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01-12-2013 | Review

Lifestyle intervention and anti-obesity therapies in the polycystic ovary syndrome: impact on metabolism and fertility

Authors: Dimitrios Panidis, Konstantinos Tziomalos, Efstathios Papadakis, Christos Vosnakis, Panagiotis Chatzis, Ilias Katsikis

Published in: Endocrine | Issue 3/2013

Abstract

Obesity is frequently present in patients with polycystic ovary syndrome (PCOS) and plays an important role in the pathogenesis of the metabolic, endocrine, and reproductive abnormalities associated with this syndrome. We aimed to summarize the effects of lifestyle changes and anti-obesity pharmacotherapy in patients with PCOS. We reviewed the literature regarding the effects of lifestyle changes and anti-obesity agents on the metabolic and endocrine abnormalities of PCOS. Lifestyle changes, including diet, exercise, and behavioral modification, appear to improve the metabolic and reproductive abnormalities of overweight and obese patients with PCOS. Therefore, lifestyle changes appear to represent the first-line management for all overweight and obese patients with PCOS. However, the optimal composition of diet and the optimal type of exercise in these patients are unknown. Anti-obesity agents that have been studied in PCOS include orlistat, sibutramine, and rimonabant. However, the latter two agents have been withdrawn from the market because of side effects. Long-term studies with orlistat in overweight and obese diabetic patients showed greater weight loss and metabolic and cardiovascular benefits than those achieved with lifestyle changes alone. However, there are limited data on the efficacy of orlistat in women with PCOS. In conclusion, lifestyle changes (diet, exercise and behavioral modification), particularly when combined with anti-obesity agents, exert beneficial effects on the endocrine abnormalities of obese patients with PCOS and improve metabolic parameters.

J.E. Nestler, Metformin for the treatment of the polycystic ovary syndrome. N. Engl. J. Med. 358, 47–54 (2008)PubMedCrossRef

D. Panidis, K. Tziomalos, E. Papadakis, I. Katsikis, Infertility treatment in PCOS: lifestyle interventions, medications and surgery, in Polycystic Ovary Syndrome: Novel Insights into Causes and Therapy, ed. by D. Macut, M. Pfeifer, B. Yildiz, E. Diamanti-Kandarakis (Karger, Basel, 2012)

B.C. Fauser, B.C. Tarlatzis, R.W. Rebar, R.S. Legro, A.H. Balen, R. Lobo, E. Carmina, J. Chang, B.O. Yildiz, J.S. Laven, J. Boivin, F. Petraglia, C.N. Wijeyeratne, R.J. Norman, A. Dunaif, S. Franks, R.A. Wild, D. Dumesic, K. Barnhart, Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-sponsored 3rd PCOS consensus workshop group. Fertil. Steril. 97, 28–38.e25 (2012)PubMedCrossRef

Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil. Steril. 81, 19–25 (2004)

S. Franks, Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: in defense of the Rotterdam criteria. J. Clin. Endocrinol. Metab. 91, 786–789 (2006)PubMedCrossRef

R. Azziz, Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. J. Clin. Endocrinol. Metab. 91, 781–785 (2006)PubMedCrossRef

J.K. Zawadski, A. Dunaif, in Polycystic Ovary Syndrome, ed. by A. Dunaif, J.R. Givens, F.P. Haseltine, G.E. Merriam; in Current Issues in Endocrinology and Metabolism ed. by S.M. Hershman (Blackwell, Boston 1992) pp. 377–384

R. Azziz, E. Carmina, D. Dewailly, E. Diamanti-Kandarakis, H.F. Escobar-Morreale, W. Futterweit, O.E. Janssen, R.S. Legro, R.J. Norman, A.E. Taylor, S.F. Witchel, Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society: the Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil. Steril. 91, 456–488 (2009)PubMedCrossRef

10.

F.J. Broekmans, E.A. Knauff, O. Valkenburg, J.S. Laven, M.J. Eijkemans, B.C. Fauser, PCOS according to the Rotterdam consensus criteria: change in prevalence among WHO-II anovulation and association with metabolic factors. BJOG 113, 1210–1217 (2006)PubMedCrossRef

11.

