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Orlistat in polycystic ovarian syndrome reduces weight with improvement in lipid profile and pregnancy rates GLUT4 translocation is not impaired after acute exercise in skeletal muscle of women with obesity and polycystic ovary syndrome. Randomized Controlled Trial of Preconception Interventions in Infertile Women With Polycystic Ovary Syndrome. [Diet, metformin and inositol in overweight and obese women with polycystic ovary syndrome: effects on body composition]. Treatment with flutamide, metformin, and their combination added to a hypocaloric diet in overweight-obese women with polycystic ovary syndrome: a randomized, 12-month, placebo-controlled study. The effect of exercise and metformin treatment on circulating free DNA in pregnancy. Exercise training improves autonomic function and inflammatory pattern in women with polycystic ovary syndrome (PCOS) Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women. 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Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. Effect of weight loss on menstrual function in adolescents with polycystic ovary syndrome. High-Intensity Interval Training on an Aquatic Treadmill in Adults With Osteoarthritis: Effect on Pain, Balance, Function, and Mobility Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study. Psychological benefits of a high-protein, low-carbohydrate diet in obese women with polycystic ovary syndrome—A pilot study The effect of weight loss on anti-Müllerian hormone levels in overweight and obese women with polycystic ovary syndrome and reproductive impairment. An assessment of lifestyle modification versus medical treatment with clomiphene citrate, metformin, and clomiphene citrate-metformin in patients with polycystic ovary syndrome. Effects of a holistic yoga program on endocrine parameters in adolescents with polycystic ovarian syndrome: a randomized controlled trial. Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome.
Background Women with polycystic ovary syndrome ( PCOS ) have symptoms of depression and anxiety and impaired health related quality of life ( HRQoL ) . Here we test the post-hoc hypothesis that acupuncture and exercise improve depression and anxiety symptoms and HRQoL in PCOS women . Methods Seventy-two PCOS women were r and omly assigned to 16 weeks of 1 ) acupuncture ( n = 28 ) ; 2 ) exercise ( n = 29 ) ; or 3 ) no intervention ( control ) ( n = 15 ) . Outcome measures included : change in Montgomery Åsberg Depression Rating Scale ( MADRS-S ) , Brief Scale for Anxiety ( BSA-S ) , Swedish Short-Form 36 ( SF-36 ) , and PCOS Question naire ( PCOSQ ) scores from baseline to after 16-week intervention , and to 16-week post-intervention follow-up . Results A reduction in MADRS-S and BSA-S from baseline to 16-weeks post-intervention follow-up was observed for the acupuncture group . The SF-36 domains role physical , energy/vitality , general health perception and the mental component of summary scores improved in the acupuncture group after intervention and at follow-up . Within the exercise group the role physical decreased after treatment , while physical functioning and general health perception scores increased at follow-up . The emotion domain in the PCOSQ improved after 16-weeks of intervention within all three groups , and at follow-up in acupuncture and exercise groups . At follow-up , improvement in the infertility domain was observed within the exercise group . Conclusion There was a modest improvement in depression and anxiety scores  in women treated with  acupuncture  , and improved HRQoL scores were noted in both intervention groups . While not a primary focus of the trial , these data suggest continued investigation of mental health outcomes in women treated for PCOS.Trial registration number Clinical Trials.gov Identifier : Acupuncture has been demonstrated to improve menstrual frequency and to decrease circulating testosterone in women with polycystic ovary syndrome ( PCOS ) . Our aim was to investigate whether acupuncture affects ovulation frequency and to underst and the underlying mechanisms of any such effect by analyzing LH and sex steroid secretion in women with PCOS . This prospect i ve , r and omized , controlled clinical trial was conducted between June 2009 and September 2010 . Thirty-two women with PCOS were r and omized to receive either acupuncture with manual and low-frequency electrical stimulation or to meetings with a physical therapist twice a week for 10 - 13 wk . Main outcome measures were changes in LH secretion patterns from baseline to after 10 - 13 wk of treatment and ovulation frequency during the treatment period . Secondary outcomes were changes in the secretion of sex steroids , anti-Müllerian hormone , inhibin B , and serum cortisol . Ovulation frequency during treatment was higher in the acupuncture group than in the control group . After 10 - 13 wk of intervention , circulating levels of estrone , estrone sulfate , estradiol , dehydroepi and rosterone , dehydroepi and rosterone sulfate , and rostenedione , testosterone , free testosterone , dihydrotestosterone , and rosterone glucuronide , and rostane-3α,17β-diol-3-glucuronide , and and rostane-3α,17β-diol-17-glucuronide decreased within the acupuncture group and were significantly lower than in the control group for all of these except and rostenedione . We conclude that repeated acupuncture treatments result ed in higher ovulation frequency in lean/overweight women with PCOS and were more effective than just meeting with the therapist . Ovarian and adrenal sex steroid serum levels were reduced with no effect on LH secretion BACKGROUND Some evidence has suggested that a diet with a higher ratio of protein to carbohydrates has metabolic advantages in the treatment of polycystic ovary syndrome ( PCOS ) . OBJECTIVE The objective of this study was to compare the effect of a high-protein ( HP ) diet to a st and ard-protein ( SP ) diet in women with PCOS . DESIGN A controlled , 6-mo trial was conducted in 57 PCOS women . The women were assigned through rank minimization to one of the following 2 diets without caloric restriction : an HP diet ( > 40 % of energy from protein and 30 % of energy from fat ) or an SP diet ( < 15 % of energy from protein and 30 % of energy from fat ) . The women received monthly dietary counseling . At baseline and 3 and 6 mo , anthropometric measurements were performed , and blood sample s were collected . RESULTS Seven women dropped out because of pregnancy , 23 women dropped out because of other reasons , and 27 women completed the study . The HP diet produced a greater weight loss ( mean : 4.4 kg ; 95 % CI : 0.3 , 8.6 kg ) and body fat loss ( mean : 4.3 kg ; 95 % CI : 0.9 , 7.6 kg ) than the SP diet after 6 mo . Waist circumference was reduced more by the HP diet than by the SP diet . The HP diet produced greater decreases in glucose than did the SP diet , which persisted after adjustment for weight changes . There were no differences in testosterone , sex hormone-binding globulin , and blood lipids between the groups after 6 mo . However , adjustment for weight changes led to significantly lower testosterone concentrations in the SP-diet group than in the HP-diet group . CONCLUSION Replacement of carbohydrates with protein in ad libitum diets improves weight loss and improves glucose metabolism by an effect that seems to be independent of the weight loss and , thus , seems to offer an improved dietary treatment of PCOS women Background / Objectives : The aim of the study was to compare the effect of two-meal patterns ( three vs six meals per day ) on glucose and insulin levels in women with polycystic ovary syndrome (PCOS).Subjects/ Methods : In a r and omised , crossover , 24-week study , 40 women with PCOS , aged 27±6 years , body mass index 27±6 kg/m2 , followed a weight maintenance diet ( % carbohydrates : protein : fat , 40:25:35 ) , consumed either as a three- or a six-meal pattern , with each intervention lasting for 12 weeks . Anthropometric measurements , diet compliance and subjective hunger , satiety and desire to eat were assessed biweekly . All women underwent an oral glucose tolerance test ( OGTT ) with 75 g glucose for measurement of plasma glucose  and insulin at the beginning and end of each intervention . HaemoglobinA1c ( HbA1c ) , blood lipids and hepatic enzymes were measured at the beginning and end of each intervention . Results : Body weight remained stable throughout the study . Six meals  decreased significantly fasting insulin ( P=0.014 ) and post-OGTT insulin sensitivity ( Matsuda index , P=0.039 ) vs three meals . After incorporation of individual changes over time , with adjustment for potential confounders , the only variable that remained significant was the Matsuda index , which was then used in multivariate analysis and general linear models . Six meals  improved post-OGTT insulin sensitivity independently of age and body weight vs three meals ( P=0.012 ) . No significant differences were found between six and three meals for glucose , HbA1c , blood lipids , hepatic enzymes , subjective desire to eat and satiety . Conclusions : Six meals had a more favourable effect on post-OGTT insulin sensitivity in women with PCOS compared with