More intensive weight loss interventions led to improvements in menstrual frequency but not in hyperandrogenism symptoms.

Primary care management of polycystic ovarian syndrome (PCOS) focuses on preventing complications of chronic anovulation and encouraging weight loss. Although about 50% of women with PCOS have overweight or obesity, the effects of weight loss on PCOS symptoms and laboratory markers remain unclear. Researchers conducted a meta-analysis of randomised trials in which investigators examined the effect of weight loss by behavioural interventions (12 studies) or weight-loss drugs (17 studies) in patients with PCOS.

Weight loss interventions resulted in an average weight loss of −3.8 kg, which was associated with less insulin resistance and free androgen index values. Menstrual frequency improved significantly, with an average of 2.6 additional cycles annually. However, this amount of weight loss did not improve levels of free testosterone, luteinising hormone, follicle-stimulating hormone or sex hormone-binding globulin. And importantly, weight loss did not alleviate symptoms of hyperandrogenism (e.g. acne, hirsutism) or improve PCOS-related quality of life.

Comment: PCOS guidelines recommend lifestyle interventions, including targeting a 5% weight loss in women with PCOS and obesity. Notably in this analysis, the weight loss achieved was modest overall, and the weight loss medications studied were not representative of the most effective weight loss medications available today. In practice, I have found that weight loss of at least 10% is needed for symptomatic improvement; because this goal is often challenging, I am prescribing adjunctive weight loss medication increasingly for these patients – with anecdotal success.

Marie Claire O’Dwyer, MB BCh BAO, MPH, Clinical Assistant Professor in Family Medicine, University of Michigan Medical School, Ann Arbor, USA.

Scragg J, et al. Effect of weight loss interventions on the symptomatic burden and biomarkers of polycystic ovary syndrome: a systematic review of randomized controlled trials. Ann Intern Med 2024; 177: 1664-1674.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Women’s Health.