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Management
Obesity and Polycystic Ovary Syndrome
➤ Diagnosis can be established based on varying sets of criteria;
however, most experts recommend using the Rotterdam criteria
and excluding other conditions that can present with similar
clinical findings.
➤ The presence of two of the following three criteria: oligo- or
anovulation, clinical and/ or biochemical signs of hyperandrogenism,
and polycystic ovarian morphology on ultrasound, suggests PCOS.
➤ To confirm the diagnosis of PCOS, exclude thyroid disease,
hyperprolactinemia, and congenital adrenal hyperplasia with
the following tests: serum thyroid-stimulating hormone (TSH),
prolactin, and 17-hydroxyprogesterone (collected before 8:30 AM
during the follicular phase).
➤ Recommend lifestyle changes that improve central adiposity and
address both reproductive and metabolic dysfunction.
➤ No specific dietary intervention is recommended: Tailor the plan
to achieve nutritional goals while considering patient preferences,
psychological factors, and sociocultural factors.
➤ Behavioral strategies may include self-monitoring, goal setting,
stimulus control, problem-solving, and relapse prevention.
➤ Address psychological factors such as body image issues, eating
disorders, and the need for non-stigmatizing, patient-centered
communication.
➤ Avoid sedentary behavior by engaging in regular physical activity,
with no specific modality preferred.
➤ Follow the duration and intensity guidelines for general health
and weight management. For the management of menstrual
abnormalities, hirsutism, or acne, first-line therapy is combined
hormonal contraception.
➤ If hirsutism and/or acne are not well controlled after six months of
combined estrogen-progestin oral contraceptives, consider adding
spironolactone.
➤ For women with PCOS who develop a metabolic disorder such as
type 2 diabetes or dyslipidemia, recommend weight loss and direct
therapy to address the metabolic disorder.
➤ Consider metformin monotherapy in adults and adolescents with a
BMI ≥25 kg/m².
➤ For women with PCOS and anovulatory infertility who are pursuing
pregnancy, recommend weight loss. If ovulation is not restored,
refer to a gynecologist for ovulation induction.
