What lifestyle modifications should I recommend to a patient with PCOS

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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 .
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 .
Recommend a multicomponent lifestyle intervention including diet, exercise, and behavioural strategies to reduce weight, central obesity, and insulin resistance .
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 ,.
Encourage regular physical activity tailored to the patient’s preferences, such as walking, cycling, swimming, or aerobics, to improve metabolic health and PCOS symptoms ,.
Advise smoking cessation if applicable, as smoking can worsen cardiovascular risk .
Monitor and manage cardiovascular risk factors including blood pressure, lipid profile, and glycaemic status regularly to guide further interventions .

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

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