Exploring lifestyle management in polycystic ovary syndrome through implementation frameworks

Polyendocrine metabolic ovarian syndrome [PMOS; previously known as polycystic ovary syndrome (PCOS)] is an endocrine condition affecting 10%-13% of women of reproductive age, with cardiometabolic, reproductive and psychological features. The PMOS guidelines have established recommendations for its management, which can include pharmacological, lifestyle and/or traditional medicines. The aim of this narrative review is to explore the pathophysiology, treatment recommendations and current evidence for lifestyle management for those with PMOS. Using the consolidated framework for implementation research (CFIR) and capability, opportunity, motivation and behaviour (COM-B) frameworks, this review identifies barriers and facilitators to implement lifestyle recommendations for PMOS, followed by strategies to support improvement in lifestyle management. There is limited high-quality evidence to support specific physical activity and dietary recommendations for those with PMOS. Underlying physiological mechanisms driving PMOS can impact energy expenditure, metabolism, appetite and satiety hormones, acting as barriers for weight and lifestyle-management strategies. Qualitative research suggests that implementation of lifestyle-management strategies from the PMOS guidelines has not been adopted. From a psychosocial perspective, those with PMOS often report that their health needs are not being met by health professionals. This might be related to a disproportionate focus on weight-focused care, inadequate lifestyle-management education for health professionals and inadequate support for people with PMOS to achieve lifestyle management. Working in partnership with those who have lived experience is crucial to translate the PMOS guidelines to improve health professional education, resources and adaption of lifestyle-management programmes to meet the needs of those with PMOS better.