, follicular stimulating hormone (FSH), luteinizing hormone (LH), hirsutism, and PCOS quality of life. Notably, adverse events were more common among participants receiving weight loss intervention, primarily due to gastrointestinal effects of pharmacotherapy. The generalizability of this study was limited by high statistical heterogeneity; lack of precision and inconsistent confidence intervals in several analyses; and a high risk of bias in some of the studies used. Nevertheless, this study demonstrated how weight loss interventions may attenuate the effects of PCOS among women who are overweight.

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Relevant Reading: Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis

In-Depth [systematic review and meta-analysis]: This study examined 39 randomized controlled trials to assess the impact of weight loss intervention programs on various metabolic, hormonal, and gynecological outcomes among people with PCOS and overweight or obesity. Weight loss interventions included dietary modification, physical activity, pharmacotherapy, bariatric surgery, or combinations of these treatments; control measures entailed standard of care, including metformin, oral contraceptives, and standard advice. Primary outcomes were biomarkers and symptoms of PCOS, including Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), fasting insulin, fasting glucose, total testosterone, FAI, SHBG, LH, FSH, menstruation frequency, hirsutism, and quality of life measures. Primary analyses compared more intense weight loss interventions with less intense weight loss interventions, while secondary analyses compared weight loss interventions with any intervention that was of lower intensity. Weight loss interventions resulted in a weight change of -3.78 kg (95% CI, -4.61 to -2.94) in the primary analysis and -3.43 kg in the secondary analysis (95% CI, -4.08 to -2.77). The mean difference (MD) in change in HOMA-IR associated with weight loss interventions was -0.45 (95% CI, -0.75 to -0.15) in the primary analysis and -0.56 (95% CI, -0.9 to -0.23) in the secondary analysis. The MD in change in FAI associated with weight loss interventions was -2.03 (95% CI, -3.0 to -1.07) in the primary analysis and -1.37 (95% CI, -2.43 to -0.31) in the secondary analysis. The MD in change in menstruation frequency associated with weight loss interventions was 2.64 (95% CI, 0.65 to 4.63) menses per year in the primary analysis and 1.88 (95% CI, 0.84 to 2.93) menses per year in the secondary analysis. Weight loss interventions were also associated with larger decreases in fasting insulin (-1.28 [95% CI, -2.24 to -0.31]), total testosterone (-0.16 [95% CI, -0.26 to -0.05]), and SHBG (7.46 [95% CI, 2.26 to 12.67]). Overall, despite the heterogeneity of interventions and comparisons, this study clarified the impact of weight loss interventions on PCOS symptoms and biomarkers.

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