Similarly, The DIADEM-I trial demonstrated the effectiveness of intensive lifestyle interventions for young adults with early-stage T2D in the Middle East and North Africa. However, the absence of a control group, the open-label design, and the singular focus on a specific dietary intervention without a comparative analysis may compromise the robustness of the findings, limiting their applicability to diverse populations . The study, involving 155 participants, reported an average adjusted weight loss of 8.1% (95% CI 7.2–9.1) after 12 months, with 56% achieving T2D remission. In a 12-week, randomized, open-label study of 39 overweight or obese patients with PCOS, empagliflozin 25 mg/day reduced body weight, BMI, waist circumference, hip circumference and total body fat mass more than metformin 1500 mg/day (by 0.2%, 0.3%, 1.4%, 0.9% and 2.5%, respectively) (Table 3) . In these studies, the incidence of adverse events did not differ between patients who were treated with DPP-4 inhibitors and those who received a placebo or lifestyle intervention alone 58,59. Tirzepatide, a dual GLP-1 and glucose-dependent insulinotropic peptide (GIP) receptor agonist appears to induce even greater weight loss than semaglutide but has not been evaluated in patients with PCOS. In a randomized, placebo-controlled, double-blind trial of 20 patients with PCOS, licogliflozin 50 mg tid, a dual SGLT1/2 inhibitor, did not induce weight loss after 2 weeks . In an open-label, randomized trial of 41 overweight/obese patients with PCOS, canaglifozin 100 mg/day combined with metformin 1000 mg bid for 3 months induced similar reductions in weight and BMI compared with metformin 1000 mg bid monotherapy (by 6.2 kg and 2.35 kg/m2, respectively) . The weight loss effect of SGLT-2 inhibitors was preserved in studies with follow-ups up to 4 years 66,67. Apart from their role in the management of glycemia, SGLT-2 inhibitors facilitate weight loss 64,65. Cardiovascular exercises, such as brisk walking, cycling, swimming, or dancing, help burn calories and improve heart health. Research suggests that circadian fasting may help regulate blood sugar levels, improve insulin sensitivity, enhance digestion, and promote better sleep patterns. Aim to consume slightly fewer calories than your estimated needs to create a calorie deficit and promote weight loss. By promoting regularity, insoluble fiber helps to eliminate waste and toxins from the body, supporting a healthy gut environment. No, Ozempic is approved for type 2 diabetes but is sometimes used off-label to help manage PCOS symptoms like weight and insulin resistance. While it is not a cure, its ability to support metabolic health can improve symptoms and potentially fertility. Ozempic offers a promising option for women managing PCOS, particularly for those struggling with weight and insulin resistance. Combining Ozempic with a balanced diet, regular exercise, and stress management can maximize benefits. While supplements are a convenient way to ensure you're getting enough of these vitamins, it's also important to focus on dietary sources. Foods high in magnesium include leafy greens, nuts, seeds, and whole grains, which are excellent additions to a PCOS-friendly diet. In addition to its anti-inflammatory properties, Vitamin C is also crucial for collagen production, which supports skin health. By incorporating Vitamin E into your diet through foods like nuts, seeds, and green leafy vegetables, or through supplements, you can help combat these issues. This helps keep hormones balanced and aids in weight management. These problems make it hard to keep a healthy weight. Getting quality sleep is key for managing weight, especially for women with PCOS. Aim for 30 minutes of exercise, three times a week, for better health. Exercise is key for weight loss, especially for those with PCOS. Body composition (fat body mass FBM, lean body mass LBM and visceral adipose tissue VAT) was analysed by Dual X Ray Absorptiometry (DEXA) Hologic HorizonTM QDR RSeries Bedford, Massachusetts, USA.High levels of adiponectin and ghrelin appear to be essential for glucose metabolism.Starting a weight loss journey with PCOS can be tough.Emerging evidence suggests that novel cardiovascular risk factors are also deregulated in PCOS, with increased CRP 13,14, IL-6 15,16, and TNF-α levels , as well as reduced adiponectin levels observed in both obese and non-obese women with PCOS 18,19.Due to the heterogeneity in interventions, a meta-analysis was not performed, results are thus presented narratively and in tabular form.In animal models, the DPP-4 inhibitor teneligliptin improved brown adipose tissue function, reduced body weight and fat mass and increased energy expenditure 51,52,53.I encourage most of my clients to judge their progress by their energy levels, their bloodwork, how clothes fit, or their measurements.Our past longitudinal community cohort studies also show unselected community dwelling women with PCOS report a higher caloric intake, which corresponds closely to higher rates of weight gain . The ovaries of PCOS patients usually maintain a normal response to insulin. However, it is important to remark that these metabolic abnormalities may also be present in non-obese patients . Women with PCOS have increased visceral and subcutaneous body fat due to higher androgen levels. Common signs of PCOS not included in diagnostic criteria are represented by insulin resistance, reversal of the FSH/LH ratio and obesity, which is an important clinical feature of PCOS. None of the funders had any role in the design, analysis or writing of this article. Contributed to the conception and design of the study; and revised the article critically for important intellectual content and approved the final draft for publication. A.E.J. contributed to acquisition of data; interpretation of data; and revised the article for important intellectual content and approved the final draft for publication. No one dietary strategy can be preferentially recommended based on current evidence. Pooled mean differences were obtained from random-effects meta-analysis with Knapp-Hartung adjustment. Androstenedione pooled analysis of 4… CRP pooled analysis for periods of both less than and more than eight… CRP pooled analysis for periods… This was followed by 8 weeks of structured food reintroduction and 31 weeks of supported weight maintenance. Continuing the exploration of the impact of IWMPs, The DiRECT-Aus study, conducted in primary care settings across New South Wales, Australia, evaluated