Weight and polycystic ovary syndrome

WEIGHT management and weight gain prevention should be the key first-line strategies to treat polycystic ovary syndrome (PCOS) and improve a woman’s quality of life, say experts.

Associate Professor Lisa Moran, who leads the Healthy Lifestyle Research Program within the Monash Centre of Health Research and Implementation, told MJA InSight that “we know weight management is really important”.

“It improves all features of PCOS, and the reasons for a woman’s worsened quality of life. It improves the hormonal profile, improves physical characteristics of excess hair growth, and may improve reproductive manifestations of infertility.”

Professor Moran said that the importance of weight management in PCOS had been highlighted in guidelines approved by the NHMRC.

Professor Helena Teede, executive director of Monash Partners Academic Health Science Centre, described the relationship between weight gain and PCOS as a double-edged sword that health professionals need to be aware of.

“The hormonal changes that underpin PCOS may drive weight gain, but weight gain still very much drives PCOS,” she told MJA InSight.

“Weight management is critical for women with PCOS, but the real thing that is forgotten is a focus on prevention. All across their life, we need to support them in preventing weight gain from happening.”

A population-based study recently published in Human Reproduction looked at the weight management practices in women with and without PCOS. A total of 7767 women in the 1973–1978 birth cohort and aged 18–23 years at the Australian Longitudinal Study on Women’s Health commencement (in 1996) were included in the research. The authors found that women with PCOS were more likely to be following both healthy and alternative weight management practices than women without PCOS. In PCOS, the use of a range of healthy weight management practices was associated with increases in physical activity and decreases in glycaemic index, and percentages of fat, saturated fat or fibre.

“In PCOS, we should focus on improving healthy weight practices across both diet quality and quantity, and on assessing alternative weight practices and their potential adverse effect on dietary intake,” the authors wrote.

Professor Teede said that there was growing recognition of the need to promote weight management as a way to manage PCOS.

“If you have a young girl in front of you and she’s read the wrong information and she says to you – and this is a real quote – ‘I’m going to get fat, hairy, depressed and infertile’, it’s demoralising. So being able to say to her that we can treat her excess hair with laser, that we can help her not put on further weight, and we can tell her that with fairly minimal help she may have the same family size as women without PCOS, that is really important.”

Professor Moran said that PCOS could be seen as a way of encouraging women early on to improve their quality of life with weight management.

“A woman with PCOS may be more likely to enter the health system and then may be more likely to be targeted for assistance in improving weight and lifestyle. From this, we can see how to work with young women and their life challenges.”

Professor Moran said that GPs had a crucial role to play in helping women manage the features of PCOS.

“A GP can be integral in this by being the community-based point of call for women with PCOS, where they may have their treatment plan co-owned. This means they don’t always need to be dealing with specialists.

“There are some really important resources that may be used when engaging with GPs, such as subsidised referrals to dieticians, exercise physiologists and psychologists.”

Professor Teede said that GPs talking about the importance of weight management and getting a patient to monitor their weight were key strategies.

“But we know that we don’t always train our health professionals around how to do that and deal with the conversations. For example, what does not work is just telling someone to eat well and exercise.

“Helping in the ‘how’ is effective – things such as getting to think about what their aims and barriers to weight loss may be.”

“There are now programs available to upskill GPs in having these conversations and using behaviour change strategies,” Professor Teede said.

Professor Moran felt that recognition was increasing around PCOS.

“The prevalence is possibly increasing and this could be due to changes in diagnostic criteria, but this is also because we’re having an obesity epidemic, and PCOS is so closely tied to weight.”

She said that research into what consumers wanted when it came to PCOS, including aspects of diagnosis and management, was needed.

“We also need to know what health professionals want. A woman with PCOS could engage with a dermatologist, endocrinologist, obstetrician, dietician, exercise physiologist, and psychologist, and every single one may have different training and perceptions on what needs to be the focus.

“We need to know what the different disciplines are focusing on and how we could standardise that, or how we could improve education to better equip these specialists,” Professor Moran said.

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