isocaloric three meals Objective : The recommended composition of a hypocaloric diet for obese women with polycystic ovary syndrome ( PCOS ) is unclear . The aim of this study was to investigate the effects of a high-protein , low-glycemic-load diet compared with a conventional hypocaloric diet on reproductive hormones , inflammatory markers , lipids , glucose , and insulin levels in obese women with PCOS . Methods : A total of 60 overweight and obese women with PCOS who did not use insulin-sensitizing agents were recruited and r and omly assigned to 1 of the 2 hypocaloric diet groups for a single-blind clinical trial . The groups included a conventional hypocaloric diet ( CHCD ) ( 15 % of daily energy from protein ) and a modified hypocaloric diet ( MHCD ) with a high-protein , low-glycemic load ( 30 % of daily energy from protein plus low-glycemic-load foods selected from a list ) that was prescribed via counseling visits weekly during 12 weeks of study . Anthropometric assessment s and biochemical measurements including reproductive hormones , inflammatory factors , lipids , glucose , and insulin were performed on fasting blood sample s at baseline and after 12 weeks of dietary intervention . Results : Weight loss was significant and similar in the 2 groups . Mean of testosterone in the MHCD and CHCD groups decreased from 1.78 ± 0.32 to 1.31 ± 0.26 ng/ml and from 1.51 ± 0.12 to 1.15 ± 0.11 ng/ml , respectively ( p < 0.001 ) . Follicle sensitizing hormone ( FSH ) , luteinizing hormone ( LH ) , and blood lipids concentrations were not changed except low-density lipoprotein cholesterol ( LDL-C ) was reduced by 24.5 % ± 12.3 % ( p < 0.001 for both ) after 12 weeks of intervention . MHCD result ed in a significant reduction in insulin level , homeostatic model assessment for insulin resistance ( HOMA ) , and high-sensitivity C- reactive protein ( hsCRP ) concentration ( p < 0.001 ) . Conclusions : In this study both hypocaloric diets significantly led to reduced body weight and and rogen levels in these two groups of women with PCOS . The combination of high-protein and low-glycemic-load foods in a modified diet caused a significant increase in insulin sensitivity and a decrease in hsCRP level when compared with a conventional diet BACKGROUND Women with polycystic ovary syndrome ( PCOS ) present with vascular abnormalities , including elevated markers of endothelial dysfunction . There is limited evidence for the effect of lifestyle modification and weight loss on these markers . The aim of this study was to determine if 20 weeks of a high-protein energy-restricted diet with or without exercise in women with PCOS could improve endothelial function . METHODS This is a secondary analysis of a subset of 50 overweight/obese women with PCOS ( age : 30.3 ± 6.3 years ; BMI : 36.5 ± 5.7 kg/m(2 ) ) from a previous study . Participants were r and omly assigned by computer generation to one of three 20-week interventions : diet only ( DO ; n = 14 , ≈ 6000 kJ/day ) , diet and aerobic exercise ( DA ; n = 16 , ≈ 6000 kJ/day and five walking sessions/week ) and diet and combined aerobic-resistance exercise ( DC ; n = 20 , ≈ 6000 kJ/day , three walking and two strength sessions/week ) . At Weeks 0 and 20 , weight , markers of endothelial function [ vascular cell adhesion molecule-1 ( sVCAM-1 ) , inter-cellular adhesion molecule-1 ( sICAM-1 ) , plasminogen activator inhibitor-1 ( PAI-1 ) and asymmetric dimethylarginine ( ADMA ) ] , insulin resistance and hormonal profile were assessed . RESULTS All three treatments result ed in significant weight loss ( DO 7.9 ± 1.2 % , DA 11.0 ± 1.6 % , DC 8.8 ± 1.1 ; P < 0.001 for time ; P = 0.6 time × treatment ) . sVCAM-1 , sICAM-1 and PAI-1 levels decreased with weight loss ( P≤ 0.01 ) , with no differences between treatments ( P ≥ 0.4 ) . ADMA levels did not change significantly ( P = 0.06 ) . Testosterone , sex hormone-binding globulin and the free and rogen index ( FAI ) and insulin resistance also improved ( P < 0.001 ) with no differences between treatments ( P ≥ 0.2 ) . Reductions in sVCAM-1 were correlated to reductions in testosterone ( r = 0.32 , P = 0.03 ) and FAI ( r = 0.33 , P = 0.02 ) as well as weight loss ( r= 0.44 , P = 0.002 ) . Weight loss was also associated with reductions in sICAM-1 ( r= 0.37 , P = 0.008 ) . CONCLUSIONS Exercise training provided no additional benefit to following a high-protein , hypocaloric diet on markers of endothelial function in overweight/obese women with PCOS Polycystic ovary syndrome ( PCOS ) , the most common endocrine disorder in women of reproductive age , is characterized by hyper and rogenism , oligo/amenorrhea , and polycystic ovaries . We aim ed to determine whether low-frequency electro-acupuncture ( EA ) would decrease hyper and rogenism and improve oligo/amenorrhea more effectively than physical exercise or no intervention . We r and omized 84 women with PCOS , aged 18 - 37 yr , to 16 wk of low-frequency EA , physical exercise , or no intervention . The primary outcome measure changes in the concentration of total testosterone ( T ) at week 16 determined by gas and liquid chromatography-mass spectrometry was analyzed by intention to treat . Secondary outcome measures were changes in menstrual frequency ; concentrations of and rogens , estrogens , and rogen precursors , and glucuroni date d and rogen metabolites ; and acne and hirsutism . Outcomes were assessed at baseline , after 16 wk of intervention , and after a 16-wk follow-up . After 16 wk of intervention , circulating T decreased by -25 % , and rosterone glucuronide by -30 % , and and rostane-3α,17β-diol-3-glucuronide by -28 % in the EA group ( P = 0.038 , 0.030 , and 0.047 , respectively vs. exercise ) ; menstrual frequency increased to 0.69/month from 0.28 at baseline in the EA group ( P = 0.018 vs. exercise ) . After the 16-wk follow-up , the acne score decreased by -32 % in the EA group ( P = 0.006 vs. exercise ) . Both EA and exercise improved menstrual frequency and decreased the levels of several sex steroids at week 16 and at the 16-wk follow-up compared with no intervention . Low-frequency EA and physical exercise improved hyper and rogenism and menstrual frequency more effectively than no intervention in women with PCOS . Low-frequency EA was superior to physical exercise and may be useful for treating hyper and rogenism and oligo/amenorrhea BACKGROUND Cross-sectional studies have shown a high frequency of impaired glucose tolerance ( IGT ) and non-insulin dependent diabetes mellitus ( NIDDM ) in women with polycystic ovarian syndrome ( PCOS ) . However , little is known about the change in glucose tolerance that occurs over a period of several years in women with PCOS . METHODS Sixty-seven women with PCOS received a 75 g glucose tolerance test and measurement of lipids at baseline and at follow-up after an average time of 6.2 years . All women followed prospect ively had normal glucose tolerance ( n = 54 ) or IGT ( n = 13 ) at the start of the study . RESULTS Change in glycaemic control from baseline was frequent , with 5/54 ( 9 % ) of normoglycaemic women at baseline developing IGT and a further 4/54 ( 8 % ) moving directly from normoglycaemic to NIDDM . For women with IGT at baseline , 7/13 ( 54 % ) had NIDDM at follow-up . Body mass index ( BMI ) at baseline was an independent significant predictor of adverse change in glycaemic control . CONCLUSIONS Women with PCOS , particularly those with a high BMI , should be review ed regularly with respect to IGT or NIDDM , as the frequency of impaired glycaemic control is high , and that the rate of conversion from normal glucose tolerance to IGT or NIDDM , or from IGT to NIDDM is substantial CONTEXT Polycystic ovary syndrome ( PCOS ) presents in adolescence , and obesity is a common finding . The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear . OBJECTIVE We investigated the effects of metformin , oral contraceptives ( OCs ) , and /or lifestyle modification in obese adolescent women with PCOS . DESIGN Two small , r and omized , placebo-controlled clinical trials were performed . PATIENTS AND PARTICIPANTS A total of 79 obese adolescent women with PCOS participated . INTERVENTIONS In the single treatment trial , subjects were r and omized to metformin , placebo , a lifestyle modification program , or OC . In the combined treatment trial , all subjects received lifestyle modification and OC and were r and omized to metformin or placebo . MAIN OUTCOME MEASURES Serum concentrations of and rogens and lipids were measured . RESULTS Lifestyle modification alone result ed in a 59 % reduction in free and rogen index with a 122 % increase in SHBG . OC result ed in a significant decrease in total testosterone ( 44 % ) and free and rogen index ( 86 % ) but also result ed in an increase in C-reactive protein ( 39.7 % ) and cholesterol ( 14 % ) . The combination of lifestyle modification , OC , and metformin result ed in a 55 % decrease in total testosterone , as compared to 33 % with combined treatment and placebo , a 4 % reduction in waist circumference , and a significant increase in HDL ( 46 % ) . CONCLUSIONS In these preliminary trials , both lifestyle modification and OCs significantly reduce and rogens and increase SHBG in obese adolescents with PCOS . Metformin , in combination with