Lifestyle modifications alleviate polycystic ovary syndrome (PCOS) by improving biochemical, hormonal, and anthropometric parameters.
Study: The Role of Lifestyle Interventions in PCOS Management: A Systematic Review. Image Credit: Images Products/Shutterstock.com
Scientists have recently conducted a systematic review to evaluate whether lifestyle interventions aid PCOS management and published their findings in Nutrients.
PCOS: Symptoms and Etiology
PCOS is a common hormonal condition that affects women of reproductive age. Approximately 6% to 20% of women worldwide develop PCOS. This endocrine disorder is characterized by hyperandrogenism, polycystic ovaries (PCO), and ovulatory dysfunction (OD, oligo-ovulation/anovulation).
Several studies have indicated that PCOS is a multifaceted disease that influences metabolic disturbances, such as insulin resistance (IR) and dyslipidemia. Furthermore, PCOS increases the risk of cardiovascular disease and type 2 diabetes (T2D). It must also be noted that obesity exacerbates PCOS symptoms.
Even though the exact cause of PCOS remains unknown, it has been associated with endogenous and exogenous factors. The etiology of PCOS has been associated with epigenetics, genetics, dietary preferences, environment, and lifestyle factors. Most patients diagnosed with PCOS exhibit high androgen levels, commonly referred to as hyperandrogenism.
Furthermore, these patients experience an abnormal secretion of follicle-stimulating hormone (FSH) and gonadotropins like luteinizing hormone (LH). Hyperandrogenism also gets aggravated through hyperinsulinemia, which leads to the production of excessive androgens.
Immunological factors, such as chronic low-grade inflammation characterized by a rise in CRP levels, IL-6, and TNF-α, are involved in PCOS pathogenesis. Chronic inflammation and oxidative stress together play a significant role in the incidence of PCOS and its progression.
Increased oxidative stress negatively influences the pathophysiology of PCOS patients, which leads to increased androgen, insulin resistance, and chronic inflammation.
PCOS management through lifestyle intervention
It is not easy to manage PCOS because it requires a comprehensive and personalized approach. Several studies have shown that lifestyle changes, dietary interventions, stress management, and physical activities positively help manage PCOS symptoms.
A diet with appropriate macronutrient composition and caloric intake can effectively improve insulin sensitivity, weight management, and inflammatory markers in women with PCOS.
A low-glycemic-index (GI) diet containing high fiber and low carbohydrates helps improve insulin sensitivity and regulate blood sugar levels. A diet with high antioxidant content (e.g., α-tocopherol, vitamin D, vitamin C, polyphenols, and β-carotene) also decreases the odds of PCOS incidence.
Low-GI foods include whole grains (e.g., oats and quinoa), legumes (e.g., beans and lentils), fruits (e.g., berries, apples, and pears), and vegetables (e.g., leafy greens, and broccoli), are rich in anti-inflammatory compounds.
In comparison to high-GI diets, low-GI diets significantly decrease fasting insulin, LDL cholesterol, total cholesterol, triglycerides, waist circumference, and total testosterone levels in patients with PCOS.
A ketogenic diet, which is a high-fat, adequate-protein, and low-carbohydrate diet, was found to reduce androgen levels, improve insulin sensitivity, and enhance reproductive hormone levels in PCOS women.
However, this diet is not recommended for a longer period because of its low nutritional value, which can negatively affect health.
Omega-3 fatty acids and vitamin D have powerful anti-inflammatory and antioxidant properties that significantly improve insulin sensitivity and reduce androgen levels in metabolic syndromes like PCOS. A higher intake of omega-3 and vitamin E also alleviates mental health parameters and gene expression of PPAR-γ, IL-8, and TNF-α in women with PCOS.
Dietary supplements, such as antioxidants like N-acetylcysteine (NAC), vitamin D, inositol, and omega-3 fatty acids, and mineral supplements (zinc, magnesium selenium, and chromium) help in reducing insulin resistance. These supplements also enhance ovulatory function and decrease inflammation in PCOS patients.
Omega-3 fatty acid supplements improve biochemical parameters LH, LH/FSH, lipid profiles, and adiponectin levels and regularize the menstrual cycle in women with PCOS. A recent RCT also indicated that probiotic/symbiotic supplementation significantly improves triglyceride, insulin, and HDL levels in women with PCOS.
Several studies have highlighted that physical activity and regular exercise alleviate PCOS symptoms. Regular exercise that constitutes a combination of aerobic (e.g., cycling, brisk walking, running, or swimming) and resistance training via weight training positively reduces body fat, enhances cardiovascular health, and improves insulin sensitivity in women with PCOS.
Continuous aerobic training (CAT) and intermittent aerobic training (IAT) were found to be significantly effective in decreasing hyperandrogenism and anthropometric indices, which positively enhanced the overall quality of life of women with PCOS.
Mechanistically, aerobic exercise enhances insulin sensitivity by enhancing muscle’s capacity to absorb glucose from the blood. A decrease in insulin levels helps regulate menstrual periods and increases ovarian function.
Exercise also improves the psychological well-being of PCOS patients. Several studies have also indicated the positive effects of yoga, such as mudras, breathing, asana, and meditation, in managing regular menstrual cycles and hormone levels and reducing anxiety and stress in these patients.
Furthermore, behavioral interventions through proper diet, sleep, exercise, and stress management help manage PCOS symptoms.
Conclusions
The current review indicated the positive effects of lifestyle interventions based on optimal diets, regular physical activity, and behavioral interventions in managing PCOS symptoms.
Consumption of omega-3 three- and antioxidant-rich, high-fiber-containing, and low-glycemic-index foods alleviate PCOS symptoms by improving hormonal balance and insulin sensitivity and regulating the menstruation cycle.
Besides diet, regular physical activities also reduce weight and help achieve glucose homeostasis improving overall quality of life in these patients.
In the future, scientists must develop optimal lifestyle interventions that reduce depression in PCOS patients as well.