the efficacy of a 13-week TDR phase using Optifast products in participants with newly diagnosed T2D. The study’s retrospective design and the variable duration of follow-up among participants pose limitations, potentially introducing bias and affecting the generalisability of the results 23, 24. Impact of Weight Loss on PCOS Symptoms Regarding the duration of treatment, it is possible that life-long therapy will be required to prevent weight regain. Nausea, diarrhea and headache were the most frequent adverse events in patients treated with roflumilast . In mice, roflumilast prevented visceral fat and weight gain and reduced adipogenesis and lipolysis mediated by the AMPK pathway . The reduction in total body fat was also similar with exenatide/dapagliflozin combination and phentermine/topiramate and greater than exenatide or dapagliflozin monotherapy or dapaglifozin/metformin combination (by 1.8, 2.2, 0.8, 0.6 and 0.0%, respectively) . However, the absence of a control group, the open-label design, and the singular focus on a specific dietary intervention without a comparative analysis may compromise the robustness of the findings, limiting their applicability to diverse populations .Overall CRP pooled analysis of 9 studies 26,31,32,33,34,44,46,47,49.The interventions were also delivered by a specially trained team, which may not be available in typical clinical settings, potentially limiting the practical implementation of the program in broader healthcare contexts .Exercise is not just about burning calories; it's a powerful tool in managing PCOS symptoms.On the other hand, polycystic ovary syndrome (PCOS) represents the commonest endocrine disorder among women of reproductive age 3,4.The present review included three studies that compared the effects of monotherapy (diet/exercise) with combination therapy 16,21,24. You're not alone in your journey with PCOS and hormone management. By knowing your calorie needs and making smart food choices, you can move towards a healthier you. Losing weight with PCOS might take a bit more planning and understanding, but it's entirely possible. Hormonal imbalances increase appetite and cravings, making weight loss tough. This makes it hard for the body to control glucose levels. This condition is linked to metabolic problems like insulin resistance. Women with PCOS often struggle with weight management. Women who are pregnant or planning to become pregnant should discuss alternative treatments with their healthcare provider. Telehealth services like Doctronic.ai make it easy to consult with doctors who can evaluate your needs and prescribe medications if appropriate. Most side effects improve over time, but should be discussed with a healthcare provider. This approach helps women with PCOS navigate their treatment options confidently and improve their quality of life. Working with knowledgeable healthcare providers, including those available through telehealth services like Doctronic.ai, ensures safe, personalized care. Moreover, there was no significant difference between the two interventions with regard to weight loss, and both resulted in adequate weight loss. Furthermore, the subgroup analysis revealed that combination therapy with diet and exercise had better effects on metabolic and androgenic parameters than monotherapy. In addition, the current review performed a subgroup analysis according to the type of intervention and degree of weight loss. Combining healthy eating with exercise can lead to similar results as in women without PCOS. Recent studies highlight the need for diet and exercise changes. Studies show losing just 5% of body weight can improve insulin sensitivity. Data management and meta-analysis were performed using the RevMan program (Review Manager 5.4) for items that were reported by two or more studies. Furthermore, despite the fact that improvement in reproductive function is an important factor regarding PCOS, the effect of lifestyle interventions on the improvement of reproductive function has not been confirmed to date. A variety of balanced dietary approaches to reduce dietary caloric intake and a gradual increase in physical activity are recommended to accomplish weight loss . Hence, international evidence-based guidelines emphasize the importance of pre-pregnancy weight management among PCOS patients . (25) In addition, significant decreases in HOMA-IR and insulin levels occurred with supplementation as did favorable changes in markers of inflammation (e.g. hs-CRP, adiponectin levels). Bariatric surgery is especially promising for decreasing weight in adults and youth, and reversing type 2 diabetes in youth, though PCOS data are lacking. Whereas there are promising data on anti-obesity medications such as glucagon like peptide-1 receptor agonists in adults with PCOS and adolescents with obesity, further work is needed to know if these therapies are effective in youth with PCOS. There is limited data that vitamins, nutraceuticals and probiotics may improve hormonal and metabolic outcomes. With the right help, you can overcome dieting ups and downs and manage your health. An initial overall meta-analysis for CRP was performed for all included investigations. To assess the statistical heterogeneity between studies, the chi-square test and I-squared (I2) statistics were utilised. The original Newcastle–Ottawa scale for nonrandomised studies assesses three main categories, including selection, comparability, and outcomes, giving a maximum of four, two, and three stars for each category, respectively . Four intervention groups from three studies reported results for blood lipids 31,35,39. Three intervention groups from two studies reported OGTT-glucose 30,39. The majority of studies did not report whether there were between-group statistical significance, and three studies 35,43,44 reported that there was no statistically significant difference in fasting glucose post-intervention between the two groups (Table 4). Eleven intervention groups from nine studies reported fasting glucose 30,31,35,38,39,40,43,44,46. There has been extensive prior research on the metabolic and weight effects of metformin in PCOS, with conflicting results secondary to varied inclusion criteria and dosing, although as above, meta-analysis is favorable for weight loss in adolescents.(40) Newer data are from studies that included a metformin arm compared to another medication, which show minimal weight loss when added to a COCP (41), or increased weight loss in women with PCOS and obesity who received 1500 mg/day metformin for 6 months (average weight loss of −6.81 (−7.51 to −6.10) kg).