Lifestyle modification and selected pharmacological therapies in Polycystic Ovary Syndrome: current evidence and emerging approaches
DOI:
https://doi.org/10.12775/QS.2026.51.68457Keywords
Polycystic ovary syndrome, PCOS, lifestyle modification, physical activity, diet, insulin resistance, metformin, combined oral contraceptives, GLP-1 receptor agonists, patient educationAbstract
Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age, associated with hyperandrogenism, menstrual irregularities, infertility, insulin resistance, and increased cardiometabolic risk.
Aim: The aim of this narrative review was to summarize current evidence-based therapies for PCOS management, focusing on lifestyle modification and selected pharmacological options.
Materials and Methods: A literature search was conducted in PubMed using the term “Polycystic Ovary Syndrome (PCOS)” combined with the following keywords: “lifestyle”, “physical activity”, “exercise”, “diet”, “pharmacotherapy”, “treatment”, “metformin”, “fertility”, “GLP-1”, “inositol”, and “gut microbiota”. Articles published from 2019 onwards were included.
Results: Lifestyle modification remains the first-line approach and may improve metabolic, hormonal, and reproductive outcomes. Pharmacotherapy is used as an adjunct when lifestyle measures are insufficient. Established options include metformin, combined oral contraceptives, antiandrogens in selected cases, and ovulation induction agents. Emerging evidence supports GLP-1 receptor agonists for obesity-related PCOS, although long-term data are limited. Inositol and gut microbiota-targeted strategies remain experimental.
Conclusions: PCOS management should be individualized and long-term, combining lifestyle interventions with appropriate pharmacotherapy and patient education to improve adherence and outcomes.
References
1. Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469. doi:10.1210/clinem/dgad463
2. Stańczak NA, Grywalska E, Dudzińska E. The latest reports and treatment methods on polycystic ovary syndrome. Ann Med. 2024;56(1):2357737. doi:10.1080/07853890.2024.2357737
3. Christ JP, Cedars MI. Current Guidelines for Diagnosing PCOS. Diagnostics. 2023;13(6):1113. doi:10.3390/diagnostics13061113
4. Bader S, Bhatti R, Mussa B, Abusanana S. A systematic review of GLP-1 on anthropometrics, metabolic and endocrine parameters in patients with PCOS. Womens Health. 2024;20:17455057241234530. doi:10.1177/17455057241234530
5. Di Lorenzo M, Cacciapuoti N, Lonardo MS, et al. Pathophysiology and Nutritional Approaches in Polycystic Ovary Syndrome (PCOS): A Comprehensive Review. Curr Nutr Rep. 2023;12(3):527-544. doi:10.1007/s13668-023-00479-8
6. Capozzi A, Scambia G, Driul L, Vignali M, Lello S. Lifestyle and diet in PCOS. Minerva Obstet Gynecol. 2025;77(5):341-351. doi:10.23736/S2724-606X.25.05746-X
7. Alur-Gupta S, Dokras A. Considerations in the Treatment of Depression and Anxiety in Women with PCOS. Semin Reprod Med. 2023;41(1/2):37-44. doi:10.1055/s-0043-1777720
8. Mohamed AH, Albasheer O, Ghoniem MA, et al. Impact of lifestyle interventions on reproductive and psychological outcomes in women with polycystic ovary syndrome: A systematic review. Medicine (Baltimore). 2025;104(3):e41178. doi:10.1097/MD.0000000000041178
9. Saadati S, Mason T, Godini R, Vanky E, Teede H, Mousa A. Metformin use in women with polycystic ovary syndrome (PCOS): Opportunities, benefits, and clinical challenges. Diabetes Obes Metab. 2025;27(Suppl 3):31-47. doi:10.1111/dom.16422
10. Telagarapu VML, Nallamothu PD, Telagarapu VN, et al. Revisiting Metformin in the Management of Polycystic Ovary Syndrome (PCOS). Cureus. 17(7):e88216. doi:10.7759/cureus.88216
11. Fraison E, Kostova E, Moran LJ, et al. Metformin versus the combined oral contraceptive pill for hirsutism, acne, and menstrual pattern in polycystic ovary syndrome. Cochrane Database Syst Rev. 2020;2020(8):CD005552. doi:10.1002/14651858.CD005552.pub3
