What lifestyle modifications should I advise for a patient with polycystic ovary syndrome (PCOS) to improve their symptoms?

For patients with polycystic ovary syndrome (PCOS), lifestyle modifications are recommended as a first-line treatment, especially for those who are overweight or obese NICE CKS. These changes should precede or accompany any pharmacological treatment NICE CKS.

• Weight Management: Encourage optimal weight management, as even a reduction of as little as 5% of total body weight can reduce insulin resistance and testosterone levels, and improve body composition and cardiovascular risk markers NICE CKS. For overweight or obese women, weight loss may reduce hyperinsulinism and hyperandrogenism, decrease the risk of type 2 diabetes and cardiovascular disease (CVD), lead to menstrual regularity, and improve the chance of pregnancy if desired NICE CKS. For women with a BMI of 30 or over who have anovulatory infertility (often associated with PCOS), weight loss alone may restore ovulation and improve response to ovulation induction agents NICE CG156.
• Healthy Eating: Advise patients on healthy eating behaviours NICE CKS. A balanced diet, following the Office for Health Improvement and Disparities Eatwell Guide, and appropriate fluid intake can help achieve and/or maintain a healthy weight, optimize hormonal outcomes, and improve general health and quality of life NICE CKS,NICE NG210.
• Regular Physical Activity: Encourage regular exercise NICE CKS. Combined with dietary advice, regular physical activity aiming for sustained weight loss can ameliorate many aspects of PCOS in overweight or obese women NICE CKS. Physical activity helps achieve and/or maintain a healthy weight, optimize hormonal outcomes, and improve general health and quality of life NICE CKS.
• Smoking Cessation: Check the patient's smoking status and offer advice on smoking cessation if appropriate NICE CKS.

These lifestyle interventions, ideally multicomponent and including diet, exercise, and behavioural strategies, are recommended for all women with PCOS and excess weight to help reduce weight, central obesity, and insulin resistance NICE CKS. You can also provide sources of additional information and support, such as The Royal College of Obstetricians and Gynaecologists (RCOG), the NHS website, PCOS Challenge, and Verity NICE CKS.