(4) A retrospective study that included ten adolescents with PCOS 42) There is increased interest in understanding the specific effects of distinct types of exercise on PCOS and its co-morbidities.(33) In an RCT of women with healthy weight or obesity with PCOS, continuous aerobic training (30–50 minutes at 65–80% maximum heart rate) or intermittent aerobic training (eight, 2-minute intervals at 70–90% maximum heart rate) over 16 weeks were compared to no training.(5) Neither training protocol had an effect on body weight, body composition, fasting glucose, insulin or HOMA-IR.(5) Continuous training improved total TC, LDL-C and TT, while the intermittent regimen decreased waist circumference, TT and the FAI.(5) This study suggests that exercise routines of varying intensity may differentially effect health outcomes in PCOS.(5) First line therapy for adolescents with PCOS and excess weight include lifestyle modifications encompassing diet, exercise, and behavior change.(12) In those who have excess weight, weight loss is paramount for not only treating hormonal aspects of PCOS but mitigating metabolic risk.(1) The goal of this review is to highlight recent advances in lifestyle, psychologic, pharmacologic, and surgical management of obesity in adolescents with PCOS, which have evolved since the release of the 2018 international guidelines.(1) This review will not include animal studies, and for the most part does not include trials with a focus on lean adolescents with PCOS. The aim of this systematic review is thus to assess the effect of lifestyle (dietary and non-dietary) weight management interventions on anthropometric, reproductive and metabolic outcomes in women with PCOS, compared to women without PCOS. However, despite an inherently higher risk of metabolic morbidity, there is a notable absence of research focused on the application of IWMPs specifically for women with PCOS. A recent systematic review, encompassing studies published up to July 2022, identified eight trials evaluating the efficacy of GLP-1RAs in women with PCOS. Lastly, STEP 5 demonstrated the durability of weight loss with semaglutide, maintaining a 12.6% point reduction over placebo at two years . In STEP 1, 1961 participants achieved an average 14.9% reduction in body weight over 68 weeks, substantially outperforming the placebo group’s 2.4% reduction, with 86.4% of the treatment group losing at least 5% of their body weight . Moreover, the trial faced significant disruptions due to the COVID-19 pandemic, which impacted participant follow-up and data collection, possibly affecting the study’s outcomes . Blood viscosity was significantly increased in the lean PCOS group at lower shear rates compared to controls . Researchers proposed that IR needs to be ascertained at an early stage in PCOS, even in women with low BMI and normal glucose tolerance . Testosterone is thought to stimulate erythropoiesis in a dose-dependent manner 51, 52, which may explain why PCOS groups had higher haemoglobin levels . In the present review, we discuss the current evidence on the safety and efficacy of these agents in overweight and obese patients with PCOS. Most reports assessed glucagon-like peptide-1 receptor agonists and showed a substantial reduction in body weight. Lifestyle modifications, restoration of ovulation with the use of pharmacological interventions and even IVF in refractory cases, can provide symptomatic relief and increase chances of successful pregnancy. Our objective was to evaluate the effects of IWMPs and GLP-1 RAs on weight loss and markers of metabolic morbidity in women with PCOS combining results from published literature. They may be effective for weight loss and reducing metabolic morbidity in women with PCOS at lower thresholds. Thus, an optimal weight management strategy to reduce metabolic morbidity in the specific subgroup of women with PCOS is lacking. The interventions are delivered at various tiers of the health service and the choice of intervention depends on body mass index (BMI) and the presence of co-morbidities. In a 32-week, randomized, double-blind, placebo-controlled trial of 67 obese women with PCOS, 57% of patients treated with liraglutide 3 mg/day experienced ≥5% weight loss compared with 22% in the placebo group . Our results are also in agreement with a systematic review published in 2014 that assessed the effectiveness of lifestyle interventions including exercise with or without diet intervention on the endocrine profile of PCOS individuals . Characteristics of the 11 included studies investigating changes in circulating inflammatory markers and androgens in PCOS women undergoing diet-induced weight loss. Lifestyle Changes and Stress Management Inclusion criteria were all prospective long-term (12 months) studies of women with a diagnosis of PCOS and mean body mass index (BMI) ≥28 kg/m2, where weight loss was a primary or secondary outcome measure. A systematic review was undertaken to evaluate the success of long-term (≥12 months), nonsurgical weight loss interventions for women with PCOS and to identify counseling strategies used in these interventions. It is important to evaluate long-term (≥12 months), nonsurgical weight loss interventions, with and without behavioral or lifestyle counseling and support, and to identify effective counseling strategies for the development of standard counseling protocols for comparison. A systematic review of the literature was carried out to assess the efficacy of long-term (12 months), nonsurgical weight loss interventions for women with PCOS. Weight Management in Adolescents with Polycystic Ovary Syndrome However, there are multiple options to optimize weight loss in dietary, activity, pharmacotherapy, bariatric surgery, mood modification and sleep domains. Adolescents with PCOS and obesity may have greater sleep-related risks including circadian misalignment and obstructive sleep apnea, interventions for which have not yet been conducted. Metformin is often the first choice for weight management in PCOS patients. The patients, moreover, do not “heal” with the use of the oral contraceptives and after the suspension they often have irregularities of the cycle, so that most of them are forced to undertake therapies to induce ovulation, usually with clomiphene, as suggested the guidelines .Recent evidence suggests that mito-nuclear communication plays a crucial role in PCOS pathophysiology, with mitochondrial epigenetic modifications affecting nuclear gene expression and metabolic regulation.Given the limited number and the small size of the reviewed studies, the results of this review should be interpreted with caution.However, unlike IWMPs, GLP1-RAs have been trialled specifically in women with PCOS and reported to induce weight loss and improve markers of metabolic morbidity .Furthermore, in a comparison between Teen-LABS and LABS studies, adolescents with T2D who underwent Roux-en-Y gastric bypass had significantly higher remission rates than their adult counterparts (86 versus 53%, risk ratio 1.27, 95%CI 1.21–1.88) at 5 years postoperatively.