C.K. Welt, J.A. Gudmundsson, G. Arason, J. Adams, H. Palsdottir, G. Gudlaugsdottir, G. Ingadottir, W.F. Crowley, Characterizing discrete subsets of polycystic ovary syndrome as defined by the Rotterdam criteria: the impact of weight on phenotype and metabolic features. J. Clin. Endocrinol. Metab. 91, 4842–4848 (2006)PubMedCrossRef

12.

D. Panidis, K. Tziomalos, G. Misichronis, E. Papadakis, G. Betsas, I. Katsikis, D. Macut, Insulin resistance and endocrine characteristics of the different phenotypes of polycystic ovary syndrome: a prospective study. Hum. Reprod. 27, 541–549 (2012)PubMedCrossRef

13.

R.S. Legro, D. Driscoll, J.F. Strauss 3rd, J. Fox, A. Dunaif, Evidence for a genetic basis for hyperandrogenemia in polycystic ovary syndrome. Proc. Natl. Acad. Sci. U.S.A. 95, 14956–14960 (1998)PubMedCrossRef

14.

M.D. Kahsar-Miller, C. Nixon, L.R. Boots, R.C. Go, R. Azziz, Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS. Fertil. Steril. 75, 53–58 (2001)PubMedCrossRef

15.

S. Franks, M.I. McCarthy, K. Hardy, Development of polycystic ovary syndrome: involvement of genetic and environmental factors. Int. J. Androl. 29, 278–285; discussion 286–290 (2006)

16.

R.J. Norman, D. Dewailly, R.S. Legro, T.E. Hickey, Polycystic ovary syndrome. Lancet 370, 685–697 (2007)PubMedCrossRef

17.

S.F. Witchel, S.E. Recabarren, F. González, E. Diamanti-Kandarakis, K.I. Cheang, A.J. Duleba, R.S. Legro, R. Homburg, R. Pasquali, R.A. Lobo, C.C. Zouboulis, F. Kelestimur, F. Fruzzetti, W. Futterweit, R.J. Norman, D.H. Abbott, Emerging concepts about prenatal genesis, aberrant metabolism and treatment paradigms in polycystic ovary syndrome. Endocrine 42, 526–534 (2012)PubMedCrossRef

18.

N.A. Georgopoulos, E. Kandaraki, D. Panidis, Hyperandrogenism in PCOS. in Diagnosis and Management of Polycystic Ovary Syndrome, ed. by N.R. Farid, E. Diamanti-Kandarakis (Springer, New York, 2009), pp. 105–110

19.

F. González, C.L. Sia, F.Z. Stanczyk, H.E. Blair, M.E. Krupa, Hyperandrogenism exerts an anti-inflammatory effect in obese women with polycystic ovary syndrome. Endocrine 42, 726–735 (2012)PubMedCrossRef

20.

T. Tsilchorozidou, C. Overton, G.S. Conway, The pathophysiology of polycystic ovary syndrome. Clin. Endocrinol. (Oxf.) 60, 1–17 (2004)CrossRef

21.

E. Diamanti-Kandarakis, A.G. Papavassiliou, Molecular mechanisms of insulin resistance in polycystic ovary syndrome. Trends Mol. Med. 12, 324–332 (2006)PubMedCrossRef

22.

R. Deniz, B. Gurates, S. Aydin, H. Celik, I. Sahin, Y. Baykus, Z. Catak, A. Aksoy, C. Citil, S. Gungor, Nesfatin-1 and other hormone alterations in polycystic ovary syndrome. Endocrine 42, 694–699 (2012)PubMedCrossRef

23.

K. Farrell, M.H. Antoni, Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions. Fertil. Steril. 94, 1565–1574 (2010)PubMedCrossRef

24.

L.J. Moran, S.K. Hutchison, R.J. Norman, H.J. Teede, Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst. Rev. 7, CD007506 (2011)

25.

M.E. Sastre, M.O. Prat, M.A. Checa, R.C. Carreras, Current trends in the treatment of polycystic ovary syndrome with desire for children. Ther. Clin. Risk Manag. 5, 353–360 (2009)PubMed

26.

A. Badawy, A. Elnashar, Treatment options for polycystic ovary syndrome. Int. J. Womens Health 3, 25–35 (2011)PubMedCrossRef

27.

L.J. Moran, M.L. Misso, R.A. Wild, R.J. Norman, Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum. Reprod. Update 16, 347–363 (2010)PubMedCrossRef

28.

