Yang Shilong, Pan Xiaoyang, Yang Ran, Wang Yan, Zhang Zhengjun, Chen Guangrui, Li Zecheng, Qiu Gongzheng, Li Leping, Jing Changqing, Tian Feng
Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250021, Shandong, China.
Key laboratory of Pharmaceutical Chemistry, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.
Curr Obes Rep. 2025 Jun 28;14(1):57. doi: 10.1007/s13679-025-00649-5.
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.
多囊卵巢综合征（PCOS）是育龄女性中一种常见的内分泌紊乱疾病，肥胖常常会加剧其严重程度。PCOS与肥胖之间的双向关系导致了一个自我强化且有害的循环。本综述评估了各种减肥干预措施对超重或肥胖PCOS女性生殖、激素和代谢结局的影响。目的是为该人群临床上相关的体重管理策略提供循证指导。
生活方式改变是多囊卵巢综合征（PCOS）的一线干预措施。高强度间歇训练（HIIT）已显示出改善受影响女性胰岛素抵抗（IR）的潜力。限时进食（TRF）也可能改善高雄激素血症、月经不规律和胰岛素抵抗。生酮饮食（KD）对生殖和代谢结局均显示出有益作用。在药物治疗中，胰高血糖素样肽-1受体激动剂（GLP-1RAs），特别是与二甲双胍联合使用时，在管理高雄激素血症和月经紊乱方面表现出显著疗效。减肥手术对于PCOS似乎比传统药物治疗更有效；然而，关于其机制的数据以及与GLP-1RAs的直接比较仍然有限。减肥干预措施对PCOS相关症状产生不同影响。未来的研究应专注于优化联合策略以提高治疗效果。目前，关于这些干预措施对超重或肥胖PCOS女性妊娠率和长期生殖结局影响的证据有限。此外，缺乏跨不同减肥方式的系统、直接比较突出了设计良好的对比试验的必要性。