(70) These data underscore the potential increased benefits of early MBS intervention among high-risk adolescents, which may include those with PCOS.As hormonal balance is restored through weight management, ovulation rates often increase.The potential importance of macronutrient composition in diet has been extensively studied and there is currently insufficient evidence to support a particular macronutrient dietary composition in women with PCOS for weight loss.7The time factor is particularly relevant to BMS, as women are advised not to get pregnant for at least 12–18 months postsurgery 32 with a minimum interval of 12 months due to risk of nutritional deficiencies and rapidity of weight loss with careful consideration of further reduction in this time interval in select cases after assessing potential risks.33 However, it must be noted that there is uncertainty as to the benefit of this delay between surgery and pregnancy.34 Keep in mind that while supplements can potentially support your efforts, it’s always wise to consult with a healthcare professional before adding them to your routine. Find activities that help you relax and unwind, and prioritize self-care to reduce stress levels. Gradually increase intensity and duration as your energy levels improve, but remember to prioritize self-care and rest when necessary. Listen to your body and modify your workouts when needed. Fatigue is a common symptom experienced by individuals with PCOS, making it essential to balance exercise with rest and recovery. In women with PCOS, incremental weight gain increases the severity of their insulin resistance, but conversely, losing weight can help bring their insulin levels to more manageable levels. The link between PCOS and obesity forms a cycle where obesity can worsen PCOS symptoms and PCOS can make weight management more challenging. While not all individuals with PCOS are obese, there is a higher prevalence of overweight and obesity among women with PCOS compared to the general population. Lifestyle modification as a first-line treatment of obese women with PCOS may effect outcomes, and accompanying moderate weight loss is also expected to improve the metabolic index. The present systematic review studied the efficacy of lifestyle modification in the management of obese PCOS patients using the most updated data. Future studies should have robust study designs, such as randomised controlled trials with well-defined control groups, and with sufficiently calculated sample size to ensure sufficient statistical power. Interestingly, this meta-analysis presents possible evidence indicating a positive association between chronic inflammation and reproductive endocrine hormones (androstenediones, and LH) in PCOS women. Additionally, following a healthy diet could reduce oxidative stress and lower inflammatory markers 61,62. Additionally, weight loss could increase the production of adipokine, which has anti-inflammatory effects . Another limitation is the insufficient data for adiponectin, leading to its inclusion in the systematic review only but not rather in the meta-analysis. Though there isn’t a cure for PCOS, some medications can help manage symptoms. Too much exercise can also put you at risk for injury, especially if you push yourself past your physical limits. Research also confirms that extreme calorie-cutting ends with most people regaining weight, especially for those who return to poor eating habits. It may take you longer to lose weight than someone without hormonal imbalances. To help on your journey to good health, Dr. Ayazo recommends following these steps for success. These practices help keep your emotions stable and support a healthy lifestyle. Chronic stress can upset hormone levels, leading to weight gain. Stress management is key for weight control in PCOS. Regular exercise is crucial for managing weight with PCOS. Telehealth services like Doctronic.ai provide a convenient way to connect with experienced doctors from home. A healthcare provider can monitor for side effects, adjust dosages, and ensure the medication fits the patient’s overall health plan. Women planning to conceive should discuss stopping the medication with their healthcare provider. Several dietary models have been proposed to correct the metabolic alterations of PCOS, but no one has reached, at the moment, a scientific validation as the best to recommend and it is still not clear even if normal weight, or overweight women may take benefit from a suitable dietary program to improve insulin resistance without caloric restriction. However, significant weight loss may take a few months, especially when combined with a healthy diet and regular exercise. Recent studies frequently highlight the role of Inositol, particularly Myo-Inositol, in improving insulin sensitivity and promoting weight loss in women with PCOS. What Is Polycystic Ovary Syndrome (PCOS) As discussed by March et al,2 this may have led to the inclusion of different phenotypic groups in the reviewed studies. Possible reasons for this difference were not discussed, but may reflect lesser participant satisfaction with EE/CPA during the first stage of the study when attrition rate is traditionally higher and benefits have yet to be seen. However, there was a notable difference in attrition rates in each arm of this study with the EE/CPA group having a higher noncompletion rate than in the rosiglitazone arm. In addition to vitamins for PCOS weight loss, managing PCOS often requires a holistic approach that includes regular exercise, stress management, and a balanced diet. Weight management, particularly through weight loss, can significantly improve insulin sensitivity, helping to regulate menstrual cycles and reduce male hormone levels. The first-line treatment is lifestyle interventions though the weight loss and any impact on fertility are limited. Several studies showed that in patients