A.M. Clark, W. Ledger, C. Galletly, L. Tomlinson, F. Blaney, X. Wang, R.J. Norman, Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum. Reprod. 10, 2705–2712 (1995)PubMedCrossRef

29.

A.M. Clark, B. Thornley, L. Tomlinson, C. Galletley, R.J. Norman, Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum. Reprod. 13, 1502–1505 (1998)PubMedCrossRef

30.

M.M. Huber-Buchholz, D.G. Carey, R.J. Norman, Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone. J. Clin. Endocrinol. Metab. 84, 1470–1474 (1999)PubMedCrossRef

31.

R.L. Thomson, J.D. Buckley, M. Noakes, P.M. Clifton, R.J. Norman, G.D. Brinkworth, The effect of a hypocaloric diet with and without exercise training on body composition, cardiometabolic risk profile, and reproductive function in overweight and obese women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 93, 3373–3380 (2008)PubMedCrossRef

32.

R.L. Thomson, J.D. Buckley, G.D. Brinkworth, Exercise for the treatment and management of overweight women with polycystic ovary syndrome: a review of the literature. Obes. Rev. 12, e202–e210 (2011)PubMedCrossRef

33.

R.L. Thomson, J.D. Buckley, S.S. Lim, M. Noakes, P.M. Clifton, R.J. Norman, G.D. Brinkworth, Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome. Fertil. Steril. 94, 1812–1816 (2010)PubMedCrossRef

34.

K. Marsh, J. Brand-Miller, The optimal diet for women with polycystic ovary syndrome? Br. J. Nutr. 94, 154–165 (2005)PubMedCrossRef

35.

H. Farshchi, A. Rane, A. Love, R.L. Kennedy, Diet and nutrition in polycystic ovary syndrome (PCOS): pointers for nutritional management. J. Obstet. Gynaecol. 27, 762–773 (2007)PubMedCrossRef

36.

G.U. Liepa, A. Sengupta, D. Karsies, Polycystic ovary syndrome (PCOS) and other androgen excess-related conditions: can changes in dietary intake make a difference? Nutr. Clin. Pract. 23, 63–71 (2008)PubMedCrossRef

37.

L.J. Moran, M. Noakes, P.M. Clifton, L. Tomlinson, C. Galletly, R.J. Norman, Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 88, 812–819 (2003)PubMedCrossRef

38.

K. Stamets, D.S. Taylor, A. Kunselman, L.M. Demers, C.L. Pelkman, R.S. Legro, A randomized trial of the effects of two types of short-term hypocaloric diets on weight loss in women with polycystic ovary syndrome. Fertil. Steril. 81, 630–637 (2004)PubMedCrossRef

39.

K.A. Marsh, K.S. Steinbeck, F.S. Atkinson, P. Petocz, J.C. Brand-Miller, Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Am. J. Clin. Nutr. 92, 83–92 (2010)PubMedCrossRef

40.

H.H. Mehrabani, S. Salehpour, Z. Amiri, S.J. Farahani, B.J. Meyer, F. Tahbaz, Beneficial effects of a high-protein, low-glycemic-load hypocaloric diet in overweight and obese women with polycystic ovary syndrome: a randomized controlled intervention study. J. Am. Coll. Nutr. 31, 117–125 (2012)PubMedCrossRef

41.

S.E. Kasim-Karakas, R.U. Almario, L. Gregory, R. Wong, H. Todd, B.L. Lasley, Metabolic and endocrine effects of a polyunsaturated fatty acid-rich diet in polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 89, 615–620 (2004)PubMedCrossRef

42.

C.C. Douglas, B.A. Gower, B.E. Darnell, F. Ovalle, R.A. Oster, R. Azziz, Role of diet in the treatment of polycystic ovary syndrome. Fertil. Steril. 85, 679–688 (2006)PubMedCrossRef

43.

L.J. Moran, R. Pasquali, H.J. Teede, K.M. Hoeger, R.J. Norman, Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil. Steril. 92, 1966–1982 (2009)PubMedCrossRef

44.

A. Tolino, V. Gambardella, C. Caccavale, A. D’Ettore, F. Giannotti, V. D’Antò, C.L. De Falco, Evaluation of ovarian functionality after a dietary treatment in obese women with polycystic ovary syndrome. Eur. J. Obstet. Gynecol. Reprod. Biol. 119, 87–93 (2005)PubMedCrossRef

45.

