Effect of lifestyle intervention on the reproductive endocrine profile in women with polycystic ovarian syndrome: a systematic review and meta-analysis

Liza Haqq,Neil Smart,Gudrun Dieberg,James Mcfarlane

doi:10.1530/ec-14-0010

Abstract

Polycystic ovarian syndrome (PCOS) affects 18–22% of women at reproductive age. We conducted a systematic review and meta-analysis evaluating the expected benefits of lifestyle (exercise plus diet) interventions on the reproductive endocrine profile in women with PCOS. Potential studies were identified by systematically searching PubMed, CINAHL and the Cochrane Controlled Trials Registry (1966–April 30, 2013) systematically using key concepts of PCOS. Significant improvements were seen in women receiving lifestyle intervention vs usual care in follicle-stimulating hormone (FSH) levels, mean difference (MD) 0.39 IU/l (95% CI 0.09 to 0.70, P=0.01), sex hormone-binding globulin (SHBG) levels, MD 2.37 nmol/l (95% CI 1.27 to 3.47, P<0.0001), total testosterone levels, MD −0.13 nmol/l (95% CI −0.22 to −0.03, P=0.008), androstenedione levels, MD −0.09 ng/dl (95% CI −0.15 to −0.03, P=0.005), free androgen index (FAI) levels, MD −1.64 (95% CI −2.94 to −0.35, P=0.01) and Ferriman–Gallwey (FG) score, MD −1.01 (95% CI −1.54 to −0.48, P=0.0002). Significant improvements were also observed in women who received exercise-alone intervention vs usual care in FSH levels, MD 0.42 IU/l (95% CI 0.11 to 0.73, P=0.009), SHBG levels, MD 3.42 nmol/l (95% CI 0.11 to 6.73, P=0.04), total testosterone levels, MD −0.16 nmol/l (95% CI −0.29 to −0.04, P=0.01), androstenedione levels, MD −0.09 ng/dl (95% CI −0.16 to −0.03, P=0.004) and FG score, MD −1.13 (95% CI −1.88 to −0.38, P=0.003). Our analyses suggest that lifestyle (diet and exercise) intervention improves levels of FSH, SHBG, total testosterone, androstenedione and FAI, and FG score in women with PCOS.

Highlights

Polycystic ovarian syndrome (PCOS) is a heterogeneous endocrine disorder, affecting 18–22% of reproductive-age women (1)
Significant improvements were seen in women receiving lifestyle intervention vs usual care in follicle-stimulating hormone (FSH) levels, mean difference (MD) 0.39 IU/l, sex hormone-binding globulin (SHBG) levels, MD 2.37 nmol/l, total testosterone levels, MD K0.13 nmol/l, androstenedione levels, MD K0.09 ng/dl, free androgen index (FAI) levels, MD K1.64 and Ferriman–Gallwey (FG) score, MD K1.01
Our analyses suggest that lifestyle intervention improves levels of FSH, SHBG, total testosterone, androstenedione and FAI, and FG score in women with PCOS

Summary

Introduction

Polycystic ovarian syndrome (PCOS) is a heterogeneous endocrine disorder, affecting 18–22% of reproductive-age women (1). Hormonal manifestations include elevated levels of androgens (testosterone, DHEA and androstenedione), oestrogens and prolactin. The resultant oestrogen environment alters the hypothalamic release of gonadotrophin-releasing hormone and leads to an increase in LH secretion and suppression of FSH secretion by the pituitary (8, 10). This altered LH:FSH ratio is used as a diagnostic criterion for this condition, but it is not universally present (11). The levels of sex hormone-binding globulin (SHBG), the primary plasma transport system which controls the availability of androgens, are reduced in women with PCOS leading to an increase in free testosterone levels contributing to the free androgen index (FAI) (12). We conducted a systematic review and meta-analysis, and the primary aim was to evaluate the expected benefits of exercise training and dietary interventions on a range of endocrinal outcomes in women with PCOS

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