treated with SGLT-2 inhibitors, weight loss is accompanied by total body fat mass and VAT volume reduction 66,68. Few studies evaluated the effects of liraglutide 3.0 mg/day, i.e., the dose indicated for the management of obesity. Major studies evaluating the effects of glucagon-like peptide-1 (GLP-1) receptor agonists on obesity in patients with polycystic ovary syndrome. A number of studies evaluated the effect of GLP-1 agonists on weight in patients with PCOS (Table 1). The STANDby trial sought to evaluate the effectiveness of a structured weight management program, specifically designed for South Asians with T2D, through a TDR phase followed by food reintroduction. Weight regain was inversely related to initial weight loss and participant age, and directly related to the follow-up duration. Moreover, 45% of the TDR group lost at least 10% of their initial body weight, as opposed to 15% in the usual care group. This randomized controlled trial (RCT), conducted in the UK, included an 8-week TDR phase, followed by a 4-week food reintroduction and ongoing behavioural support for weight management. 34% of participants who initially achieved remission of T2D continuing to remain in remission, underlining the program’s long-term effectiveness in metabolic health improvement 18–20. The outcome measures were body weight, BMI, FBM, LBM, FBM percentage, LBM percentage, glucose, insulin, HOMA-IR, total cholesterol, HDL, LDL, triglycerides, total testosterone, free testosterone, progesterone, estradiol, LH, FSH, DHEAS, LH/FSH ratio, SHBG and Ferriman Gallwey Score. Thus, aim of the present study was to determine the effects of a ketogenic diet (KD) in women of childbearing age with a diagnosis of PCOS. However, even though lifestyle modification based on the principles of caloric restriction remains a primary therapy for PCOS and caloric restriction seems more important than macronutrient composition 13, 14, little data are available about diet’s macronutrient modification as therapeutic approach 15–17. Therefore, diet and exercise, not metformin, should be the first line of therapy in obese women with PCOS. Sustainability of weight loss was a primary aim.In another cohort study by Glueck et al13 on the effects of metformin + diet vs metformin + diet + pioglitazone in metformin nonresponders, pioglitazone had little effect on weight loss. The diet + metformin group achieved In the third RCT with cross-over design, Lemay et al17 found no significant weight loss in the groups that received rosiglitazone, oral contraceptive (EE/CPA), and a combination of the two drugs, and these data were not reported in the article. Trials of nonsurgical, long-term weight loss interventions and their impact on weight change In this study, significant weight loss was seen in groups receiving lifestyle education and support, with and without metformin (−8.9 ± 2.9 kg and −6.8 ± 3.8 kg, respectively), and in the group receiving only metformin (−6.5 ± 3.7 kg), but not in the placebo group (−0.2 ± 0.8 kg). Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects millions of women worldwide. Here are 20 healthy meals from a variety of cuisines that won’t pack on the pounds. I’ve been specializing in PCOS for over 20 years and helped thousands of women. When you don’t get enough sleep, your body releases more ghrelin, which stimulates appetite, and release less leptin, which suppresses appetite. Plus, insulin resistance messes with your hunger and satiety signals, making you more prone to overeating and craving all those high-calorie treats.However, getting enough of these vitamins through diet alone can be challenging, which is why supplementation is often recommended, especially for those with PCOS.Many women with PCOS are resistant to the action of insulin in their body and produce higher levels of insulin to overcome this.Understanding PCOS and Its ChallengesPolycystic Ovary Syndrome, or PCOS, affects millions of women worldwide.Vitamin D deficiency is common in women with PCOS and is linked to insulin resistance and obesity.PCOS is linked to various metabolic disorders, including obesity, insulin resistance, T2DM and CVD 7,8,9,10.Out of 71 studies initially identified, only eight met the inclusion criteria for this review. How Weight Loss Supports Fertility Losing weight with PCOS (Polycystic Ovary Syndrome) is a unique challenge. Let us break down how many calories you should be eating, how PCOS impacts weight, and some tips to help you along the way. When you have Polycystic Ovary Syndrome (PCOS), losing weight can sometimes feel like an uphill battle. You can be diagnosed with PCOS due to many reasons, such as hormonal disorders, genetic conditions and poor lifestyle habits, which need to be managed with expert guidance.Anyway, metformin does not increase weight loss in patients treated with lifestyle modifications (diet and exercise programs).It might be tough, but with the right info, you can lose weight with PCOS.PDE-4 inhibitors have been evaluated for the treatment of several diseases, including chronic obstructive pulmonary disease and metabolic disorders such as T2DM, obesity and hypertension .Understanding this connection helps create more effective weight management strategies.Hirsutism scores and menstrual regularity also improved.(29) Co-supplementation with therapeutic doses of vitamin D and a probiotic (Lactobacillus acidophilus, Bifidobacterium bifidum, Lactobacillus reuteri and Lactobacillus fermentum) supplying 8×109 colony-forming units/day in women with PCOS over 12 weeks improved TT, hirsutism, hs-CRP, and measures of antioxidant capacity.