Treatment Guideline Chart
Polycystic ovarian syndrome (PCOS) is the accumulation of underdeveloped follicles in the ovaries due to anovulation. It is characterized by menstrual abnormalities and clinical or biochemical features of hyperandrogenism.
It results mainly from abnormal steroidogenesis that may be caused by insulin resistance leading to hyperinsulinemia.
There is increased sensitivity to androgens and the majority of women have elevated androgen levels.

Polycystic%20ovarian%20syndrome Patient Education

Lifestyle Modification

  • Lifestyle modification is recommended in all PCOS patients
    • Diet modification with healthy eating, regular exercise and weight loss in obese patients all contribute to reestablishing insulin sensitivity and optimizing general health and quality of life  
    • Benefits should be emphasized during preconception counseling
  • In women with PCOS, excess body fat aggravates insulin resistance and its associated clinical consequences
  • Central obesity and high BMI have a major impact on the development of hyperinsulinemia and hyperandrogenism
  • Goal setting and self-monitoring which are specific, measurable, achievable, realistic and timely (SMART) can help achieve lifestyle goals 
    • All patient interactions should be patient-centered and should consider individualized healthy lifestyle preferences including cultural, socioeconomic and ethnic differences 
    • A respectful and considerate approach should be considered when assessing patient’s weight due to associated negative body image, low self-esteem and/or related stigma
  • PCOS patients with normal body habitus should be advised to continue this and to maintain their body weight within the normal range
  • PCOS patients should be informed of and screened for risk factors of CVD: Cigarette smoking, obesity, dyslipidemia, type 2 DM or impaired glucose tolerance, insulin resistance, family history of early CVD, subclinical vascular disease, hypertension, metabolic syndrome, OSA, nonalcoholic steatohepatitis and absence of physical activity
  • PCOS patients should also be screened for anxiety and depressive symptoms to ensure adherence to lifestyle changes 
    • If positive, a specialist referral for further assessment and/or treatment may be done
  • Behavioral strategies including goal-setting, self-monitoring, assertiveness training, problem solving, slower eating, stimulus control, reinforcing changes and relapse prevention can help optimize a healthy lifestyle, weight management and patient’s emotional wellbeing 

Diet Modification

  • There is no particular food plan that is recommended for PCOS; it is recommended to follow general healthy eating practices
  • Frequent feedings (4-6x/day) may be helpful to avoid hypoglycemia and hunger
    • Hypoglycemia can lead to cravings and poor food choices
  • To promote weight loss, diet should be modified to an intake of carbohydrates with a low glycemic index, and a reduced intake of fat and simple sugars
    • High-protein diet appears as effective as high-carbohydrate diet as long as fat and total calories are comparable
  • May consider reducing intake by 500-750 kcal/day taking into consideration the patient’s weight, energy requirements and activity level


  • Weight reduction and exercise can help reverse the metabolic problems in PCOS by improving ovarian function and the associated hormonal aberrations
    • Vigorous activity at 75 minutes/week or moderate-intensity activity at 150 minutes/week, or a combination of both, together with muscle strengthening on 2 non-consecutive days/week are encouraged to prevent weight gain and to maintain health 
    • Activities of vigorous intensity at 150 minutes/week or moderate intensity at 250 minutes/week, or a combination of both, and strengthening of the major muscle groups on 2 non-consecutive days/week are encouraged to lose modest weight and to prevent regained weight 
    • Physical activity can be incidental or structured; self-monitoring, including use of fitness tracking devices and technologies, could support and promote active lifestyles
  • Decreases risk of diabetes and CVD
  • Improvement in physical fitness and reduction in body fat will assist in resumption of ovulation and increase in fertility especially in anovulatory obese women with PCOS

Weight Reduction

  • Associated with improved pregnancy rates and decreased hirsutism, as well as improvements in glucose and lipid levels 
    • Helps lower circulating androgen levels leading to spontaneous resumption of menses
    • Improves insulin resistance in obese patients
  • A 5-10% weight loss in 6 months is considered successful 
    • It is estimated that a loss of 5-10% of body weight can restore reproductive function in 55-100% of PCOS patients within 6 months of weight-reducing program
    • Hirsutism can also improve within 6-9 months of weight loss
  • BMI and waist circumference categories that are adolescent and ethnic-specific should be considered to optimize lifestyle and weight management 
  • Anti-obesity medications can be considered with lifestyle intervention as per general population guidelines
    • Consider treatment availability, cost, side effects, contraindications and regulatory status, and avoid pregnancy while on therapy  

Management for Hirsutism

  • If hirsutism is moderate and localized, it may be treated with hair removal by shaving, plucking, waxing, bleaching, laser therapy, electrolysis or depilatory creams
  • In more severe hair growth, alternative methods can be used until androgen-suppressing therapies take effect
    • Treatment is often palliative rather than curative
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