Abstract
Research questionWhat is the effect of weight loss through different interventions (three-component lifestyle intervention with short message service [SMS+] versus three-component lifestyle intervention without SMS [SMS–] versus care as usual [CAU]) on polycystic ovary syndrome (PCOS) characteristics (ovulatory dysfunction, hyperandrogenism, polycystic ovarian morphology [PCOM]) and phenotype distribution? DesignAnalysis of secondary outcome measures of a randomized controlled trial. Women diagnosed with PCOS (n = 183), who wished to become pregnant, with a body mass index above 25 kg/m², were assigned to a 1-year three-component (cognitive behavioural therapy, diet, exercise) lifestyle intervention group, with or without SMS, or to CAU (advice to lose weight). ResultsThe prevalence of biochemical hyperandrogenism was 30.9% less in the SMS- group compared with CAU after 1 year (P = 0.027). Within-group analyses revealed significant improvements in ovulatory dysfunction (SMS+: –39.8%, P = 0.001; SMS–: –30.5%, P = 0.001; CAU: –32.1%, P < 0.001), biochemical hyperandrogenism (SMS–: –27.8%, P = 0.007) and PCOM (SMS–: –14.0%, P = 0.034). Weight loss had a significantly favourable effect on the chance of having ovulatory dysfunction (estimate 0.157 SE 0.030, P < 0.001) and hyperandrogenism (estimate 0.097 SE 0.027, P < 0.001). ConclusionsAll groups demonstrated improvements in PCOS characteristics, although these were more profound within the lifestyle intervention groups. Weight loss per se led to an amelioration of diagnostic characteristics and in the phenotype of PCOS. A three-component lifestyle intervention aimed at a 5–10% weight loss should be recommended for all women with PCOS before they become pregnant.
Highlights
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women with a reported overall prevalence of 8–13% (Azziz et al, 2006; Diamanti-Kandarakis et al, 2006; March et al, 2010; Bozdag et al, 2016; Teede et al, 2018)
The secondary outcome measures comprised the longitudinal effect of the lifestyle intervention (LSI) groups Short Message Service (SMS)+ and SMS– compared with care as usual (CAU) on PCOS characteristics ovulatory dysfunction, hyperandrogenism and polycystic ovarian morphology (PCOM) and phenotype distribution (A–D)
Sixty-three participants were randomly assigned to the LSI without SMS group (SMS–) and 60 were assigned to the LSI with SMS group (SMS+), which resulted in 123 participants in the LSI group
Summary
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive-aged women with a reported overall prevalence of 8–13% (Azziz et al, 2006; Diamanti-Kandarakis et al, 2006; March et al, 2010; Bozdag et al, 2016; Teede et al, 2018). Women with PCOS and obesity have a greater prevalence of hirsutism and menstrual disorders (Glueck and Goldenberg, 2019). Women with phenotype A and B are believed to have ‘classic PCOS’ (Lizneva et al, 2016), which is associated with a more pronounced ovulatory dysfunction (Kim et al, 2014), metabolic syndrome (Goverde et al, 2009) and a greater prevalence of obesity (Moran and Teede, 2009). A subdivision can be made between hyperandrogenic (phenotype A, B and C) and normoandrogenic (phenotype D) phenotypes in the severity of the condition (Daan et al, 2014, Lizneva et al, 2016)
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