(30)The haemorheological profile, or study of blood constituents and flow, of lean young women with PCOS was found to be deranged in this cohort of women.In the third RCT with cross-over design, Lemay et al17 found no significant weight loss in the groups that received rosiglitazone, oral contraceptive (EE/CPA), and a combination of the two drugs, and these data were not reported in the article.High cortisol levels, linked to weight gain, can be lowered. In addition, the current review assessed the clinical outcomes of lifestyle modification programs. In the current review, age, definition of obesity, and the criteria used to diagnose PCOS were recorded as the characteristics of the participants. The reviewers performed data extraction using a prearranged data extraction form and double-checked the same. The present study excluded review articles, abstracts, conference posters, articles written in languages other than English, and duplicate publications. Only studies that matched and/or adjusted for age and BMI and measured circulating CRP, TNF, IL-6 and/or testosterone were included. Hormonal manifestations in PCOS involve increased serum concentrations of androgens including testosterone, DHEAS, and androstenedione , and reduced sex hormone-binding globulin (SHBG) levels . Adipose tissue releases various bioactive substances known as adipocytokines, including leptin, TNF-α, IL-6, IL-18, plasminogen activator inhibitor type 1, and adiponectin, which further contribute to inflammation and metabolic disorders 9,10. Insulin is a hormone that controls sugar levels in the body. More than half of these women do not have any symptoms. Get the latest information from our Mayo Clinic experts on women’s health topics, serious and complex conditions, wellness and more. A systematic search (Supplementary Table S2) was developed incorporating terms related to weight management (including lifestyle, behaviour, pharmacological, surgical and complementary and alternative interventions) and combined with terms related to PCOS.However, weight loss can lead to substantial symptom relief and improve overall well-being, making it a powerful tool in managing PCOS.Using telehealth can help women with PCOS get timely answers, adjust treatments like Ozempic safely, and track progress without frequent in-person visits.Studies show that women with PCOS can see big improvements by making lifestyle changes.A variety of balanced dietary approaches to reduce dietary caloric intake and a gradual increase in physical activity are recommended to accomplish weight loss .Insulin resistance was increased in women with PCOS compared with controls and this included lean PCOS women and their control counterparts.Exercise helps improve insulin sensitivity, which can combat insulin resistance – a common issue for people with PCOS.Up to 75% of lean PCOS women and as high as 95% of obese PCOS women are reported to have insulin resistance . But I’m actually a fan of keeping a journal on good old paper and pen because it lets you collect a lot more data. So unless you deal with these 2 sneaky culprits, you’ll probably have trouble losing weight and, more importantly, keeping it off! Chronic stress can lead to excessive cortisol production, which can cause weight gain or make it more difficult to lose weight. And for the record, I don’t recommend a very low-carb diet for the majority of people. Now if you really want to try a “diet” short term to gain some momentum, then go for it. Trying to follow unrealistic diets only increases the chances that your eating may become disordered. Not a very healthy cycle! There is a need for further investigation and comparison of weight loss interventions based on behavioral change, with and without concurrent drug therapy. In view of the chronic nature of obesity, effective, long-term self-management of weight must be the key to reducing costs, in health and in social and economic terms of this burgeoning pandemic. Approaches to weight loss interventions remain variable, and intervention strategies have been poorly described in the literature. The results of this review, particularly for the study by Hoeger et al,20 support the view expressed by Brown et al7 that ongoing support and education is an important component of a weight loss intervention, enhancing the effects of drug therapies. Lemay et al’s17 study of rosiglitazone + diet vs oral contraceptive (EE/CPA) + diet was not primarily aimed at weight loss, and this lack of emphasis may explain the lack of weight change. In a meta-analysis of three randomized controlled studies, liraglutide reduced body weight more than metformin . In a 12-week, open-label, randomized study of 28 obese women with a new diagnosis of PCOS, liraglutide 1.2 mg/day and metformin 1000 bid induced similar reductions in weight (−2.52 kg), BMI (−0.98 kg/m2), waist circumference (−3.38 cm) and total body fat mass (−1.26%) . However, weight loss is frequently suboptimal, even in patients who adhere to lifestyle recommendations . Indeed, a 5–10% weight loss is sufficient to ameliorate the metabolic and reproductive abnormalities in patients with PCOS . Several epidemiologic studies suggested that weight loss and adipose fat loss improve fertility and ovulation rates in obese women with PCOS 15,16,17. Our findings are that there is insufficient evidence to indicate significant differences in weight loss in women with PCOS compared to women without PCOS with lifestyle or weight management strategies. In this systematic review, we evaluated for the first time the effect of weight management interventions in women with PCOS compared to women without PCOS. One study with an anti-obesity drug intervention (Orlistat) + a hypocaloric diet + exercise intervention reported a statistically significant difference in total, LDL and HDL cholesterol post-intervention between groups, with women in the PCOS group having lower mean values (Table 5). Interventions varied across the included studies (diet, diet + behavior change program, diet + Metformin, diet + anti-obesity drug, anti-obesity drug, diet + anti-obesity drug + exercise, bariatric surgery, and various exercise training programs), as did the duration of interventions. It has been proposed that weight management interventions may be less effective in women with PCOS compared to those without PCOS given the higher rate of longitudinal weight gain in PCOS . Considering the lack of increased live birth despite increasing ovulation and pregnancy following LBIs and modest weight loss29 and the increased live births after VLED and pharmacotherapy with about 10% weight loss, it can be stipulated that the degree of weight loss might be important to improve pregnancy outcomes in women with obesity and subfertility beyond improving ovulation rates. The risk of SGA following bariatric surgery is likely related to the catabolic state and weight loss during pregnancy if the pregnancy occurs within the first 12 months postsurgery as these women can continue to lose weight even during pregnancy.28 Despite a lower weight, women who get pregnant at a longer interval postsurgery have a reduced risk of neonatal complications compared to those who get pregnant within the first 12 months.28 Small numbers of RCTs and uncontrolled studies have assessed the impact of obesity pharmacotherapy on fertility outcomes in women with overweight or obesity (with or without PCOS; Table 1). VLED, that achieve greater weight loss, can