lifestyle modification and OC , reduces central adiposity , reduces total testosterone , and increases HDL , but does not enhance overall weight reduction Background To evaluate the feasibility of executing a r and omized controlled trial of progressive resistance training ( PRT ) in women with polycystic ovary syndrome ( PCOS ) . Methods Women with PCOS were r and omized to an  experimental ( PRT ) group or a no-exercise ( usual care ) control group . The PRT group was prescribed two supervised and two unsupervised ( home-based ) training sessions per week for 12 weeks . Feasibility outcomes included recruitment and attrition , adherence , adverse events , and completion of assessment s. Secondary outcomes , collected pre and post intervention , included a range of pertinent physiological , functional and psychological measures . Results Fifteen participants were r and omised into the PRT group ( n = 8) or control group ( n = 7 ) ; five women ( n = 2 in PRT group and n = 3 in control group ) withdrew from the study . The most successful recruitment sources were Facebook ( 40 % ) and online advertisement ( 27 % ) , while least successful methods were referrals by clinicians , colleagues and flyers . In the PRT group , attendance to supervised sessions was higher ( 95 % ; st and ard deviation ±6 % ) compared to unsupervised sessions ( 51 % ; st and ard deviation ±28 % ) . No adverse events were attributed to PRT . Change in menstrual cycle status was not significantly different between groups over time ( p = 0.503 ) . However , the PRT group significantly increased body weight ( p = 0.01 ) , BMI ( p = 0.04 ) , lean mass ( p = 0.01 ) , fat-free mass ( p = 0.005 ) and lower body strength ( p = 0.03 ) , while reducing waist circumference ( p = 0.03 ) and HbA1c ( p = 0.033 ) versus the control group . The PRT group also significantly improved across several domains of disease-specific and general health-related quality of life , depression , anxiety and exercise self-efficacy . Conclusion A r and omized controlled trial of PRT in PCOS would be feasible , and this mode of exercise may elicit a therapeutic effect on clinical ly important outcomes in this cohort . The success of a large-scale trial required to confirm these findings would be contingent on addressing the feasibility hurdles identified in this study with respect to recruitment , attrition , compliance , and collection of st and ardized clinical data .Trial registration Australia New Zeal and Clinical Trials Registry ; ACTRN12614000517673 Registered 15 May 2014 Abdominal obesity and hyperinsulinemia play a key role in the development of the polycystic ovary syndrome ( PCOS ) . Dietary-induced weight loss and the administration of insulin-lowering drugs , such as metformin , are usually followed by improved hyper and rogenism and related clinical abnormalities . This study was carried out to evaluate the effects of combined hypocaloric diet and metformin on body weight , fat distribution , the glucose-insulin system , and hormones in a group of 20 obese PCOS women [ body mass index ( BMI ) > 28 kg/m2 ] with the abdominal phenotype ( waist to hip ratio > 0.80 ) , and an appropriate control group of 20 obese women who were comparable for age and pattern of body fat distribution but without PCOS . At baseline , we measured sex hormone , sex hormone-binding globulin ( SHBG ) , and leptin blood concentrations and performed an oral glucose tolerance test and computerized tomography ( CT ) at the L4-L5 level , to measure sc adipose tissue area ( SAT ) and visceral adipose tissue area . All women were then given a low-calorie diet ( 1,200 - 1,400 kcal/day ) alone for one month , after which anthropometric parameters and CT scan were newly measured . While continuing dietary treatment , PCOS women and obese controls were subsequently placed , in a r and om order , on metformin ( 850 mg/os , twice daily ) ( 12 and 8 , respectively ) or placebo ( 8 and 12 , respectively ) , according to a double-blind design , for the following 6 months . Blood tests and the CT scan were performed in each woman at the end of the study while they were still on treatment . During the treatment period , 3 women of the control group ( all treated with placebo ) were excluded because of noncompliance ; and 2 PCOS women , both treated with metformin , were also excluded because they became pregnant . Therefore , the women cohort available for final statistical analysis included 18 PCOS ( 10 treated with metformin and 8 with placebo ) and 17 control women ( 8 treated with metformin and 9 with placebo )  . The treatment was well tolerated . In the PCOS group , metformin therapy improved hirsutism and menstrual cycles significantly more than placebo .  Baseline anthropometric and CT parameters were similar in all groups . Hypocaloric dieting for 1 month similarly reduced BMI values and the waist circumference in both PCOS and control groups , without any significant effect on CT scan parameters . In both PCOS and control women , however , metformin treatment reduced body weight and BMI significantly more than placebo . Changes in the waist-to-hip ratio values were similar in PCOS women and controls , regardless of pharmacological treatment . Metformin treatment significantly decreased SAT values in both PCOS and control groups , although only in the latter group were SAT changes significantly greater than those observed during the placebo treatment . On the contrary , visceral adipose tissue area values significantly decreased during metformin treatment in both PCOS and control groups , but only in the former was the effect of metformin treatment significantly higher than that of placebo .  Fasting insulin significantly decreased in both PCOS women and controls , regardless of treatment , whereas glucose-stimulated insulin significantly decreased only in PCOS women and controls treated with metformin . Neither metformin or placebo significantly modified the levels of LH , FSH , dehydroepi and rosterone sulphate , and progesterone in any group , whereas testosterone concentrations decreased only in PCOS women treated with metformin .  SHBG concentrations remained unchanged in all PCOS women ; whereas in the control group , they significantly increased after both metformin and placebo .  Leptin levels decreased only during metformin treatment in both PCOS and control groups . ( ABSTRACT TRUNCATED Objective . The objectives of the present pilot study were to : ( 1 ) examine the prevalence of body image distress in overweight and obese women with polycystic ovary syndrome ( PCOS ) ; ( 2 ) assess the effects of a low-cost intervention in the form of a self-directed brisk walking program on body image distress ; and ( 3 ) assess the level of participation , the feasibility of a larger study and the sample size required . Methods . This was an observational study whereby volunteers acted as their own control . Thirty-five women with PCOS ( mean age 29.26 ± 7.57 years ) with body mass index ( BMI ) > 25 kg/m2 volunteered for the study . Twenty-three returned six months later for re assessment . Of these , 12 completed the exercise program ( completers ) and 11 did not ( non-completers ) . Pre and post assessment s comprised the exercise tolerance test , the Body Dysmorphic Disorder Examination – Self-Report ( BDDE-SR ) , a question naire on self-perceived hirsutism and dietary and activity records . Results . Distress with body size was highly prevalent for the overall sample . However , completers had significantly higher BDDE-SR scores at baseline compared with non-completers ( p < 0.005 ) . Pre and post assessment s showed a significant reduction in body image distress only for completers ( p < 0.01 ) despite no significant change in BMI . Conclusions . A self-directed walking program is a low-cost intervention that can have psychological benefits for overweight women with PCOS . Specific recommendations for a r and omized study are put forward OBJECTIVE To investigate whether r and omized diet and /or physical exercise influence serum levels of antimüllerian hormone ( AMH ) in obese women with polycystic ovary syndrome ( PCOS ) . DESIGN R and omized , 4-month trial with three interventions . SETTING Women 's health clinical research unit at a university hospital . PATIENT(S ) Fifty-seven overweight/obese women with PCOS . INTERVENTION(S ) Diet , physical exercise , or both , using programs individually adapted and supervised by a dietician and /or a physiotherapist . MAIN OUTCOME MEASURE(S ) Serum AMH levels before and after the interventions and correlations to reproductive function , body composition , and endocrine and metabolic variables . RESULT ( S ) After intervention , serum levels of AMH were significantly decreased only in the diet group , and the levels were significantly lower than in the exercise group . The strongest predictor of decreased AMH was a decrease in free T , whereas weight loss had no significant influence . Normalized levels of AMH were associated with improvements in menstrual cyclicity and hyper and rogenism but not in metabolic variables . CONCLUSION ( S ) This r and omized study supports that diet reduces serum AMH in association with decreased and rogen levels in obese women with PCOS . Increased serum AMH may be used as