Lifestyle Modification Programs in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis

Domecq, Juan Pablo; Prutsky, Gabriela; Mullan, Rebecca J.; Hazem, Ahmad; Sundaresh, Vishnu; Elamin, Mohammed B.; Phung, Olivia J; Wang, Amy; Hoeger, Kathleen M.; Pasquali, Renato; Erwin, Patricia J.; Bodde, Amy E.; Montori, Víctor M.; Murad, M. Hassan

doi:10.1210/jc.2013-2385

Cited by 152 publications

(109 citation statements)

References 45 publications

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“…The ovulatory disorder is frequently exacerbated by hyperinsulinemia, which is present in well over 50% of women with PCOS (225), and is further accentuated by central obesity, and hence lifestyle modification programs should be the first intervention strategy (88). The elevated endogenous serum insulin promotes ovarian androgen secretion, via IGF-I receptor activation of theca cell androgen secretion (317) and perturbs folliculogenesis (292).…”

Section: Polycystic Ovary Syndromementioning

confidence: 99%

Physiological Aspects of Female Fertility: Role of the Environment, Modern Lifestyle, and Genetics

Hart

2016

Physiological Reviews

160

119

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Across the Western World there is an increasing trend to postpone childbearing. Consequently, the negative influence of age on oocyte quality may lead to a difficulty in conceiving for many couples. Furthermore, lifestyle factors may exacerbate a couple's difficulty in conceiving due mainly to the metabolic influence of obesity; however, the negative impacts of low peripheral body fat, excessive exercise, the increasing prevalence of sexually transmitted diseases, and smoking all have significant negative effects on fertility. Other factors that impede conception are the perceived increasing prevalence of the polycystic ovary syndrome, which is further exacerbated by obesity, and the presence of uterine fibroids and endometriosis (a progressive pelvic inflammatory disorder) which are more prevalent in older women. A tendency for an earlier sexual debut and to have more sexual partners has led to an increase in sexually transmitted diseases. In addition, there are several genetic influences that may limit the number of oocytes within the ovary; consequently, by postponing attempts at childbearing, a limitation of oocyte number may become evident, whereas in previous generations with earlier conception this potentially reduced reproductive life span did not manifest in infertility. Environmental influences on reproduction are under increasing scrutiny. Although firm evidence is lacking however, dioxin exposure may be linked to endometriosis, phthalate exposure may influence ovarian reserve, and bisphenol A may interfere with oocyte development and maturation. However, chemotherapy or radiotherapy is recognized to lead to ovarian damage and predispose the woman to ovarian failure.

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Section: Polycystic Ovary Syndromementioning

confidence: 99%

Physiological Aspects of Female Fertility: Role of the Environment, Modern Lifestyle, and Genetics

Hart

2016

Physiological Reviews

160

119

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“…38,48,49 Results from five meta-analyses of RCTs with women with PCOS supported the benefits of LSM programs on decreased BMI, fasting blood glucose, IR, FSH, sex hormone-binding globulin (SHBG), total testosterone, androstenedione, free androgen index (FAI) and Ferriman-Gallwey (FG) score and improved cardiorespiratory fitness, but not on glucose tolerance or lipid profiles. 57,63,[70][71][72] No studies have assessed the effects of LSM programs on clinical reproductive outcomes, quality of life or treatment satisfaction in women with PCOS.…”

Section: Lsm Programs and Pcosmentioning

confidence: 99%

Nutritional support and dietary interventions for women with polycystic ovary syndrome

Papavasiliou¹,

Papakonstantinou²

2017

NDS

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Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductiveaged women, which leads to reproductive, metabolic and hormonal abnormalities. Hyperinsulinemia, insulin resistance, androgen excess, ovulatory dysfunction, polycystic ovaries, gonadotropin abnormalities, obesity, adipose tissue dysfunction, difficulty to conceive and high-risk pregnancy are the most common PCOS-associated complications. The aim of this review was to describe and evaluate the effects of dietary interventions on PCOS-associated outcomes and to provide some evidence-based dietary advice for use in clinical practice. There is no optimal diet or macronutrient composition for PCOS. However, lifestyle modification, including a small-to-moderate weight loss of 5-10% (combined diet with regular physical activity) with any dietary pattern of choice, depending on the individuals' preferences, culture, habits and metabolic needs (ie, Mediterranean diet, Dietary Approaches to Stop Hypertension [DASH] diet or moderately low-carbohydrate diets [30-45% of energy]), as well as alternative dietary interventions, including small, frequent meal (five to six meals daily) consumption at regular times, with the majority of carbohydrates consumed at lunch time or equally distributed throughout the day, seems to offer the evidence-based first-line strategy for the management of PCOS symptoms and insulin resistance. No conclusions can be drawn at this time for high protein diets, polyunsaturated fatty acids or micronutrient supplementation.

