In the Journals Plus

Lifestyle changes may restore menstrual regularity in PCOS

Show Citation

December 28, 2018

Women with polycystic ovary syndrome and irregular menses who completed a 4-month program focusing on goal setting, stress management and weight control were more likely to report improved menstrual regularity than similar women who received usual care, according to findings published in Clinical Endocrinology.

Angelica Lindén Hirschberg

“Behavioral modification intervention could be beneficial to improve reproductive function in obese women with PCOS even if only minor weight loss is achieved,” Angelica Lindén Hirschberg, MD, PhD, professor in the department of gynecology and reproductive medicine at Karolinska University Hospital in Sweden, told Endocrine Today. “Behavioral modification intervention should be one of the first-line treatments in obese women with PCOS to improve fertility.”

In a randomized controlled trial, Hirschberg and colleagues analyzed data from 68 women aged 18 to 40 years with a BMI of at least 27 kg/m² who fulfilled Rotterdam criteria for PCOS diagnosis. Researchers randomly assigned women to a 4-month behavior modification intervention (n = 34) consisting of small group meetings focusing on weight control, personal leadership, mindfulness and information on physical activity and diet or to usual care (n = 34) plus general healthy lifestyle recommendations given by a research midwife. The intervention sessions were led by a lifestyle coach with a PhD in endocrinology and metabolism, and the intervention included individualized coaching sessions once a month with the course leader to discuss individual training regimens, diet changes and personal support. All participants also received a protein drink and were encouraged to consume the drink 30 minutes before each major meal to reduce hunger.

The primary reproductive outcome measure was improved menstrual regularity at 4 months, obtained via menstrual diaries or apps. Secondary outcomes were initiation of ovulation at 4 months and improved menstrual regularity and initiation of ovulation and menstrual periods at 12 months. Researchers also reported on pregnancies within 1 year of study completion.

At baseline, there were no study participants reporting a regular menstrual cycle. In the intervention group, 68% reported oligomenorrhea and 32% reported amenorrhea. In the control group, 77% reported oligomenorrhea and 24% reported amenorrhea.

At 4 months, researchers observed a small reduction in mean body weight of 2.1% (P = .002) in the intervention group, but no mean change in the control group. The intervention group also experienced a 0.8% reduction in total fat percentage (P = .021) and an 893-g decrease in trunk fat mass (P = .042); similar changes were not observed in controls.


At 4 months, more participants in the intervention group reported improved menstrual function vs. controls (59% vs. 24%; mean difference, 35%; 95% CI, 16-60). In the intervention group, 32% had a regular menstrual period vs. 21% of controls. In logistic regression analysis, the 4-month intervention was the only predictor of improved menstrual function (OR = 3.9; 95% CI, 1.3-11.9), according to researchers.

At 12 months, after both groups of participants had received the 4-month intervention, 54% of the cohort reported improved menstrual function and 43% had a regular menstrual cycle (P < .0001 for both). Ovulation rate was 43% at 12 months (P < .0001) and mean weight loss was 1.6% (P = .001).

Within the cohort, 29 of 68 women reported a desire to become pregnant. Among those, 11 women became pregnant (nine spontaneously and two after ovarian stimulation within 1 year). Ten women gave birth to full-term children.

“Extensive weight loss can be difficult to achieve in obese women with PCOS through [a] behavioral modification intervention,” the researchers wrote. “However, this type of intervention can help to reduce weight, improve menstrual function and potentially improve the chances of conceiving.” – by Regina Schaffer

For more information:

Angelica Lindén Hirschberg, MD, PhD, can be reached at Karolinska University Hospital, Department of Gynecology and Reproductive Medicine, SE 171 76 Stockholm, Sweden; email:

Disclosures: Indevex Biotech provided a protein drink for the study. The authors report no relevant financial disclosures.

itj+ Infographic

itj+ Perspective