improve fertility and pregnancy outcomes in women with obesity, although these trials were not PCOS specific and the dropout was high. The potential importance of macronutrient composition in diet has been extensively studied and there is currently insufficient evidence to support a particular macronutrient dietary composition in women with PCOS for weight loss.7 During semaglutide treatment, significant weight loss occurred, decreasing from 101 kg to 92 kg, and metabolic and endocrine parameters improved. Furthermore, another study published in 2024, examined the long-term outcomes in 25 obese women with PCOS who continued metformin treatment for 2 years after a 16-week intervention with Semaglutide. The treatment resulted in a mean weight loss of 11.5 kg and improvements in metabolic parameters. In a 2023 study, 27 women with PCOS unresponsive to lifestyle changes alone were treated with semaglutide (0.5 mg subcutaneously, once weekly) for six months. Meta-analysis revealed no significant differences between exenatide and metformin in terms of anthropometric, biochemical hyperandrogenism, or metabolic outcomes, except that metformin resulted in a greater reduction in fasting blood glucose compared to exenatide . Adiponectin is secreted by adipocytes and is involved in lipid and glucose homeostasis , insulin sensitisation and possesses antidiabetic properties 42, 43. The greater prevalence of T2DM, impaired glucose tolerance and endometrial hyperplasia in the obese cohort mean that they are at a greater risk of morbidity at a younger age than lean PCOS patients and need to be treated using a ‘more rigorous’ approach . The prevalence of T2DM was higher amongst the overweight group as was impaired glucose tolerance. There were also no differences in clinical manifestations of PCOS between the lean and overweight subgroups, such as hirsutism, hyperandrogenism and findings from pelvic ultrasonography. However, IR was not significantly different amongst patients with positive or negative family histories of T2DM in a similar trial . Two studies, by Gambineri et al,18 and Hoeger et al,20 reported similar results for their diet and lifestyle + placebo arms; however, Gambineri et al’s18 results indicated a wide range of individual results. In the three studies reported by Glueck et al, only data from participants who completed the intervention were included. In the third RCT with cross-over design, Lemay et al17 found no significant weight loss in the groups that received rosiglitazone, oral contraceptive (EE/CPA), and a combination of the two drugs, and these data were not reported in the article. This lifestyle adjustment holds promise in enhancing metabolic health by addressing insulin resistance and metabolic disruptions. In addition, future research could also explore the possible effect of weight loss intervention on emerging inflammatory pathways including the NLRP3 inflammasome and its related components (such as Casp-1, ASC, and IL-1β) in PCOS patients. Given the above-mentioned limitations of this review, further adequately designed and sufficiently powered studies are needed to further assess the impact of diet-induced weight loss on PCOS-related chronic inflammation and hyperandrogenism. If you have signs and symptoms of PCOS, they'll usually become apparent during your late teens or early 20s.Based on our findings reported elsewhere 21,22, recommendations in PCOS for lifestyle or pharmacological intervention and weight management should mirror those for the general population.Metabolic morbidity worsens in individuals who are overweight and obese with a linear correlation to adiposity 44, 45.Studies indicate that people with PCOS have a tougher time losing weight with exercise than people without PCOS.Low density lipoprotein (LDL) and total cholesterol were also significantly raised in women with lean PCOS versus controls.Publication bias could not be evaluated owing to the inadequate number of studies included in the meta-analysis.These results are concurrent with the results reported by previous studies, which observed that lifestyle modification programs have positive effects on anthropometric indices .While lifestyle behavioural modifications are generally accepted as first‐line treatment, the time available for the patient to achieve pregnancy or receive assisted conception treatments, the likelihood of success of the treatment option, the baseline BMI, other personal factors such as treatment availability and affordability as well as the amount that the patient needs to lose to pursue IVF should be considered to personalize the treatment plan. Women with PCOS often have elevated serum insulin and IR, regardless of androgen concentrations and their levels of ‘adiposity’ . Another effect of insulin is to decrease sex hormone binding globulin (SHBG) synthesis in the liver, resulting in elevated levels of free androgens . Subsequent elevations in insulin-like growth factor-1 (IGF-1) and growth hormone levels mean that more amino acids are available for growth . Up to 70% of women with hyperandrogenism present with hirsutism, or excess body hair. This review highlights the potential role of interventions such as IWMPs and GLP-1 RAs in managing these risks but acknowledges the limited robust evidence specific to women with PCOS. Another notable gap is the insufficient engagement of patients in the design and implementation of weight management programs, which may impact adherence and long-term success. Intensive regimes for exercise are moderately effective in inducing short term weight loss but are not sustainable in the long term 56, 57. Insulin sensitisers such as metformin improve insulin sensitivity but have minimal impact on weight loss 52–54. Lifestyle advice, which is universal, is delivered in primary care, and includes advice on an active lifestyle, exercise and diet. In a randomized, single-blind study of 34 patients with PCOS, metformin 2000 mg/day, saxagliptin 5 mg, and the combination of saxagliptin 5 mg and metformin 2000 mg/day for 16 weeks induced similar reductions in BMI and waist circumference (by 0.8 kg/m2 and 2.5 cm, respectively) . Few studies evaluated the effects of DPP-4 inhibitors in patients with PCOS (Table 2). In animal models, the DPP-4 inhibitor teneligliptin improved brown adipose tissue function, reduced body weight and fat mass and increased energy expenditure 51,52,53. Finally, some studies evaluated the combination of exenatide with metformin compared with monotherapy. Scientists are still studying the causes