Losing weight can help improve period frequency and other symptoms

• Polycystic ovary syndrome (PCOS) affects an estimated one in 10 women.
• Researchers recently found that weight loss interventions can help people with PCOS lose weight and improve blood sugar regulation and hormonal markers.
• This work may be the first to discover an association between weight loss interventions and a clinically significant increase in menstrual frequency.
• The study authors suggest that clinicians can review these results to advise PCOS patients on weight loss strategies.

Polycystic ovary syndrome (PCOS)also known as Stein-Leventhal syndrome, it affects women of reproductive age. It is the most common endocrine disease and the cause of infertility among women.

PCOS has no known cause or cure. Some people with PCOS experience few or no symptoms.

This condition often contributes to irregular or missed ovulation and menstrual periods. This can also lead to abnormally high androgen levels, which can cause hirsutism.

Overweight or obesity affects more than half of women with PCOS. At least 65% to 80% of people with PCOS also live with insulin resistance.

Moreover, people with PCOS and overweight tend to experience poorer health outcomes than women with PCOS and a healthier weight.

However, experts from University of Oxford in the UK found limited evidence quantifying the effect of weight loss on PCOS symptoms. This deficiency makes it difficult for doctors to recommend specific weight loss strategies to treat PCOS.

In search of stronger confirmation, scientists reviewed over 3,000 scientific studies. They also interviewed several dozen women with PCOS.

Their systematic review suggested that weight loss interventions contributed to “improving some important clinical features of PCOS.”

According to clinical guidelines in the UK, a 5% weight loss can reduce testosterone levels and markers of insulin resistance. Health experts recommend giving women with PCOS and overweight advice on lifestyle changes, usually including losing weight through a low-carb diet and exercise.

However, Patient and Public Engagement (PPI) advisors in this study said that in their experience, weight management support was rare. Evidence also shows that encouraging weight loss without further support is largely ineffective.

Medical news today discussed this study with a PCOS expert Dr. Ali Chappell, PhD, MS, RDfounder and CEO of Lilli Health, who was not involved in the review.

“When interventions focus on the root cause of weight gain – insulin resistance – PCOS symptoms are more likely to improve. “Directly addressing insulin resistance is essential to achieving significant improvement in PCOS symptoms, including weight loss,” she explained.

MNT also discussed this research with Alyssa Pacheco, RDThe PCOS dietitian Alyssa, who was also not involved in the study.

“PCOS is characterized by hormonal imbalance and metabolic disorders, (I)sulin resistance, chronic inflammation, estrogen imbalance, high cortisol levels and gut dysbiosis – all of which can make weight loss difficult,” she said.

Pacheco agreed that losing weight can help alleviate many of the symptoms of PCOS.

“When someone loses weight, they can usually expect to see improvements in their blood sugar levels and insulin levels, cholesterol levels and testosterone levels. This usually also means they feel less hungry and tired while having more regular periods.
—Alyssa Pacheco, RD

Pacheco also said that people with PCOS have a disproportionately higher risk of eating disorders. This, she says, requires greater caution when discussing weight loss interventions.

Previous research suggests that low-carbohydrate interventions or drug therapy may promote weight loss and greater improvements in markers of insulin resistance, glucose, and hemoglobin than metformin or no intervention.

However, the University of Oxford team noted that no review had compared the “full range of weight loss interventions” for treating PCOS.

Moreover, previous studies often lacked sufficient data to analyze clinically relevant symptoms and treatment markers of PCOS, including menstrual frequency, hirsutism, and free androgen index (FAI).

The study authors searched major medical databases for randomized controlled trials (RCTs) from inception to June 2024. They focused on RCTs of weight loss interventions in adults diagnosed with PCOS.

• “usual care.” metforminoral contraceptives and standard advice,
• ‘minimal intervention’ such as weight loss advice without further support, or
• placebo.

They also analyzed studies that compared lower- and higher-intensity weight loss interventions.

The main outcomes of the review included symptoms and biological markers of PCOS. They were selected after consultation with doctors with expertise in PCOS and 36 people with PCOS.

Included RCTs included data to calculate weight change and at least one PCOS symptom or biomarker, such as fasting insulin, fasting glucose, testosterone, FAI, menstrual frequency, acne, and hirsutism.

Researchers in the study started with 3,760 studies, narrowing the list to 39. More than 1,500 people contributed data to primary analyses, and more than 2,300 contributed data to secondary analyses.

The University of Oxford team reported: “For women with PCOS, our systematic review suggests that weight loss interventions led to improvements in some important clinical features of PCOS.”

They noticed a decrease in fasting insulin levels, FAI and HOMA-IRa marker of insulin resistance, with an increase in menstrual frequency.

“To our knowledge, this is the first review to demonstrate a clinically significant association between improved menstrual frequency and weight loss interventions, which is an important indicator of later fertility and an important outcome for women,” the team also said.

However, the evidence was inconclusive to establish an association between weight loss interventions and significant changes in fasting glucose, testosterone, hirsutism, and other markers.

MNT asked surveyed experts which weight loss interventions seemed most effective.

Chappell shared her experience that methods to lower insulin levels are most effective: “Since insulin resistance is the cause of all PCOS symptoms, focusing on lifestyle changes that lower insulin levels helps reverse insulin resistance and leads to weight loss and improvement of other clinical symptoms.” I call it the low insulin lifestyle.”

“The most effective weight loss interventions are those that focus on treating the underlying cause why weight loss is difficult to begin with. I recommend eating balanced meals containing foods rich in fiber, protein and healthy fats – this combination keeps blood sugar levels stable and reduces the feeling of hunger throughout the day, Pacheco said. MNT.

“Other lifestyle factors such as exercise, sleep and stress can play a big role in insulin resistance and weight loss,” she added.

The study authors acknowledge that their review has several limitations.

The most important of these, they noted, is “the high statistical heterogeneity of interventions, comparators and outcomes…”. They hope that a more detailed meta-analysis will compare weight loss interventions.

Additionally, most of the studies reviewed lasted less than six months. Therefore, the long-term effects of the intervention are unknown.

This review does not reflect recent developments in weight management, such as complete dietary replacement.

Chappell believes the study results highlight the importance of combating insulin resistance to alleviate PCOS symptoms.

She also noted that while calorie restriction and other weight-loss interventions resulted in moderate weight loss, they “often did not improve sex hormone levels and related symptoms of PCOS, such as hirsutism.”

“Insulin is a major driver of androgen secretion and the associated symptoms of PCOS that calorie restriction alone has no effect on,” she said.

Overall, the University of Oxford researchers believe their work provides useful information for overweight people with PCOS and their health care providers: “Weight loss interventions were associated with improvements in some important features of PCOS and should be considered routine treatment option for people with PCOS.”