a marker of ovulatory dysfunction and hyper and rogenism but not as a marker of insulin resistance . CLINICAL TRIAL REGISTRY NUMBER IS RCT N48342048 This pilot study assessed the effects of exercise and nutritional counseling on hormonal , menstrual , and reproductive function in women with polycystic ovary syndrome ( PCOS ) . Twelve females with a clinical , biochemical , and ultrasonographic diagnosis of PCOS were r and omly assigned to endurance and resistance exercise plus nutritional counseling ( EN ) or nutritional counseling only ( N ) for a period of 12 weeks . Anthropometry , resting metabolic rate ( RMR ) , selected hormones , and ovarian follicle population were measured pre and post-intervention . Following the 12 week intervention , greater decreases in sum of 2 skinfolds ( p = 0.002 ) and a greater increase in estimated VO2 max ( p = 0.017 ) occurred in the exercise group . Significant decreases in waist girth ( p = 0.001 ) and insulin levels ( p = 0.03 ) occurred in both groups . Hormonal changes were not statistically significant ; however , a trend towards an improved hormonal profile , specifically sex-hormone binding globulin ( EN , 39 % increase ; N , 8 % increase ) and lutenizing hormone : follicle-stimulating hormone ( LH : FSH ) ( EN , 9 % decrease ; N , 27 % decrease ) occurred in the absence of weight loss . These findings suggest exercise and nutritional counseling may benefit the metabolic and reproductive abnormalities associated with PCOS Objective : To compare the efficacy of metformin with that of lifestyle changes in patients with polycystic ovary syndrome ( PCOS ) . Design : Prospect i ve , r and omized clinical trial of 40 women with PCOS to analyze the effects of metformin and lifestyle intervention treatments on menstrual pattern and hormone and metabolic profile . The duration of treatment was 6 months . Statistical analysis was done using Student ’s t-test . Results : Fifteen women in the metformin group and 12 in the lifestyle changes group completed the study . The menstrual pattern improved by ~67 % in both groups . There was a significant decrease in waist circumference in the lifestyle changes group ( 101.8 ± 3.9 and 95.1 ± 3.6 , at baseline and at 6 months of treatment , respectively ; p < 0.001 ) and in body mass index ( BMI ) in both groups . The predictor of menstrual pattern improvement was BMI . Conclusions : Both metformin and lifestyle changes may increase the number of menstrual cycles in PCOS . This effect was related to a decrease in BMI OBJECTIVE To examine the efficacy of sibutramine together with brief lifestyle modification for weight reduction in obese women with polycystic ovary syndrome ( PCOS ) . DESIGN Investigator-initiated , multicenter , double-blind , r and omized , parallel-group clinical trial . SETTING Departments of Obstetrics and Gynecology in primary care , referral centers , and private practice . PATIENT(S ) Forty-two patients with confirmed PCOS were included in the study , and 34 patients completed the study . INTERVENTION Sibutramine 15 mg once daily together with brief lifestyle modification was compare with placebo together with brief lifestyle modification . MAIN OUTCOME MEASURE(S ) The primary endpoint was to assess weight loss . Secondary endpoints included the efficacy of sibutramine for treatment of menstrual pattern and cardiovascular risk factors . RESULT ( S ) After 6 months the sibutramine group had lost 7.8 + /- 5.1 kg compared with a weight loss of 2.8 + /- 6.2 kg in the placebo group . Sibutramine treatment result ed in significant decreases in apolipoprotein B , apolipoprotein B/apolipoprotein A ratio , triglycerides , and cystatin C levels . CONCLUSION ( S ) Sibutramine in combination with lifestyle intervention results in significant weight reduction in obese patients with PCOS . In addition to the weight loss , sibutramine seems to have beneficial effects on metabolic and cardiovascular risk factors BACKGROUND This prospect i ve study evaluated the effect of weight reduction on anthropometric indices and ovarian morphology in anovulatory overweight patients with polycystic ovary syndrome ( PCOS ) . METHODS Thirty-three anovulatory overweight patients with PCOS were enrolled in the study . All had patent Fallopian tubes and chronic anovulation : 27 of them were oligo-amenorrhoeic . The partners were normospermic . Patients were prescribed a 1200 kcal/day diet , and physical exercise was recommended .  Anthropometric indices and ovarian imaging parameters were assessed at baseline and after weight loss of 5 and 10 % . RESULTS Twenty-five patients ( 76 % ) lost at least 5 % of their body weight . Eleven of these patients ( 33 % ) reached a 10 % decrease in weight . Waist circumference at the umbilical level , hip circumference , four skin folds , body mass index and fatty mass ratio were significantly reduced after 5 and 10 % weight loss . Ovarian morphology changed during the diet : we observed a significant reduction in ovarian volume and in the number of microfollicles per ovary . Among the 27 patients with oligo-amenorrhoea , 18 had a resumption of regular cycles and 15 experienced spontaneous ovulation ; 10 spontaneous pregnancies occurred in patients who lost at least 5 % of their weight . CONCLUSIONS Weight loss through a controlled low-calorie diet improves anthropometric indices in obese PCOS patients , reduces ovarian volume and microfollicle number and can restore ovulatory cycles , allowing spontaneous pregnancy We have recently shown that polycystic ovary syndrome ( PCOS ) is associated with high muscle sympathetic nerve activity ( MSNA ) . Animal studies support the concept that low-frequency electroacupuncture ( EA ) and physical exercise , via stimulation of ergoreceptors and somatic afferents in the muscles , may modulate the activity of the sympathetic nervous system . The aim of the present study was to investigate the effect of these interventions on sympathetic nerve activity in women with PCOS . In a r and omized controlled trial , 20 women with PCOS were r and omly allocated to one of three groups : low-frequency EA ( n = 9 ) , physical exercise ( n = 5 ) , or untreated control ( n = 6 ) during 16 wk . Direct recordings of multiunit efferent postganglionic MSNA in a muscle fascicle of the peroneal nerve before and following 16 wk of treatment . Biometric , hemodynamic , endocrine , and metabolic parameters were measured . Low-frequency EA ( P = 0.036 ) and physical exercise ( P = 0.030 ) decreased MSNA burst frequency compared with the untreated control group . The low-frequency EA group reduced sagittal diameter ( P = 0.001 ) , while the physical exercise group reduced body weight ( P = 0.004 ) and body mass index ( P = 0.004 ) compared with the untreated control group . Sagittal diameter was related to MSNA burst frequency ( Rs = 0.58 , P < 0.005 ) in the EA group . No correlation was found for body mass index and MSNA in the exercise group . There were no differences between the groups in hemodynamic , endocrine , and metabolic variables . For the first time we demonstrate that low-frequency EA and physical exercise lowers high sympathetic nerve activity in women with PCOS . Thus , treatment with low-frequency EA or physical exercise with the aim to reduce MSNA may be of importance for women with PCOS BACKGROUND It has been reported that women with polycystic ovary syndrome ( PCOS ) benefit from metformin therapy . METHODS A r and omized ,  placebo-controlled  , double-blind study of obese ( body mass index > 30 kg/m2 ) , oligo-/amenorrhoeic women with PCOS .  Metformin ( 850 mg ) twice daily was compared with placebo over 6 months . All received the same advice from a dietitian . The primary outcome measures were : ( i ) change in menstrual cycle ; ( ii ) change in arthropometric measurements ; and ( iii ) changes in the endocrine parameters , insulin sensitivity and lipid profile . RESULTS A total of 143 subjects was r and omized [ metformin  ( MET ) = 69 ; placebo ( PL ) = 74 ] . Both groups showed significant improvements in menstrual frequency [ median increase ( MET = 1 , P < 0.001 ; PL = 1 , P < 0.001 ) ] and weight loss [ mean ( kg ) ( MET = 2.84 ; P < 0.001 and PL = 1.46 ; P = 0.011 ) ] . However , there were no significant differences between the groups . Logistic regression analysis was used to analyse the independent variables  ( metformin , percentage of weight loss , initial BMI and age ) in order to predict the improvement of menses . Only the percentage weight loss correlated with an improvement in menses ( regression coefficient = 0.199 , P = 0.047 , odds ratio = 1.126 , 95 % CI 1.001 , 1.266 ) . There were no significant changes in insulin sensitivity or lipid profiles in either of the groups . Those who received metformin achieved a significant reduction in waist circumference and free and rogen index . CONCLUSIONS Metformin does not improve weight loss or menstrual frequency in obese patients with PCOS .  