What lifestyle modifications should I recommend to a patient with PCOS to help manage symptoms and reduce metabolic risks?

Lifestyle modifications recommended for patients with polycystic ovary syndrome (PCOS) to manage symptoms and reduce metabolic risks include:

• Encourage a healthy lifestyle focusing on healthy eating and regular physical activity to achieve and maintain a healthy weight, which can improve hormonal balance, reduce insulin resistance, and lower cardiovascular and type 2 diabetes risk ¹.
• Advise weight loss for overweight or obese women, aiming for as little as a 5% reduction in total body weight, which has been shown to reduce hyperinsulinism, hyperandrogenism, improve menstrual regularity, and enhance fertility chances ¹.
• Recommend a multicomponent lifestyle intervention including diet, exercise, and behavioural strategies to reduce weight, central obesity, and insulin resistance ¹.
• Promote dietary advice consistent with a balanced, healthy diet such as the Eatwell Guide, emphasizing whole grains, fibre-rich foods, fruits, vegetables, and limiting intake of high-fat, high-sugar foods and alcohol ¹,⁴.
• Encourage regular physical activity tailored to the patient’s preferences, such as walking, cycling, swimming, or aerobics, to improve metabolic health and PCOS symptoms ¹,⁴.
• Advise smoking cessation if applicable, as smoking can worsen cardiovascular risk ¹.
• Monitor and manage cardiovascular risk factors including blood pressure, lipid profile, and glycaemic status regularly to guide further interventions ¹.

These lifestyle changes should be the first-line treatment and ideally precede or accompany pharmacological treatments for PCOS ¹.