Abstract / Summary
Lifestyle interventions are recommended as first-line treatment in polyendocrine metabolic ovarian syndrome (PMOS), but their effectiveness across various outcomes remains unclear. In this systematic review, we evaluate the effectiveness of lifestyle interventions on reproductive, anthropometric, and metabolic outcomes. We searched Medline, EMBASE, All EBM, PsycInfo, and CINAHL to June 2026 for studies examining lifestyle intervention compared with minimal or no treatment (usual care) in PMOS. Meta-analyses were conducted using random-effects model to estimate pooled odd ratios (OR) with 95% confidence intervals (CI). We conducted subgroup analyses to evaluate differences by intervention type and duration, and by baseline body mass index (BMI). A total of 34 studies (1,871 participants) were included from the retrieved 1,798 publications. Women who participated in lifestyle interventions were more likely to achieve regular menstrual cycles OR 4.03 (95% CI [1.16, 14.05] I2 = 73%, 5 studies, 237 women), and have reduced waist circumference mean difference (MD) -2.38 (95% CI [-4.68, -0.08] I2 = 90%, 18 studies, 915 women), fasting glucose MD -0.13 (95% CI [-0.25, -0.02] I2 = 86%, 22 studies, 1,045 women) and fasting insulin MD -6.08 (95% CI [-9.86, -2.30] I2 = 71%, 18 studies, 824 women) compared to women who had minimal or no treatment. Subgroup analyses showed that diet interventions had greater effect on reducing fasting glucose levels while exercise was most effective at reducing waist circumference and fasting insulin. In women with PMOS who were overweight or obese, lifestyle interventions led to greater reduction in weight, waist/hip ratio, fasting glucose, fasting insulin, total testosterone, total cholesterol, and low-density lipoprotein. The main limitation of this review is the high between-study heterogeneity in pooled estimates across many of the outcomes. Our review found that lifestyle interventions were associated with improved menstrual regularity and metabolic outcomes in women with PMOS, suggesting complementary benefits as no single intervention showed overall superiority. These findings support international recommendations, which endorse lifestyle interventions as first-line treatment, tailored to individual needs.