Effects of lifestyle modification in polycystic ovary syndrome compared to metformin only or metformin addition: A systematic review and meta-analysis

Abstract

Polycystic ovary syndrome (PCOS) is a common disease that has an effect on approximately 10% of women of childbearing age. Although there is evidence regarding the role of lifestyle factors in the development of PCOS, the exact etiology remains unclear. Additionally, metformin is used in the treatment of PCOS but its role remains unclear. We compared the effects of lifestyle modification (LSM) + metformin and metformin alone on PCOS. We performed a systematic review by searching electronic databases for publications until December 2019. The primary endpoints were clinical outcomes, such as menstrual cycles and pregnancy rates, and the secondary endpoints were anthropometric, metabolic, and androgenic parameters. The meta-analysis revealed that there was no significant difference in the improvements in the menstrual cycles between LSM and metformin alone (weighted mean difference [MD] = 1.62) and between LSM + metformin and LSM (MD = 1.20). The pregnancy rates and body mass indices were not significantly different between LSM and metformin alone (MD = 1.44 and −0.11, respectively). LSM reduced insulin resistance (MD = −0.52) and increased serum levels of sex hormone-binding globulins (MD = 8.27) compared with metformin. Therefore, we suggest recommending lifestyle modifications actively to women with PCOS if they do not have indications for metformin.

Ficus deltoidea ameliorates biochemical, hormonal, and histomorphometric changes in letrozole-induced polycystic ovarian syndrome rats

“…It is important to note that F. deltoidea treatment at 500 and 1000 mg/kg/day for up to 15 days signi cantly reduced BMI and Lee's Index values in PCOS rats. A small weight loss of approximately 5% can improve insulin resistance, hormone levels, menstrual cycles, and infertility associated with PCOS [36,37]. Indeed, lower HOMA-IR values were found in the PFD500 and PFD1000 groups (Table 2),…”

Effects of metformin withdrawal after long and short term treatment in PCOS: observational longitudinal study

“…Other therapeutic alternatives for weight loss and restoration of menstrual cyclicity such as multicomponent lifestyle intervention including diet, exercise and behavioral strategies [ 25 ], myo-inositol [ 26 ] and GLP-1 based therapies [ 27 , 28 ] also need further exploration in overweight/obese patients with PCOS and high metabolic risk who are metformin non-adherent or metformin-intolerant.…”

Association Between the Food Security Status and Dietary Patterns With Polycystic Ovary Syndrome (PCOS) in Overweight and Obese Iranian Women: A Case-Control Study

“…smoking [2], physical activity [2,3,23], and diet [2,8,9,21,23]. However, inappropriate lifestyle particularly unhealthy dietary pattern results in IR and obesity [8,24] which are considered as most common etiological factors of this syndrome [3,25].…”