Weight loss alone through lifestyle changes improves menstrual frequency Background This study assessed the perceived benefits and barriers to exercise participation in overweight and obese women with polycystic ovary syndrome ( PCOS ) and monitored changes in response to a lifestyle intervention . Methods Forty-three overweight/obese PCOS women ( Age , 30.3(6.2 ) yrs ; BMI , 36.4(5.6 ) kg/m2 ) were r and omised to one of three 20-week lifestyle programs : diet only ( DO , n = 13 ) , diet and aerobic exercise ( DA , n = 11 ) and diet and combined aerobic-resistance exercise ( DC , n = 19 ) . Exercise Benefits /Barriers Scale ( EBBS ) , weight , aerobic fitness , depression and PCOS specific health-related quality of life were measured . Results Barriers score was related to depression ( r = 0.45 , P = 0.002 ) and aerobic fitness ( r = −0.32 , P = 0.04 ) , while benefits score was related to aerobic fitness ( r = 0.41 , P = 0.007 ) . EBBS , benefits and barriers scores improved overtime ( P ≤ 0.001 ) . Benefits subscales psychological outlook and social interaction increased ( P ≤ 0.001 ) and life enhancement and preventative health did not change ( P ≥ 0.3 ) . Physical performance increased only in DA ( P = 0.009 ) . There were no differences between treatments for any of the other subscales ( P ≥ 0.2 ) . Barriers subscales exercise milieu , time expenditure and physical exertion reduced ( P ≤ 0.003 ) and family discouragement did not change ( P = 0.6 ) . Conclusions This study demonstrated that lifestyle modification consisting of an energy-restricted diet with or without exercise training improved the perceived benefits from and barriers to exercise . Trial registration Australian New Zeal and Clinical Trials Register ACTRN12606000198527 , registered 26 May [ Purpose ] The short-term effects of structured exercise on the anthropometric , cardiovascular , and metabolic parameters of non-overweight women diagnosed with polycystic ovary syndrome were evaluated . [ Subjects and Methods ] Thirty women with a diagnosis of polycystic ovary syndrome were prospect ively r and omized to either a control group ( n=16 ) or a training group ( n=14 ) for a period of 8 weeks . Anthropometric , cardiovascular , and metabolic parameters and hormone levels were measured and compared before and after the intervention . [ Results ] Waist and hip measurements ( anthropometric parameters ) ; diastolic blood pressure ; respiratory rate ( cardiovascular parameters ) ; levels of low-density lipoprotein cholesterol , total cholesterol , fasting glucose , and fasting insulin ; and the homeostasis model assessment of insulin resistance index ( metabolic parameters ) were significantly lower in the training group after 8 weeks of exercise compared to the baseline values . After exercise , the training group had significantly higher oxygen consumption and high-density lipoprotein levels and significantly shorter menstrual cycle intervals . The corresponding values for controls did not significantly differ between the start and end of the 8-week experiment . [ Conclusion ] Short-term regular exercise programs can lead to improvements in anthropometric , cardiovascular , and metabolic parameters of non-overweight women with polycystic ovary syndrome OBJECTIVE To compare the efficacy of weight loss , metformin and rosiglitazone in women with polycystic ovary syndrome ( PCOS ) . METHODS A r and omized controlled trial ( RCT ) was carried out in Peking Union Medical College Hospital ( PUMCH ) , one hundred and six women with PCOS were assigned to three intervention groups : weight loss , weight loss and metformin , weight loss and rosiglitazone group . Patients were treated with weight loss ( diet and exercise ) , weight loss and metformin ( 500 mg three times daily ) , weight loss and rosiglitazone ( 4 mg once daily ) for three months . Sixty patients completed treatments . Basal body temperature ( BBT ) , total testosterone as well as fasting serum insulin levels and lipid were measured and compared in all patients before and after weight loss . RESULTS No significant differences were found in the baseline characteristics among three groups . In weight loss group 51 % ( 22/43 ) patients completed treatment , and 23 % ( 5/22 ) patients resumed ovulation . In weight loss and metformin group 58 % ( 21/36 ) patients completed treatment , and 43 % ( 9/21 ) patients resumed ovulation . In weight loss and rosiglitazone group 63 % ( 17/27 ) patients completed treatment , and 59 % ( 10/17 ) patients resumed ovulation . Ovulation rate was significantly higher in weight loss and rosiglitazone group than in weight loss group . There was no significant difference among three groups in body mass index ( BMI ) , waist circumference , waist-hip ratio ( WHR ) , sex hormone , serum fasting insulin and lipid level after treatment . CONCLUSION Weight loss , metformin and rosiglitazone all can improve ovulation each OBJECTIVE To investigate the possible effects of low-frequency electroacupuncture ( EA ) and physical exercise on markers of coagulation and fibrinolysis , insulin sensitivity , and adipose tissue characteristics in women with polycystic ovary syndrome ( PCOS ) . DESIGN Secondary analyses of a prospect i ve , r and omized controlled clinical trial . SETTING Department of Physiology and Department of Obstetrics and Gynecology , University of Gothenburg . PATIENT(S ) Eighty-four women with PCOS were r and omized . INTERVENTION(S ) Women with PCOS were r and omized to 16 weeks of low-frequency EA ( 14 treatments ) , physical exercise ( at least 3 times/wk ) , or no intervention . MAIN OUTCOME MEASURE(S ) Anthropometrics , circulating coagulation and fibrinolytic markers , insulin sensitivity ( euglycemic hyperinsulinemic clamp ) , hemodynamics , and adipose tissue morphology/function recorded at baseline , after 16 weeks of intervention , and after a 16-week follow-up . RESULT ( S ) In the low-frequency EA group , circulating plasminogen activator inhibitor 1 activity decreased by 21.8 % after 16 weeks of intervention and by 31.1 % at the 16-week follow-up and differed from the physical exercise and the no intervention groups . The EA group had decreases in circulating fibrinogen and tissue plasminogen activator ( t-PA ) , sagittal diameter , and diastolic blood pressure after treatment , and fibrinogen remained lower at the 16-week follow-up . In the physical exercise group , lipoprotein lipase activity increased and diastolic blood pressure decreased after treatment , and both diastolic and systolic blood pressure were lower at follow-up . No other variables were affected . CONCLUSION ( S ) Low-frequency EA counteracted a possible prothrombotic state in women with PCOS , as reflected by a decrease in plasminogen activator inhibitor 1 activity . Despite within-group improvements , there were no between-group differences in anthropometric , metabolic , or hemodynamic variables after 16 weeks of EA or physical exercise at the dose/intensity studied The aim of this r and omized pilot was to assess the feasibility of a dietary intervention among women with polycystic ovary syndrome ( PCOS ) comparing a vegan to a low-calorie ( low-cal ) diet .  Overweight ( body mass index , 39.9 ± 6.1 kg/m(2 ) ) women with PCOS ( n = 18 ; age , 27.8 ± 4.5 years ; 39 % black ) who were experiencing infertility were recruited to participate in a 6-month r and omized weight loss study delivered through nutrition counseling , e-mail , and Facebook . Body weight and dietary intake were assessed at 0 , 3 , and 6 months . We hypothesized that weight loss would be greater in the vegan group . Attrition was high at 3 ( 39 % ) and 6 months ( 67 % ) . All analyses were conducted as intention-to-treat and presented as median ( interquartile range ) . Vegan participants lost significantly more weight at 3 months ( -1.8 % [ -5.0 % , -0.9 % ] vegan , 0.0 [ -1.2 % , 0.3 % ] low-cal ; P = .04 ) , but there was no difference between groups at 6 months ( P = .39 ) . Use of Facebook groups was significantly related to percent weight loss at 3 ( P < .001 ) and 6 months ( P = .05 ) . Vegan participants had a greater decrease in energy ( -265 [ -439 , 0 ] kcal/d ) and fat intake ( -7.4 % [ -9.2 % , 0 ] energy ) at 6 months compared with low-cal participants ( 0 [ 0 , 112 ] kcal/d , P = .02 ; 0 [ 0 , 3.0 % ] energy , P = .02 ) . These preliminary results suggest that engagement with social media and adoption of a vegan diet may be effective for promoting short-term weight loss among women with PCOS ; however , a larger trial that addresses potential high attrition rates is needed to confirm these results BACKGROUND : The effects of exercise , metformin , and orlistat on anthropometric parameters , lipid profile , endocrine parameters , and ovulation in polycystic ovarian syndrome ( PCOS ) women were compared . AIM : The aim was to study the efficacy of orlistat compared with metformin and exercise in PCOS . DESIGN : R and omized control trial . METHODS : A total of 90 eligible PCOS women were r and omly assigned to receive either of the two drugs ( orlistat or metformin ) in combination with lifestyle interventions or as controls where they received lifestyle interventions alone .  