12. Collée J, Mawet M, Tebache L, Nisolle M, Brichant G. Polycystic ovarian syndrome and infertility: overview and insights of the putative treatments. Gynecol Endocrinol. 2021;37(10):869-874. doi:10.1080/09513590.2021.1958310
13. Lin S, Deng Y, Huang J, et al. Efficacy and safety of GLP-1 receptor agonists on weight management and metabolic parameters in PCOS women: a meta-analysis of randomized controlled trials. Sci Rep. 2025;15:16512. doi:10.1038/s41598-025-99622-4
14. Barrea L, Arnone A, Annunziata G, et al. Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS). Nutrients. 2019;11(10):2278. doi:10.3390/nu11102278
15. Gautam R, Maan P, Jyoti A, Kumar A, Malhotra N, Arora T. The Role of Lifestyle Interventions in PCOS Management: A Systematic Review. Nutrients. 2025;17(2):310. doi:10.3390/nu17020310
16. Mirabelli M, Chiefari E, Arcidiacono B, et al. Mediterranean Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases. Nutrients. 2020;12(4):1066. doi:10.3390/nu12041066
17. Shang Y, Zhou H, He R, Lu W. Dietary Modification for Reproductive Health in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Front Endocrinol. 2021;12:735954. doi:10.3389/fendo.2021.735954
18. Lello S, Fagotti A, Colonna L, DI Lella G, Vignali M, Capozzi A. Antiandrogens and insulin sensitizers in PCOS management. Minerva Obstet Gynecol. 2025;77(5):407-414. doi:10.23736/S2724-606X.25.05822-1
19. Sha Y, Zhu J, Shen F. A meta-analysis of efficacy on dexamethasone and clomiphene in the treatment of polycystic ovary syndrome patients. BMC Womens Health. 2024;24(1):298. doi:10.1186/s12905-024-03141-9
20. Carmina E, Longo RA. Semaglutide Treatment of Excessive Body Weight in Obese PCOS Patients Unresponsive to Lifestyle Programs. J Clin Med. 2023;12(18):5921. doi:10.3390/jcm12185921
21. Cena H, Chiovato L, Nappi RE. Obesity, Polycystic Ovary Syndrome, and Infertility: A New Avenue for GLP-1 Receptor Agonists. J Clin Endocrinol Metab. 2020;105(8):e2695-e2709. doi:10.1210/clinem/dgaa285
22. Szczesnowicz A, Szeliga A, Niwczyk O, Bala G, Meczekalski B. Do GLP-1 Analogs Have a Place in the Treatment of PCOS? New Insights and Promising Therapies. J Clin Med. 2023;12(18):5915. doi:10.3390/jcm12185915
23. Celik O, Yazici D, Ciudin A, et al. GLP-1 Receptor Analogs: Evidence Linking to Effect on Metabolic and Reproductive Functions in Patients with PCOS and Obesity. Obes Facts. Published online July 31, 2025. doi:10.1159/000547055
24. Monney M, Mavromati M, Leboulleux S, Gariani K. Endocrine and metabolic effects of GLP-1 receptor agonists on women with PCOS, a narrative review. Endocr Connect. 2025;14(5):e240529. doi:10.1530/EC-24-0529
25. Fitz V, Graca S, Mahalingaiah S, et al. Inositol for Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis to Inform the 2023 Update of the International Evidence-based PCOS Guidelines. J Clin Endocrinol Metab. 2024;109(6):1630-1655. doi:10.1210/clinem/dgad762
26. Lentini G, Querqui A, Monti N, Bizzarri M. PCOS and Inositols – Advances and Lessons We are Learning. A Narrative Review. Drug Des Devel Ther. 2025;19:4183-4199. doi:10.2147/DDDT.S524718
27. Sivasankari R, Usha B. Reshaping the Gut Microbiota Through Lifestyle Interventions in Women with PCOS: A Review. Indian J Microbiol. 2022;62(3):351-363. doi:10.1007/s12088-022-01019-8
28. Zhou P, Feng P, Liao B, et al. Role of polyphenols in remodeling the host gut microbiota in polycystic ovary syndrome. J Ovarian Res. 2024;17:69. doi:10.1186/s13048-024-01354-y
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Agnieszka Brzozowska, Anna Izabela Garbacz, Tomasz Julian Majszyk, Jacek Głuski, Patrycja Anna Borowiecka, Aleksandra Węglarz, Paweł Kosiorek, Ada Niezgoda, Anna Olborska, Bartłomiej Maciej Wrochna, Agnieszka Radziwonka, Gabriela Stondzik
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 7
Number of citations: 0
