Weight loss can help improve menstrual frequency and other symptoms

• Polycystic ovary syndrome (PCOS) affects an estimated one in ten women.
• Researchers recently found that weight loss interventions can help people with PCOS reduce weight and improve blood sugar control and hormonal markers.
• This work may be the first to reveal a link between weight loss interventions and a clinically significant increase in menstrual frequency.
• The study authors suggest that doctors can refer to these findings to advise patients with PCOS on weight loss strategies.

Polycystic Ovary Syndrome (PCOS)also known as Stein-Leventhal syndrome, affects women of childbearing age. It is the most common endocrine disorder and cause of infertility in women.

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

The condition often contributes to irregular or missed ovulation and menstruation. It can also lead to abnormally high levels of androgens, which can lead to diabetes hirsutism.

Being overweight or obese affects more than half of women with PCOS. At least 65% to 80% of people with PCOS also suffer from insulin resistance.

Furthermore, individuals with PCOS and overweight tend to experience worse medical outcomes than women with PCOS and a healthier weight.

Experts from the University of Oxford in Britain have found limited evidence quantifying the effects of weight loss on PCOS symptoms. This scarcity has made it difficult for practitioners to recommend specific weight loss strategies for managing PCOS.

Looking for stronger confirmation, the scientists searched more than 3,000 scientific studies. They also interviewed dozens of women with PCOS.

Their systematic review suggests that weight loss interventions have promoted ‘improvements in some key clinical features of PCOS’.

According to clinical guidelines in Britain, 5% weight loss could reduce testosterone levels and insulin resistance markers. Health experts recommend counseling women with PCOS and overweight on lifestyle changes, with weight loss typically involving low-carb diets and exercise.

However, this study’s patient and public involvement (PPI) advisors shared that, in their experience, support for weight management was scarce. There is also evidence that encouraging weight loss without further support is largely ineffective.

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

“When interventions target the root cause of weight gain – insulin resistance – PCOS symptoms are more likely to improve. Addressing insulin resistance head-on is essential to achieving meaningful improvements in PCOS symptoms, including weight loss,” she explains.

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

“PCOS is characterized by hormonal imbalances and metabolic disorders, insulin resistance, chronic inflammation, estrogen imbalances, high cortisol and gut dysbiosis can all make weight loss difficult,” she said.

Pacheco agreed that weight loss can help improve many PCOS symptoms.

“When someone loses weight, they can usually expect improvements in blood sugar, insulin levels, cholesterol levels and testosterone levels. It usually also means that they experience less cravings and fatigue, while also having more regular periods.”
– Alyssa Pacheco, RD

Pacheco also said that people with PCOS are at a disproportionately higher risk for eating disorders. This, she said, calls for more caution when discussing weight loss interventions.

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

However, the University of Oxford team noted that no reviews had compared “the full range of weight loss interventions” related to PCOS management.

Furthermore, previous studies often lacked sufficient data to analyze clinically relevant symptoms and markers for the treatment 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 through June 2024. They focused on RCTs of interventions to reduce weight in adults diagnosed with PCOS.

• “ordinary care” of metforminoral contraceptives and standard advice,
• “minimal intervention” such as advice to lose weight without further support, or
• placebos.

They also analyzed studies comparing lower and higher intensity weight loss interventions.

The primary outcomes of the review consisted of symptoms and biological markers of PCOS. They were chosen in consultation with physicians with expertise in PCOS and 36 individuals with PCOS.

The included RCTs included data that allowed calculations of weight change and at least one symptom or biomarker of PCOS, such as fasting insulin, fasting glucose, testosterone, FAI, menstrual frequency, acne and hirsutism.

The study’s researchers started with 3,760 studies and narrowed their list to 39. More than 1,500 people contributed data to the primary analyses, and more than 2,300 people contributed data to the secondary analyses.

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

They noted a decrease in fasting insulin, FAI and HOMA-IRa marker for insulin resistance, along with an increase in menstrual frequency.

“To our knowledge, this is the first review to demonstrate a clinically significant association in improving menstrual frequency with weight loss interventions, an important indicator of subsequent 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 the experts interviewed which weight loss interventions seemed to work best.

Chappell said that in her experience, insulin-lowering methods are the most effective: “Since insulin resistance is at the root of all PCOS symptoms, focusing on lifestyle changes that lower insulin levels helps reverse insulin resistance and leads to weight loss and improvements in other clinical symptoms. . I call this a low-insulin lifestyle.”

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

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

The study authors acknowledge several limitations of their review.

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

Furthermore, most of the studies analyzed lasted less than six months. The long-term effects of the interventions are therefore unknown.

This rating does not reflect recent changes in weight management, such as total diet replacements.

Chappell believes the study’s findings highlight the importance of targeting insulin resistance to improve PCOS symptoms.

She also noted that while calorie restriction and other weight loss interventions led to modest weight loss, “they often failed to improve sex hormone levels and related PCOS symptoms such as hirsutism.”

“Insulin is the main driver of androgen secretion and associated PCOS symptoms, which are not affected by calorie restriction alone,” she said.

Overall, the University of Oxford researchers believe their work offers useful considerations for people with PCOS and overweight and their healthcare providers: “Weight loss interventions were associated with improvements in some key features of PCOS and should be considered a routine treatment option for people with PCOS.”