Anthropometric parameters were assessed at baseline and 4 weekly intervals for 3 months . And rogen levels , insulin resistance , ovulation and conception rates and lipid profile were also assessed at the end of study . STATISTICAL ANALYSIS : Statistical analysis was performed using the SPSS version 17.0 . RESULTS : The levels of fasting blood sugar , fasting insulin and homeostatic model assessment insulin resistance were comparable in three treatment groups . Mean total testosterone , serum hormone binding globulin , free and rogen index , dehydroepi and rosterone sulfate in all arms were comparable and statistically nonsignificant . However , orlistat and metformin were more effective in reducing weight , body mass index , waist circumference and waist-hip ratio . However , side-effects were less with orlistat .  Ovulation rate was 33.3 % , 23.35 % with orlistat and metformin group respectively , but were not statistically significant . In orlistat group , significant improvement was observed in lipid profile at the end of 3 months . Conception rates were 40 % and 16.7 % and 3.3 % in orlistat , metformin group and control group respectively ( P - 0.003 ) . Weight loss was found to be the best predictor of ovulation with sensitivity with good sensitivity . CONCLUSION : Orlistat is as effective as metformin in reducing weight and achieves similar ovulation rates in obese PCOS patients . However , orlistat has minimal side-effects and is better tolerated compared with metformin OBJECTIVE The aim of this study was to examine the effects of acute exercise on insulin signaling in skeletal muscle of women with polycystic ovary syndrome ( PCOS ) and controls ( CTRL ) . METHODS Fifteen women with obesity and PCOS and 12 body mass index-matched CTRL participated in this study . Subjects performed a 40-min single bout of exercise . Muscle biopsies were performed before and 60 min after exercise . Selected proteins were assessed by Western blotting . RESULTS CTRL , but not PCOS , showed a significant increase in PI3-k p85 and AS160 Thr 642 after a single bout of exercise ( P = 0.018 and P = 0.018 , respectively ) . Only PCOS showed an increase in Akt Thr 308 and AMPK phosphorylation after exercise ( P = 0.018 and P = 0.018 , respectively ) . Total GLUT4 expression was comparable between groups ( P > 0.05 ) . GLUT4 translocation tended to be significantly higher in both groups after exercise ( PCOS : P = 0.093 ; CTRL : P = 0.091 ) , with no significant difference between them ( P > 0.05 ) . CONCLUSIONS A single bout of exercise elicited similar GLUT4 translocation in skeletal muscle of PCOS and CTRL , despite a slightly differential pattern of protein phosphorylation . The absence of impairment in GLUT4 translocation suggests that PCOS patients with obesity and insulin resistance may benefit from exercise training CONTEXT Lifestyle modification is recommended in women with polycystic ovary syndrome ( PCOS ) prior to conception but there are few r and omized trials to support its implementation or benefit . OBJECTIVE This study aim ed to determine the relative efficacy of preconception intervention on reproductive and metabolic abnormalities in overweight/obese women with PCOS . DESIGN , SETTING , AND PARTICIPANTS This was a r and omized controlled trial of preconception and infertility treatment at Academic Health Centers in women with infertility due to PCOS , age 18 - 40 y and body mass index 27 - 42 kg/m(2 ) . INTERVENTION Women were r and omly assigned to receive either 16 weeks of 1 ) continuous oral contraceptive pills ( OCPs ) ( ethinyl estradiol 20 mcg/1 mg norethindrone acetate ) ( " OCP " ) ; 2 ) lifestyle modification consisting of caloric restriction with meal replacements , weight loss medication ( either sibutramine , or orlistat ) , and increased physical activity to promote a 7 % weight loss ( " Lifestyle " ) ; or 3 ) combined treatment with both OCP and lifestyle modification ( " Combined " ) . After preconception intervention , women underwent st and ardized ovulation induction with clomiphene citrate and timed intercourse for four cycles . Pregnancies were followed with trimester visits until delivery . MAIN OUTCOME MEASURES Weight , ovulation , and live birth were measured . RESULTS We consented 216 and r and omly assigned 149 women ( Lifestyle : n = 50 ; OCP : n = 49 ; Combined : n = 50 ) . We achieved significant weight loss with both Lifestyle ( mean weight loss , -6.2 % ; 95 % confidence interval ( CI ) , -7.4 - -5.0 ; and Combined ( mean weight loss , -6.4 % ; 95 % CI , -7.6 - -5.2 ) compared with baseline and OCP ( both P < .001 ) . There was a significant increase in the prevalence of metabolic syndrome at the end of preconception treatment compared with baseline within OCP ( odds ratio [ OR , 2.47 ; 95 % CI , 1.42 - 4.27 ) whereas no change in metabolic syndrome was detected in the Lifestyle ( OR , 1.18 ; 95 % CI , 0.63 - 2.19 ) or Combined ( OR , 0.72 ; 95 % CI , 0.44 - 1.17 ) groups . Cumulative ovulation rates were superior after weight loss : OCP , 46 % ; Lifestyle , 60 % ; and Combined , 67 % ( P < .05 ) . Live birth rates were OCP , 12 % ; Lifestyle , 26 % ; and Combined , 24 % ( P = .13 ) . CONCLUSIONS A preconception weight loss intervention eliminates the adverse metabolic oral contraceptive effects and , compared with oral contraceptive pretreatment , leads to higher ovulation rates AIM The aim of this study was to evaluate the effects of diet alone , and in association with metformin in monotherapy or in cotreatment with myoinositol ( MYO ) on menstrual irregularities , hirsutism , body weight and composition in overweight/obese women with polycystic ovary syndrome ( PCOS ) . METHODS Twenty-seven PCOS overweight/obese patients were r and omly treated : nine with only diet ( D ) ; nine with diet and metformin 1000 mg/day continuously ( D+M ) ; nine with diet , metformin 500 mg/day and MYO 4 g/day plus 400 µg folic acid daily , continuously ( D+M+I ) . Menstrual cycle , Ferriman-Gallwey score , body mass index ( BMI ) , waist hip rate ( WHR ) , body composition by BIA 101 of AKERN SRL , were measured on basal condition and at 3 months . RESULTS Regularity of menstrual cycle was restored in a significantly number of patients of group D+M+I ( P<0.05 ) ; Ferriman score was significantly improved by weight loss ( P<0.05 ) . Body weight , BMI , waist and hip circumferences decreased significantly in all groups without WHR modification ; body weight loss significantly depended on adding metformin to diet . Fat mass ( FM ) kg and % was significantly reduced in groups D and D+M+I ; fat free mass ( FFM ) kg was slightly reduced by diet ( P<0.05 ) and correlated with Ferriman score . CONCLUSION Body weight loss  in obese PCOS patients improves symptoms and body composition ; weight loss was dependent on adding metformin to diet ; MYO was more effective in restoring regularity of menstrual cycle . Further investigation occurs to confirm metformin and MYO rule on body composition improvement , specially regarding FFM that is likewise FM correlated to cardiovascular risk CONTEXT The few controlled trials performed so far indicate that the addition of metformin and /or flutamide to a hypocaloric diet in obese women with polycystic ovary syndrome ( PCOS ) effectively influences different phenotypic aspects of the syndrome . All these studies are , however , characterized by a short to medium period of treatment . OBJECTIVE Our objective was to investigate the long-term effects of these therapies . DESIGN AND SETTING We conducted a prospect i ve , r and omized , placebo-controlled trial at a medical center . PATIENTS Of 80 overweight-obese women with PCOS , 76 completed the study . INTERVENTIONS Patients were placed on a hypocaloric diet for the first month and then on a hypocaloric diet plus placebo , metformin ( 850 mg , orally , twice a day ) , flutamide ( 250 mg , orally , twice a day ) , or metformin plus flutamide for the subsequent 12 months ( 20 subjects in each group ) . MAIN OUTCOME MEASURES We assessed clinical features , computerized tomography measurement of fat distribution , and rogens , lipids , and fasting and glucose-stimulated glucose and insulin levels at baseline and after 6 and 12 months of treatment . RESULTS After 6 months , compared with placebo , flutamide further decreased visceral/sc fat mass ( P = 0.044 ) , and rostenedione ( P < 0.001 ) , dehydroepi and rosterone sulfate ( P < 0.001 ) , and hirsutism score ( P < 0.001 ) , whereas metformin further increased frequency of menstruation ( P = 0.039 ) . After 12 months , flutamide maintained the effects observed after 6 months on visceral/sc fat mass ( P = 0.033 ) and and rostenedione ( P < 0.001 ) , whereas it produced an additional decrease in dehydroepi and rosterone sulfate ( P = 0.020 ) and hirsutism score ( P = 0.019 ) ; metformin further improved the menstrual pattern ( P = 0.013 ) . Moreover , after 12 months , flutamide improved more than placebo the menstrual pattern ( P = 0.008 ) , glucose-stimulated glucose levels ( P = 0.041 ) , insulin sensitivity ( P < 0.001 ) , and low-density lipoprotein cholesterol levels ( P = 0.003 ) , whereas metformin  decreased glucose-stimulated insulin levels ( P = 0.014 ) . The combination of the two drugs maintained the specific effect of each of the compounds , without any additive or synergistic effect . CONCLUSIONS These findings add relevance to the usefulness of metformin and flutamide in the treatment of dieting overweight-obese PCOS women and provide a rationale for targeting different therapeutic options according to the required outcomes in the long term INTRODUCTION Some pregnancy complications are characterized by increased levels of cell-free fetal ( cffDNA ) and maternal DNA ( cfmDNA ) , the latter may also be elevated during physical strain . This study aims at assessing the impact of exercise and metformin intervention in pregnancy , and to compare the levels of cell free DNA in pregnant women with or without PCOS diagnosis . METHODS Consecutive women from two previous r and omized controlled trials in pregnancy were included . Women came from a trial with organized exercise vs. st and ard antenatal care in pregnancy and a trial of metformin vs. placebo in PCOS women .  