J. Holte, T. Bergh, C. Berne, L. Wide, H. Lithell, Restored insulin sensitivity but persistently increased early insulin secretion after weight loss in obese women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 80, 2586–2593 (1995)PubMedCrossRef

46.

T.L. Bützow, M. Lehtovirta, R. Siegberg, O. Hovatta, R. Koistinen, M. Seppäla, D. Apter, The decrease in luteinizing hormone secretion in response to weight reduction is inversely related to the severity of insulin resistance in overweight women. J. Clin. Endocrinol. Metab. 85, 3271–3275 (2000)PubMedCrossRef

47.

P. Andersen, I. Seljeflot, M. Abdelnoor, H. Arnesen, P.O. Dale, A. Løvik, K. Birkeland, Increased insulin sensitivity and fibrinolytic capacity after dietary intervention in obese women with polycystic ovary syndrome. Metabolism 44, 611–616 (1995)PubMedCrossRef

48.

H.S. Randeva, K.C. Lewandowski, J. Drzewoski, K. Brooke-Wavell, C. O’Callaghan, L. Czupryniak, E.W. Hillhouse, G.M. Prelevic, Exercise decreases plasma total homocysteine in overweight young women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 87, 4496–4501 (2002)PubMedCrossRef

49.

B. Bruner, K. Chad, D. Chizen, Effects of exercise and nutritional counseling in women with polycystic ovary syndrome. Appl. Physiol. Nutr. Metab. 31, 384–391 (2006)PubMedCrossRef

50.

C. Vigorito, F. Giallauria, S. Palomba, T. Cascella, F. Manguso, R. Lucci, A. De Lorenzo, D. Tafuri, G. Lombardi, A. Colao, F. Orio, Beneficial effects of a three-month structured exercise training program on cardiopulmonary functional capacity in young women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 92, 1379–1384 (2007)PubMedCrossRef

51.

S. Palomba, F. Giallauria, A. Falbo, T. Russo, R. Oppedisano, A. Tolino, A. Colao, C. Vigorito, F. Zullo, F. Orio, Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study. Hum. Reprod. 23, 642–650 (2008)PubMedCrossRef

52.

J.A. Hawley, Exercise as a therapeutic intervention for the prevention and treatment of insulin resistance. Diabetes Metab. Res. Rev. 20, 383–393 (2004)PubMedCrossRef

53.

C.L. Harrison, C.B. Lombard, L.J. Moran, H.J. Teede, Exercise therapy in polycystic ovary syndrome: a systematic review. Hum. Reprod. Update. 17, 171–183 (2011)PubMedCrossRef

54.

F. Giallauria, S. Palomba, L. Maresca, L. Vuolo, D. Tafuri, G. Lombardi, A. Colao, C. Vigorito, O. Francesco, Exercise training improves autonomic function and inflammatory pattern in women with polycystic ovary syndrome (PCOS). Clin. Endocrinol. (Oxf.) 69, 792–798 (2008)CrossRef

55.

D.S. Guzick, R. Wing, D. Smith, S.L. Berga, S.J. Winters, Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women. Fertil. Steril. 61, 598–604 (1994)PubMed

56.

G.A. Bray, Medical therapy for obesity: current status and future hopes. Med. Clin. North Am. 91, 1225–1253, xi (2007)

57.

D. Panidis, D. Farmakiotis, D. Rousso, A. Kourtis, I. Katsikis, G. Krassas, Obesity, weight loss, and the polycystic ovary syndrome: effect of treatment with diet and orlistat for 24 weeks on insulin resistance and androgen levels. Fertil. Steril. 89, 899–906 (2008)PubMedCrossRef

58.

M.A. Rubio, M. Gargallo, Isabel Millán, A., Moreno, B.: drugs in the treatment of obesity: sibutramine, orlistat and rimonabant. Public Health Nutr. 10, 1200–1205 (2007)PubMedCrossRef

59.

E. Diamanti-Kandarakis, I. Katsikis, C. Piperi, K. Alexandraki, D. Panidis, Effect of long-term orlistat treatment on serum levels of advanced glycation end-products in women with polycystic ovary syndrome. Clin. Endocrinol. (Oxf.) 66, 103–109 (2007)

60.