of PCOS and the best ways to treat it. Unfortunately, there’s a lot we don’t know about PCOS and all of the different ways this condition makes it harder to lose weight. If you have PCOS and are trying to lose weight, you may feel frustrated that you’re doing everything “right” while the scale isn’t budging. Patients with PCOS often find it’s much harder to lose weight than it is for those without PCOS—and much easier to gain weight unintentionally. Between 4 and 20% of reproductive-age women have polycystic ovarian syndrome (PCOS). Regular supplementation also boosts your energy levels, making it easier to maintain an active lifestyle, which is crucial for sustainable weight loss. Sources include scientific studies and authoritative health websites that focus on PCOS and weight loss. Incorporating the right vitamins for PCOS weight loss into your diet is a powerful way to support weight loss and manage PCOS symptoms. Along with a balanced diet and regular physical activity, these nutrients can help you overcome some of the barriers that make weight loss difficult for women with PCOS. Incorporating a magnesium supplement can help balance insulin levels and support weight management. Beyond these symptoms, many women with PCOS struggle with insulin resistance and weight gain, which can complicate their overall health and fertility. While these interventions have demonstrated benefits for weight loss and metabolic improvement, challenges remain, including variability in patient uptake, adherence, and long-term sustainability. Additionally, existing studies often lack long-term follow-up data, raising concerns about the sustainability of weight loss and metabolic benefits over time. IWMPs, including total diet replacement, achieve substantial and sustained weight loss (5–15% over 1–5 years) in individuals with obesity and type 2 diabetes, alongside improvements in metabolic markers like blood pressure and glycemic control. If you have PCOS and you're overweight, losing weight and eating a healthy, balanced diet can make some symptoms better. In Zulian et al’s14 comparison of spironolactone vs spironolactone + lifestyle modification, only participants in the latter group lost significant weight. This was also a nonintensive study, in which participants were initially provided with dietary instruction and received annual dietary follow-up. A 1200-kcal diet was prescribed, and aerobic exercise such as swimming or aerobics was recommended, but without prescribed duration or frequency. Of the 38 participants (metformin group 4, lifestyle + placebo group 5, lifestyle + metformin group 4, and placebo group 2), 13 failed to complete the intervention, resulting in an overall attrition rate of 39.5%. Of the five cohort studies, one lasted for 4 years, but only data obtained within 1 year is reported here; three were carried out by the same principal author. The presence of metabolic morbidity significantly increases the risk of all-cause mortality, irrespective of obesity status . While IWMPs and GLP-1 RAs are promising interventions, evidence for their effectiveness in PCOS-specific populations is insufficient. Understanding this connection helps create more effective weight management strategies. Weight management with PCOS presents unique challenges due to hormonal imbalances and insulin resistance. Six studies including eight intervention groups reported weight as endpoint data 31,38,39,42,45,46, whilst a further three studies reported change in weight 34,41,43, and one study reported the estimated difference in weight from baseline to post-intervention (Table 2). A systematic search (Supplementary Table S2) was developed incorporating terms related to weight management (including lifestyle, behaviour, pharmacological, surgical and complementary and alternative interventions) and combined with terms related to PCOS. Weight loss, in turn, improves all the features of PCOS, and lifestyle (diet, physical activity and behavior) changes and weight management are recommended as first line treatment for PCOS 21,22 to improve hormonal disturbances and to prevent future reproductive and metabolic complications. Get Your 7-Day Customized PCOS Meal Plan In a meta-analysis of three randomized controlled studies, liraglutide reduced body weight more than metformin .However, it remains unclear whether weight loss has a discernible effect on inflammatory markers in women with PCOS.The aforementioned result is concurrent with the updated international evidence-based guidelines that recommend a healthy lifestyle involving a healthy diet and regular physical activity for the management of patients with PCOS .Hence most women with PCOS are treated with less intensive interventions, and specialist weight management services are either never initiated or initiated at a much higher body mass index (BMI) or after the development of co-morbidities.There was no description of weight monitoring or support for this group.Polycystic Ovary Syndrome, or PCOS, affects millions of women worldwide.Further subgrouping analysis of CRP data was conducted with a diet period more or less than 8 weeks.Cardiovascular exercises, such as brisk walking, cycling, swimming, or dancing, help burn calories and improve heart health.The prevalence of PCOS among women of reproductive age varies, ranging from 6% to 25% depending on the diagnostic criteria used . Bibliographies of relevant articles were also searched for identification of additional studies. This may be related to the hormonal aberrations of PCOS such as hyperandrogenemia or IR, contributing to abnormalities in energy homeostasis and dietary intake including gut hormone regulation 25,26, or an altered metabolism due to reduced postprandial thermogenesis . Obesity, especially central obesity, worsens the clinical and biochemical presentation of the syndrome, contributing to IR, hyperandrogenism, reproductive disorders, diabetes and cardiovascular disease 18,19,20. PCOS also accounts for the majority of cases of anovulatory infertility , and women with PCOS have an increased risk of pregnancy and neonatal complications . So, make it a habit to incorporate these delicious and tangy treats into your diet. They’re a secret weapon when it comes to keeping your gut healthy and happy. Not only does it make PCOS symptoms worse, but it could also be involved in the condition developing itself. Turns out, an “unhealthy microbiome” might be playing a major role in PCOS. Trust me, your body will thank you for ditching the inflammation-causing culprits!