Levels of cffDNA , cfmDNA and cell-free total DNA ( cftDNA ) were measured by qPCR . RESULTS Training in pregnancy did not affect the levels of cffDNA , cfmDNA or cftDNA .  PCOS-women  treated with metformin had lower levels of cfmDNA and cftDNA at week 32 ( mean ± SD : 301 ± 162 versus 570 ± 337 , p = 0.012 , 345 ± 173 versus 635 ± 370 , p = 0.019 ) ; otherwise the levels were comparable to PCOS-controls . Metformin-treated PCOS-women had higher cffDNA at inclusion , in the 1st trimester ; later on in pregnancy the levels in the metformin and placebo groups were equal . A comparison of pregnant women in the exercise study ( TRIP ) to placebo-treated pregnant PCOS-women , showed the levels of cffDNA , cfmDNA or cftDNA during mid-pregnancy ( weeks 18 - 36 ) to be equal . DISCUSSION Training during pregnancy was not associated with altered levels of cffDNA cfmDNA or cftDNA , but metformin treatment may reduce cfmDNA and cftDNA in pregnant PCOS women Background Polycystic ovary syndrome ( PCOS ) is a common female reproductive‐age endocrine disease predominantly characterized by chronic anovulation , hyper and rogenism , insulin‐resistance and low‐ grade inflammatory status . Exercise training ( ET ) favourably modulates cardiopulmonary function and insulin‐sensitivity markers in PCOS women . The present study investigated the effects of ET  on autonomic function and inflammatory pattern in PCOS women OBJECTIVE To determine whether weight loss in obese , hyper and rogenic , anovulatory women is associated with resumption of ovulation and /or with changes in insulin , and rogen , and gonadotropin concentrations . DESIGN Prospect i ve , r and omized , controlled study . SETTING University research center . PATIENTS Twelve obese , hyper and rogenic , anovulatory women . INTERVENTIONS Twelve-week weight loss program in treatment ( n = 6 ) ; 12-week " waiting list " in control group ( n = 6 ) . MAIN OUTCOME MEASURES [ 1 ] Ovulation ; [ 2 ] fasting insulin and glucose measurements ; [ 3 ] sex hormone-binding globulin ( SHBG ) , total and non-SHBG T concentrations ; [ 4 ] LH pulse frequency , amplitude , and concentration ; and [ 5 ] FSH concentration . RESULTS In contrast with the control group who showed no change in weight , ovulation status , or hormone levels , women in the treatment group lost an average of 16.2 kg and showed a significant increase in SHBG , a significant decline in non-SHBG T , and a decline ( though nonsignificant ) in fasting insulin . Four of six subjects resumed ovulation . However , no changes were evident in LH pulse frequency or amplitude or in mean LH and FSH concentrations . CONCLUSIONS Weight loss in obese , hyper and rogenic , anovulatory women appears to reduce insulin and non-SHBG T concentrations despite the absence of a change in gonadotropin secretion and may lead to resumption of ovulation Abstract Objective : To test the hypothesis that a single measurement , waist circumference , might be used to identify people at health risk both from being overweight and from having a central fat distribution . Design : A community derived r and om sample of men and women and a second , validation sample . Setting : North Glasgow . Subjects : 904 men and 1014 women ( first sample ) ; 86 men and 202 women ( validation sample ) . Main outcome measures : Waist circumference , body mass index , waist : hip ratio . Results : Waist circumference > /=94 cm for men and > /=80 cm for women identified subjects with high body mass index ( > /=25 kg/m2 ) and those with lower body mass index but high waist : hip ratio ( > /=0.95 for men , > /=0.80 women ) with a sensitivity of > 96 % and specificity > 97.5 % . Waist circumference > /=102 cm for men or > /=88 cm for women identified subjects with body mass index > /=30 and those with lower body mass index but high waist : hip ratio with a sensitivity of > 96 % and specificity > 98 % , with only about 2 % of the sample being misclassified . Conclusions : Waist circumference could be used in health promotion programmes to identify individuals who should seek and be offered weight management . Men with waist circumference > /=94 cm and women with waist circumference > /=80 cm should gain no further weight ; men with waist circumference > /=102 cm and women with waist circumference > /=88 cm should reduce their weight OBJECTIVE To obtain data from a pilot r and omized trial on the effect of metformin therapy and lifestyle modification on ovulation and and rogen concentrations in women with polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve , r and omized , placebo-controlled pilot trial . SETTING Academic medical center . PATIENT(S ) Thirty-eight overweight or obese women with PCOS . INTERVENTION(S ) All subjects were r and omized to one of four 48-week interventions : metformin 850 mg two times per day , lifestyle modification plus metformin 850 mg two times per day , lifestyle modification plus placebo , or placebo alone . MAIN OUTCOME MEASURE(S ) Recruitment , dropout , and compliance with a long-term lifestyle intervention in PCOS ; preliminary estimates of treatment effect on ovulation , as measured by weekly urinary pregnanediol glucuronide , and on total T and free and rogen index . RESULT ( S ) It was necessary to screen seven women to have one subject r and omized . The dropout rate was 39 % , with the majority of dropouts occurring within the first 24 weeks . Mean body mass index was > 39 mg/kg(2 ) . Modest weight reduction was found in all treatment groups , with the most significant reduction occurring with the combination of metformin and lifestyle intervention .  Significant and rogen reduction occurred in the combination group only . Ovulation rates did not differ significantly between groups . However , when data were analyzed by presence or absence of weight reduction in subjects , independent of treatment group , the estimated odds ratio for weight loss was 9.0 ( 95 % confidence interval 1.2 - 64.7 ) with respect to regular ovulation . If weight loss occurred during metformin therapy , the odds ratio for regular ovulation was 16.2 ( 95 % confidence interval 4.4 - 60.2 ) . CONCLUSION ( S ) Key method ologic issues for a large-scale , r and omized trial of lifestyle intervention in PCOS include minimizing early dropout from the lifestyle intervention and including a range of body mass index that is not skewed toward severe obesity . Weight reduction might play the most significant role in restoration of ovulation in obese women with PCOS STUDY OBJECTIVE To investigate the effect of dietary weight loss on menstrual regularity in obese adolescent women with polycystic ovary syndrome ( PCOS ) . DESIGN AND SETTING A r and omized controlled trial was held at the Faculty of Nursing , Mansoura University , and the Obesity Clinic of the Rheumatology Department at Mansoura University Hospitals between July 2011 and January 2013 . PARTICIPANTS Sixty adolescent women with PCOS , body mass index ( BMI ) greater than 30 , and complaints of menstrual irregularities were included in this study . Enrolled women were divided equally and r and omly into 2 groups : intervention and control groups . INTERVENTIONS Women in the intervention group ( n = 30 ) were subject to an intensive dietary educational program with instructions to follow a conventional energy restricted diet , whereas women in the control group were instructed to follow the same healthy diet of the first group without calorie restriction . MAIN OUTCOME MEASURES Menstrual regularity , weight loss , the effect on waist circumference , and hirsutism score . RESULTS The 2 groups were initially matched in average body weight , BMI , hirsutism score , and waist circumference . Six months later , there were significant decreases in all parameters in the weight reduction group . In addition , more menstrual episodes were recorded in the weight reduction compared with the control group ( 3.1 ± 1.2 vs. 2.3 ± 1.3 ; P = .010 ) . Also , BMI , waist circumference , and hirsutism score were all significantly decreased at the end of the study . CONCLUSION Dietary weight loss in adolescent women with PCOS result ed in significant improvement in menstrual regularity , BMI , waist circumference , and hirsutism score CONTEXT Insulin resistance is a feature of polycystic ovary syndrome ( PCOS ) , and it is related to mitochondrial function , particularly with maximal oxygen consumption ( VO(2max ) ) . At the moment , no evaluation of cardiopulmonary functional capacity in young patients with PCOS has been performed . OBJECTIVE Our objective was to assess cardiopulmonary functional capacity in young PCOS overweight patients . DESIGN AND SETTING We conducted a prospect i ve baseline-controlled clinical study at University