Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.
Clin Endocrinol (Oxf). 2019 Mar;90(3):468-478. doi: 10.1111/cen.13919. Epub 2019 Jan 15.
Lifestyle intervention is the recommended first-line treatment for overweight women with polycystic ovary syndrome (PCOS). However, the efficacy of lifestyle change in improving reproductive function is still unclear.
A randomized controlled trial (RCT) with allocation to a behavioural modification programme (intervention) or minimal intervention (control) for 4 months with a follow-up at 12 months.
Sixty-eight women, aged 18-40 years, body mass index (BMI) ≥ 27 kg/m , fulfilling all Rotterdam PCOS criteria were randomized to treatment.
The primary outcome was improved menstrual regularity. Secondary outcomes were ovulation and pregnancy rates.
At 4 months, the weight loss was significant in the intervention group (-2.1%, P = 0.002) and nonsignificant in the control group (-1.0%). A higher proportion of patients in the intervention group improved menstrual regularity compared to the control group, mean difference 35% (95% CI: 16-60), P = 0.003. There was no difference in ovulation rate between groups. Logistic regression analysis showed that intervention was the only predictor of improved menstrual function, OR 3.9 (95% CI: 1.3-11.9). At 12 months, a total of 54% of the women improved menstrual regularity compared to baseline (P = 0.000) and 43% (P = 0.000) had confirmed ovulation. 38% of the women wishing to become pregnant succeeded within 1 year of study completion.
This is the first RCT in overweight women with PCOS showing efficacy in improving reproductive function following behavioural modification intervention in comparison with minimal intervention. Although extensive weight loss is difficult to achieve in these women, behavioural modification intervention can help improve reproductive function.
生活方式干预是超重多囊卵巢综合征（PCOS）女性的首选一线治疗方法。然而，生活方式改变改善生殖功能的效果仍不清楚。
一项随机对照试验（RCT），将患者分为行为修正方案（干预组）或最小干预（对照组）组，进行 4 个月的干预，并在 12 个月时进行随访。
68 名年龄在 18-40 岁之间、体重指数（BMI）≥27kg/m²且符合所有鹿特丹 PCOS 标准的女性被随机分配到治疗组。
主要结局是改善月经规律。次要结局是排卵和妊娠率。
在 4 个月时，干预组体重减轻（-2.1%，P=0.002），对照组体重减轻不明显（-1.0%）。与对照组相比，干预组有更多的患者月经规律得到改善，平均差异为 35%（95%CI：16-60），P=0.003。两组间排卵率无差异。逻辑回归分析显示，干预是改善月经功能的唯一预测因素，OR 3.9（95%CI：1.3-11.9）。在 12 个月时，与基线相比，共有 54%的女性月经规律得到改善（P=0.000），43%（P=0.000）的女性证实排卵。在研究结束后 1 年内，有 38%的希望怀孕的女性成功怀孕。
这是第一项针对超重多囊卵巢综合征女性的 RCT 研究，表明与最小干预相比，行为修正干预可有效改善生殖功能。尽管这些女性很难实现广泛的体重减轻，但行为修正干预可以帮助改善生殖功能。
