With the association between overweight and obesity and metabolic, reproductive and psychological dysfunction in women with PCOS, weight management is a logical treatment strategy. MCHRI’s Associate Professor Lisa Moran tells us about her latest findings.
Polycystic ovary syndrome (PCOS) is a common endocrine condition which affects up to 18% of reproductive-aged women and is associated with reproductive, metabolic and psychological features. With regards to cardiometabolic risk, systematic reviews and meta-analysis document worsened risk factors for cardiovascular disease including dyslipidaemia, inflammation and endothelial function and longer-term clinical outcomes including increased gestational diabetes, impaired glucose tolerance, type 2 diabetes mellitus, metabolic syndrome and increased coronary heart disease and stroke, in women with PCOS compared to controls. On meta-analysis, women with PCOS also have an increased prevalence of overweight, obesity and central obesity, compared with controls. PCOS is therefore associated with an elevated prevalence of overweight and obesity which further worsen metabolic, reproductive and psychological dysfunction.
Given the association between overweight and obesity and metabolic, reproductive and psychological dysfunction in women, weight management is a logical treatment strategy. This can be defined as prevention of excess weight gain, achieving a modest weight loss (5-10%) and sustaining a reduced weight long-term. However, there is limited research assessing the effect of following these practices on clinical long-term cardiometabolic outcomes in PCOS. In the general population, lifestyle modification has proved as efficacious as pharmacological intervention (metformin) in reducing diabetic mortality and morbidity in the Diabetes Prevention Program. The lifestyle intervention resulted in a 5.6 kg weight loss and reduced the risk of developing diabetes by 58% while metformin reduced the risk by 31% over 2.8 years. Effects on reducing diabetes development were maintained up to 15 years and those who did not develop diabetes had a lower prevalence of microvascular complications. In high-risk patients, a meta-analysis of n=7 studies reported that lifestyle interventions decreased the risk of diabetes at up to 10 years post-intervention. With regards to cardiovascular outcomes, lifestyle interventions focusing on factors including diet and exercise reported significant benefits for total mortality, cardiovascular mortality and nonfatal cardiac events. While it is expected that similar lifestyle programs would improve weight and long-term metabolic outcomes in PCOS based on research in the general population, further research is needed.