Effects of lifestyle intervention in overweight women with polycystic ovary syndrome : aspects on reproduction, metabolism, psychological well-being and sleep

Lifestyle intervention is the first line treatment for many symptoms in women with polycystic ovary syndrome (PCOS). However, the efficacy of this treatment in comparison to minimal intervention for improving aspects such menstrual function is still unclear.

The objective of this study was to assess the efficacy of a behavioral modification intervention in comparison to minimal intervention on a number of parameters, such as menstrual function, body weight and composition, endocrine- and metabolic-variables, psychological well-being, objectively measured sleep variables, as well as inflammatory proteins in over-weight/obese women with PCOS. Furthermore, we wanted to compare the sleep in our PCOS population with healthy non-PCOS controls but with a similar age and body weight.

We designed a randomized controlled trial where 68 over-weight/obese women, fulfilling all Rotterdam PCOS diagnostic criteria were randomized on a 1:1 ratio to 4 months of either behavioral modification intervention (intervention) or minimal intervention (control treatment), with a further assessment at 12 months. All participants were aged 18-40 years with a BMI ≥ 27 kg/m2.

Following the 4-month intervention, we found that a higher proportion of women having received the intervention improved menstrual function compared to control treatment, mean difference 35% (95% CI:16-60), P = 0.003. In addition, the weight loss in the intervention group was small but significant (-2.1%, P = 0.002), however we found no difference between the groups. At the 12-month follow-up, we found within group improvements in menstrual function, ovulation, body weight, biochemical hyperandrogenism, insulin resistance and blood lipids. Furthermore, the over-weight/obese women with POCS had a severely impacted psychological well-being compared to that of a general population. At baseline 60% of the women had a global well-being score corresponding to severe distress and 40% to moderate distress. However, some aspects of well-being improved following intervention (reduced levels of anxiety, P = 0.035, increased general health P = 0.012 and less depressed mood P=0.033). In terms of sleep, we demonstrated that the sleep duration for the women with PCOS (7.2 hours) was within the normal range, but that the amount of sleep was shorter and the sleep efficiency lower than for the healthy controls (P = 0.049 and P <0.001, respectively). Furthermore, the intervention appeared to reduce the amount of daytime sleep. At the 12-month follow-up, we also found improvements in a number of inflammatory proteins including proteins associated with neurodegeneration, autophagy and atherogenesis.

In conclusion, we believe behavioral modification intervention is a useful tool to improve menstrual function as well as other POCS symptoms in over-weight/obese women with PCOS, in particular where fertility is the key concern.

List of scientific papers

I. Oberg E*, Gidlöf S*, Jakson I, Mitsell M, Tollet Egnell P, Hirschberg AL. Improved menstrual function in obese women with PCOS after behavioral modification intervention – A randomized controlled trial. Clinical Endocrinology. 2019;00:1-11. *Shared first author.
https://doi.org/10.1111/cen.13919

II. Oberg E*, Lundell C*, Blomberg L, Gidlöf SB, Egnell PT, Hirschberg AL. Psychological well-being and personality in relation to weight loss following behavioral modification intervention in obese women with polycystic ovary syndrome: a randomized controlled trial. European Journal of Endocrinology. 2020 Jul;183(1):1-11. *Shared first author.
https://doi.org/10.1530/EJE-20-0066

III. Oberg E, Blomberg L, Åkerstedt T, Hirschberg AL. Different sleep pattern in over-weight/obese women with polycystic ovary syndrome. [Submitted]

IV. Oberg E*, Gunn H*, Alvarsson M, Viner R, Hällqvist J, Heywood W, Mills K, Brismar K, Hirschberg AL. Markers of inflammation in overweight women with PCOS following behavioral modification intervention. *Shared first author. [Manuscript]