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“…A rendszeres testmozgás nélkülözhetetlen, de a mozgás legkedvezőbb formája még nem minden szempontból ismert [14]. Ugyanakkor azt fontos hangsúlyozni, hogy csak a kombinált programmal (diéta+fokozott ÖSSZEFOGLALÓ KÖZLEMÉNY mozgás) érhető el hosszabb távon kedvező eredmény [15].…”

Section: Az Elhízás Kezeléseunclassified

A polycystás ovarium szindróma tüneteinek bizonyítékokon alapuló terápiája

Gődény

Csenteri

2015

Orvosi Hetilap

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A polycystás ovarium szindróma a nők leggyakoribb endokrin és anyagcsere-betegsége. A különböző klinikai formá-ban jelentkező betegség kardinális tünetei közé tartoznak a hiperandrogén bőrtünetek és/vagy emelkedett szérum-androgénszintek, oligo-vagy amenorrhoea, anovuláció miatt kialakuló meddőség és esetenként a petefészek polycystás szerkezete. A szindróma kezelése függ a klinikai megjelenéstől, az életkortól, az alkalmazott diagnosztikus technológiák pontosságától, valamint attól, hogy mely kritériumrendszer alkalmazásával történt a diagnózis felállítá-sa. A bizonyítékon alapuló, megfelelően kiválasztott terápiás technológiával javul a kórkép kezelésének eredményes-sége, hatékonysága, a betegek biztonsága, életminősége és várható élettartama. A közlemény a rendelkezésre álló irodalmi adatok, elsősorban a legmagasabb szintű bizonyítékoknak tekinthető szisztematikus irodalmi áttekintések és metaanalízisek felhasználásával ismerteti a szindrómához társuló tünetek, az elhízás, a hyperandrogenismus, a vér-zészavarok, a meddőség és a lelki problémák kezelésének lehetőségeit. Orv. Hetil., 2015, 156(45), 1803-1815. Kulcsszavak: PCOS, klinikai tünetek, EBM, terápia Evidence-based therapy of polycystic ovarian syndromePolycystic ovary syndrome is recognized as the most common hormonal and metabolic disorder likely to affect women. The heterogeneous endocrinopathy is characterized by clinical and/or biochemical hyperandrogenism, oligo-or amenorrhoea, anovulatory infertility, and polycystic ovarian morphology. The syndrome is often associated with obesity, hyperinsulinemia and adversely affects endocrine, metabolic, and cardiovascular health. The symptoms and complaint of the patients vary with age. To maximise health gain of the syndrome, adequate, evidence based effective, effi cient and safe treatment is necessary. This article summarises the highest available evidence provided by studies, meta-analysis and systematic reviews about the therapeutical possibilities for treating obesity, hyperandrogenism, menstrual abnormalities, infertility and psychological problems related to polycystic ovary syndrome ÖSSZEFOGLALÓ KÖZLEMÉNYRövidítések 2TDM = 2-es típusú diabetes mellitus; A = androsztendion; BMI = (body mass index) testtömegindex; CC = clomifen-citrát; CPA = ciproteron-acetát; CI = (confi dence interval) megbízhatósági tartomány, konfi denciaintervallum; DHEAS = dehidroepiandroszteron-szulfát; DHT = dihidro-tesztoszteron; DRSP = drospirenon; EBM = (evidence-based medicine) bizonyítékokon alapuló orvoslás; EE = etinil-ösztradiol; EE+CPA = etinil-ösztradiolt és ciproteron-acetátot tartalmazó kombinált készítmény; EE+DRSP = etinil-ösztradiolt és drospirenont tartalmazó kombinált készítmény; EMA = (European Medicines Agency) Európai Gyógyszerügynökség; FAI = (free androgen *A Debreceni Egyetem, Klinikai Központ, Szülészeti és Nőgyógyászati Klinika endokrin munkacsoportjának tagja.

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Lifestyle Modification Programs in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis

Abstract: The available evidence suggests that LSM reduces fasting blood glucose and insulin levels in women with PCOS. Metformin has similar effects. Translation of these short-term effects to patient-important outcomes, beyond diabetes prevention, remains uncertain.

Cited by 152 publications

References 45 publications

Physiological Aspects of Female Fertility: Role of the Environment, Modern Lifestyle, and Genetics

Physiological Aspects of Female Fertility: Role of the Environment, Modern Lifestyle, and Genetics

Nutritional support and dietary interventions for women with polycystic ovary syndrome

A polycystás ovarium szindróma tüneteinek bizonyítékokon alapuló terápiája

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