Modifications in lifestyle lessen the impact of polycystic ovary syndrome (PCOS) by enhancing biochemical, hormonal, and anthropometric factors.
Researchers have recently performed a systematic review to assess whether lifestyle modifications support the management of PCOS and published their results in Nutrients.
PCOS: Symptoms and Causes
PCOS is a prevalent hormonal disorder impacting women of childbearing age. Around 6% to 20% of women globally develop PCOS. This endocrine condition is defined by hyperandrogenism, polycystic ovaries (PCO), and ovulatory dysfunction (OD, oligo-ovulation/anovulation).
Numerous studies have suggested that PCOS is a complex disease that affects metabolic irregularities, including insulin resistance (IR) and dyslipidemia. Additionally, PCOS raises the likelihood of developing cardiovascular diseases and type 2 diabetes (T2D). It is also important to recognize that obesity intensifies PCOS symptoms.
Although the precise cause of PCOS is not fully understood, it has been linked to both internal and external factors. The origins of PCOS have been tied to epigenetics, heredity, dietary habits, environmental conditions, and lifestyle factors. The majority of individuals diagnosed with PCOS exhibit elevated androgen levels, commonly termed hyperandrogenism.
Moreover, these individuals often experience irregular secretion of follicle-stimulating hormone (FSH) and gonadotropins like luteinizing hormone (LH). Hyperandrogenism is further exacerbated by hyperinsulinemia, which results in the production of excessive androgens.
Immunological factors, such as persistent low-grade inflammation marked by elevated CRP levels, IL-6, and TNF-α, play a role in the pathogenesis of PCOS. Chronic inflammation alongside oxidative stress significantly contributes to the onset and progression of PCOS.
Heightened oxidative stress adversely affects the pathophysiology of individuals with PCOS, resulting in increased androgen levels, insulin resistance, and ongoing inflammation.
Managing PCOS through Lifestyle Changes
Managing PCOS can be challenging as it necessitates a thorough and individualized strategy. Several studies have indicated that adjustments in lifestyle, nutritional interventions, stress control, and physical exercise can effectively assist in alleviating symptoms of PCOS.
A well-balanced diet with proper macronutrient ratios and caloric intake can significantly enhance insulin sensitivity, aid in weight control, and lower inflammatory markers in women experiencing PCOS.
A low-glycemic-index (GI) diet that is high in fiber and low in carbohydrates can enhance insulin sensitivity and stabilize blood glucose levels. Consuming a diet rich in antioxidants (e.g., α-tocopherol, vitamin D, vitamin C, polyphenols, and β-carotene) is also associated with a reduction in the likelihood of developing PCOS.
Low-GI foods such as 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 abundant in anti-inflammatory properties.
Compared to high-GI diets, low-GI diets notably lower fasting insulin, LDL cholesterol, total cholesterol, triglycerides, waist circumference, and total testosterone levels in patients diagnosed with PCOS.
A ketogenic diet, characterized by high fat, sufficient protein, and low carbohydrates, has been shown to lower androgen levels, enhance insulin sensitivity, and improve reproductive hormone levels in women with PCOS.
Nonetheless, this dietary approach is not recommended for prolonged periods due to its limited nutritional value, which may adversely impact health.
Omega-3 fatty acids and vitamin D possess potent anti-inflammatory and antioxidant characteristics that significantly boost insulin sensitivity and decrease androgen levels in metabolic conditions such as PCOS. An increased intake of omega-3 and vitamin E is also beneficial for mental health and gene expression of PPAR-γ, IL-8, and TNF-α in women with PCOS.
Nutritional supplements, including antioxidants such as N-acetylcysteine (NAC), vitamin D, inositol, and omega-3 fatty acids, along with mineral supplements (zinc, magnesium, selenium, and chromium), help alleviate insulin resistance.
These supplements also improve ovulatory function and reduce inflammation in individuals with PCOS.
Omega-3 fatty acid supplements enhance biochemical indicators such as LH, LH/FSH, lipid profiles, and adiponectin levels, as well as regularize menstrual cycles in women with PCOS. A recent randomized controlled trial (RCT) also revealed that probiotic/symbiotic supplementation significantly enhances triglyceride, insulin, and HDL levels in women with PCOS.
Multiple studies have emphasized that physical activity and consistent exercise alleviate symptoms of PCOS. Regular exercise, encompassing a mix of aerobic activities (such as cycling, brisk walking, running, or swimming) and resistance training through weightlifting, effectively reduces body fat, boosts cardiovascular fitness, and enhances insulin sensitivity in women with PCOS.
Continuous aerobic training (CAT) and intermittent aerobic training (IAT) have been proven to be significantly beneficial in decreasing hyperandrogenism and anthropometric measurements, which in turn positively affects the overall quality of life for women with PCOS.
From a mechanistic perspective, aerobic exercise improves insulin sensitivity by augmenting the muscle’s ability to take up glucose from the bloodstream. Lowering insulin levels aids in regulating menstrual cycles and enhances ovarian function.
Additionally, exercise fosters improved psychological health for individuals with PCOS. Numerous studies have highlighted the beneficial effects of yoga practices, such as mudras, controlled breathing, asanas, and meditation, in managing regular menstrual cycles, hormone levels, and alleviating anxiety and stress among these patients.
Moreover, lifestyle adjustments through proper nutrition, adequate sleep, physical activity, and stress management play a vital role in managing PCOS symptoms.
Conclusions
The current review highlights the beneficial impacts of lifestyle modifications that include balanced diets, regular exercise, and behavioral adjustments in managing PCOS symptoms.
Intake of omega-3, antioxidants, fiber-rich, and low-glycemic-index foods helps mitigate PCOS symptoms by enhancing hormonal equilibrium, boosting insulin sensitivity, and regulating menstrual cycles.
In addition to dietary measures, regular physical activities also promote weight loss and help achieve glucose homeostasis, thereby improving the overall quality of life for these patients.
Looking ahead, researchers must create optimal lifestyle interventions that also address depression in individuals with PCOS.