V. Jayagopal, E.S. Kilpatrick, S. Holding, P.E. Jennings, S.L. Atkin, Orlistat is as beneficial as metformin in the treatment of polycystic ovarian syndrome. J. Clin. Endocrinol. Metab. 90, 729–733 (2005)PubMedCrossRef

61.

A.E. Nieuwenhuis-Ruifrok, W.K. Kuchenbecker, A. Hoek, P. Middleton, R.J. Norman, Insulin sensitizing drugs for weight loss in women of reproductive age who are overweight or obese: systematic review and meta-analysis. Hum. Reprod. Update 15, 57–68 (2009)PubMedCrossRef

62.

B. Trolle, A. Flyvbjerg, U. Kesmodel, F.F. Lauszus, Efficacy of metformin in obese and non-obese women with polycystic ovary syndrome: a randomized, double-blinded, placebo-controlled cross-over trial. Hum. Reprod. 22, 2967–2973 (2007)PubMedCrossRef

63.

R. Pasquali, A. Gambineri, D. Biscotti, V. Vicennati, L. Gagliardi, D. Colitta, S. Fiorini, G.E. Cognigni, M. Filicori, A.M. Morselli-Labate, Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 85, 2767–2774 (2000)PubMedCrossRef

64.

P. Moghetti, R. Castello, C. Negri, F. Tosi, F. Perrone, M. Caputo, E. Zanolin, M. Muggeo, Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebo-controlled 6-month trial, followed by open, long-term clinical evaluation. J. Clin. Endocrinol. Metab. 85, 139–146 (2000)PubMedCrossRef

65.

J. Lord, R. Thomas, B. Fox, U. Acharya, T. Wilkin, The effect of metformin on fat distribution and the metabolic syndrome in women with polycystic ovary syndrome–a randomised, double-blind, placebo-controlled trial. BJOG 113, 817–824 (2006)PubMedCrossRef

66.

G. Ladson, W.C. Dodson, S.D. Sweet, A.E. Archibong, A.R. Kunselman, L.M. Demers, N.I. Williams, P. Coney, R.S. Legro, The effects of metformin with lifestyle therapy in polycystic ovary syndrome: a randomized double-blind study. Fertil. Steril. 95, 1059–1066.e1-7 (2011)

67.

N. Agarwal, S.P. Rice, H. Bolusani, S.D. Luzio, G. Dunseath, M. Ludgate, D.A. Rees, Metformin reduces arterial stiffness and improves endothelial function in young women with polycystic ovary syndrome: a randomized, placebo-controlled, crossover trial. J. Clin. Endocrinol. Metab. 95, 722–730 (2010)PubMedCrossRef

68.

J.P. Baillargeon, D.J. Jakubowicz, M.J. Iuorno, S. Jakubowicz, J.E. Nestler, Effects of metformin and rosiglitazone, alone and in combination, in nonobese women with polycystic ovary syndrome and normal indices of insulin sensitivity. Fertil. Steril. 82, 893–902 (2004)PubMedCrossRef

69.

T. Tang, J.M. Lord, R.J. Norman, E. Yasmin, A.H. Balen, Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, d-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst. Rev. 5, CD003053 (2012)

70.

S. Palomba, F. Orio Jr, A. Falbo, F. Manguso, T. Russo, T. Cascella, A. Tolino, E. Carmina, A. Colao, F. Zullo, Prospective parallel randomized, double-blind, double-dummy controlled clinical trial comparing clomiphene citrate and metformin as the first-line treatment for ovulation induction in nonobese anovulatory women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 90, 4068–4074 (2005)PubMedCrossRef

71.

M.T. Sheehan, Polycystic ovarian syndrome: diagnosis and management. Clin. Med. Res. 2, 13–27 (2004)PubMedCrossRef

72.

A.M. Herriot, S. Whitcroft, Y. Jeanes, A retrospective audit of patients with polycystic ovary syndrome: the effects of a reduced glycaemic load diet. J. Hum. Nutr. Diet. 21, 337–345 (2008)PubMedCrossRef

Title: Lifestyle intervention and anti-obesity therapies in the polycystic ovary syndrome: impact on metabolism and fertility
Authors: Dimitrios Panidis
Konstantinos Tziomalos
Efstathios Papadakis
Christos Vosnakis
Panagiotis Chatzis
Ilias Katsikis
Publication date: 01-12-2013
Publisher: Springer US
Published in: Endocrine / Issue 3/2013
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-013-9971-5

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