The Efficacy of Various Weight Loss Strategies in Alleviating Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder in women of reproductive age, with its severity often exacerbated by obesity. The bidirectional relationship between PCOS and obesity contributes to a self-reinforcing and deleterious cycle. This review evaluates the effects of various weight loss interventions on reproductive, hormonal, and metabolic outcomes in overweight or obese women with PCOS. The objective is to provide evidence-based guidance for clinically relevant weight management strategies in this population.

Lifestyle modification is the first-line intervention for polycystic ovary syndrome (PCOS). High-intensity interval training (HIIT) has demonstrated potential in improving insulin resistance (IR) in affected women. Time-restricted feeding (TRF) may also improve hyperandrogenism, menstrual irregularities, and IR. The ketogenic diet (KD) has shown beneficial effects on both reproductive and metabolic outcomes. Among pharmacological therapies, glucagon-like peptide-1 receptor agonists (GLP-1RAs), particularly when combined with metformin, have exhibited notable efficacy in managing hyperandrogenism and menstrual disturbances. Bariatric surgery appears to be more effective than conventional pharmacologic treatments for PCOS; however, data on its mechanisms and direct comparisons with GLP-1RAs remain limited. Weight loss interventions exert differential effects on PCOS-related symptoms. Future studies should focus on optimizing combination strategies to enhance treatment efficacy. Currently, evidence on the impact of these interventions on pregnancy rates and long-term reproductive outcomes in overweight or obese women with PCOS is limited. In addition, the absence of systematic, head-to-head comparisons across different weight loss modalities underscores the need for well-designed comparative trials.