Federico II of Naples , School of Medicine ( Naples , Italy ) . PATIENTS Forty-five PCOS patients were matched with 45 healthy women for age ( mean + /- sd , 21.3 + /- 2.0 vs. 21.6 + /- 1.9 yr , respectively ) and body mass index ( 29.4 + /- 3.6 vs. 29.0 + /- 3.4 kg/m(2 ) , respectively ) . MEAN OUTCOME MEASURES We assessed hormonal and metabolic pattern and functional capacity by cardiopulmonary exercise testing to evaluate maximal oxygen consumption ( VO(2max ) ) , oxygen consumption at anaerobic threshold ( VO(2AT ) ) , and the maximal workload at peak exercise . RESULTS VO(2max ) ( 17.0 + /- 3.7 vs. 26.8 + /- 3.5 ml/kg.min ) , oxygen consumption at anaerobic threshold ( 13.9 + /- 3.0 vs. 21.2 + /- 3.8 ml/kg.min ) , and maximal workload at peak exercise ( 101.3 + /- 25.2 vs. 135 + /- 22.6 W ) were significantly ( P < 0.001 ) reduced in PCOS subjects compared with healthy women . The multiple linear regression analysis showed that only homeostasis model assessment appears to have a strong negative linear relation with VO(2max ) in PCOS . No relation was found in controls . CONCLUSIONS Our data demonstrate a reduced cardiopulmonary functional capacity  in young PCOS patients In a prospect i ve study , eight women with polycystic ovary syndrome completed 16 weeks of individualized aerobic exercise training . Independent of changes in body weight and adiposity there was a statistically significant increase in aerobic fitness and insulin sensitivity and a statistically significant decrease in the total number of follicles measured by magnetic resonance imaging OBJECTIVE To determine if the combination of lifestyle ( caloric restriction and exercise ) and metformin ( MET ) would be superior to lifestyle and placebo ( PBO ) in improving the polycystic ovary syndrome ( PCOS ) phenotype . DESIGN Double-blind r and omized 6-month trial of MET versus PBO . SETTING Two academic medical centers . PATIENT(S ) One hundred fourteen subjects with PCOS were r and omized to MET  ( N = 55 ) or PBO ( N = 59 ) . INTERVENTION(S ) Subjects collected urine daily for ovulation monitoring , had monthly monitoring of hormones and weight and determination of body composition by dual-energy x-ray absorptiometry , glucose tolerance , and were evaluated for quality of life at baseline and completion . MAIN OUTCOME MEASURE(S ) Ovulation rates and testosterone levels . RESULT ( S ) Dropout rates were high . There was no significant difference in ovulation rates . Testosterone levels were significantly lower compared with baseline in the MET group at 3 mos but not at 6 mos . There were no differences in weight loss between groups , but MET showed a significant decline at 6 months compared with baseline ( -3.4 kg , 95 % confidence interval -5.3 to -1.5 kg ) . We noted divergent effects of MET versus PBO on oral glucose tolerance test indices of insulin sensitivity ( increased ) and secretion ( worsened ) . Total bone mineral density increased significantly in MET . There were no differences in quality of life measures between the groups . The MET group had increased diarrhea and headache , but fewer bladder infections and musculoskeletal complaints . CONCLUSION ( S ) The addition of metformin to lifestyle therapy produced little reproductive or glycemic benefit in women with PCOS , although our study had limited power owing to a high dropout rate . It is not possible at baseline to identify women likely to drop out PURPOSE Women with polycystic ovary syndrome ( PCOS ) commonly have insulin resistance . Insulin resistance is associated with marked abnormalities of lipoprotein size and subclass particle concentration . The purpose of this study was to examine the effects of a moderate-intensity exercise program without weight loss on lipoprotein profiles in women with PCOS . METHODS Thirty-seven sedentary PCOS women were r and omized to either an 8- to 12-wk ramp-up followed by a 12-wk moderate-intensity exercise program ( 16 - 24 wk total , approximately 228 min x wk at 40 - 60 % peak V x O2 , n = 21 ) or control ( no change in lifestyle , n = 16 ) . PCOS was defined as < or=8 menses per year and hyper and rogenism ( biochemical or clinical with Ferriman-Gallwey score > or=8 ) . Fasting lipoprotein profiles were obtained before and after the intervention . Nuclear magnetic resonance spectroscopy was used to quantify the following : average particle size , total and subclass concentrations of HDL , LDL , and VLDL particles , and calculated HDL cholesterol , triglycerides , and VLDL triglycerides . Wilcoxon exact rank sums tests were used to compare changes in these parameters in the exercise group relative to controls . RESULTS Twenty women ( 8 exercisers , 12 controls ) completed the study . Comparing exercisers to controls , significant changes were seen in concentrations of the following lipoprotein parameters that are associated with decreased insulin resistance : decreased large VLDL ( P = 0.007 ) , calculated triglycerides ( P = 0.003 ) , VLDL triglycerides ( P = 0.003 ) , and medium/small HDL ( P = 0.031 ) and increased large HDL ( P = 0.002 ) and average HDL size ( P = 0.001 ) . CONCLUSIONS In this trial , moderate-intensity exercise without significant weight loss improved several components of the lipoprotein profiles of women with PCOS . These findings support the beneficial role of moderate exercise in this high-risk population BACKGROUND AND OBJECTIVES Polycystic ovary syndrome ( PCOS ) is a common problem in women at fertile age . A prospect i ve study was conducted to clarify the pathophysiological responses during an application of insulin sensitizer , metformin and weight reduction therapy at the Gynecology Center in Ohud hospital , in AL-Madinah AL-Munawarah , Kingdom of Saudi Arabia . METHODOLOGY Twenty healthy women served as controls and 180 PCOS women divided into three groups participated in the study . First group was treated with Clomid citrate 100mg/day from the 2nd day of menses to the 6th day plus gonadotrophin from day three to the 13th . Group II was treated as group I plus 850 mg metformin twice a day and group III was treated as group I plus weight reduction . Clinical symptoms , menstrual pattern , hirsutism , blood glucose , body mass index , waist-to-hip ratio , insulin , hormonal , and lipid profiles were assessed pre- and post treatment . Insulin resistance was calculated . RESULTS PCOS women had significantly higher values than the healthy women in most of the measurements . Metformin and weight reduction therapy result ed in a significant decrease in the fasting insulin , glucose/insulin ratio and HOMA-IR .  Metformin and weight reduction therapy result ed in a significant decrease in the lipid parameters , testosterone , LH/FSH ratio , SHBG , and prolactin levels . HOMA-IR was significantly higher in women with PCOS . HOMA-IR was positively correlated with testosterone , estradiol , TG , total cholesterol and LDL-cholesterol parameters , and negatively correlated with HDL-cholesterol and FSH levels . CONCLUSION Metformin therapy and weight reduction had favorable influences on the basic metabolic and hormonal profiles in women with PCOS and that metformin and lifestyle modification ( weight reduction via diet restriction or exercise ) result ed in a significantly greater weight loss than hormonal therapy alone . Metformin and weight reduction therapy decreased also hyper and rogenism and insulin resistance CONTEXT Polycystic ovary syndrome ( PCOS ) is an endocrine disease closely related to several risk factors for cardiovascular disease . An impaired cardiopulmonary functional capacity was previously demonstrated in PCOS women . No data regarding the effects of a structured exercise training ( ET ) program on cardiopulmonary functional capacity in PCOS women are available . OBJECTIVE Our objective was to evaluate the effects of a 3-month ET program on cardiopulmonary functional capacity in young PCOS women . DESIGN AND SETTING A prospect i ve baseline-r and omized clinical study was conducted at the University " Federico II " of Naples , School of Medicine ( Italy ) . PATIENTS Ninety young overweight PCOS women were enrolled . MEAN OUTCOME MEASURES Ninety young PCOS women were r and omly subdivided into two groups , each composed of 45 subjects . The PCOS-T ( trained ) group underwent a 3-month structured ET program , whereas the PCOS-UnT ( untrained ) group did not . Hormonal and metabolic profiles and cardiopulmonary and exercise parameters were evaluated . RESULTS After 3-month ET , PCOS-T showed a significant improvement in peak oxygen consumption ( + 35.4 % ; P<0.001 ) and in maximal workload ( + 37.2 % ; P<0.001 ) . In PCOS-T we also observed a significant reduction in body mass index ( -4.5 % ; P<0.001 ) and in C-reactive protein ( -10 % ; P<0.001 ) , and a significant ( P<0.001 ) improvement in insulin sensitivity indexes . After 3 months , no changes were observed in PCOS-UnT. CONCLUSIONS A 3-month structured ET program improves cardiopulmonary functional capacity in young PCOS women Women with polycystic ovary syndrome ( PCOS ) are insulin resistant , have insulin secretory defects , and are at high risk for glucose intolerance . We performed this study to determine the prevalence of glucose intolerance and parameters associated with risk for this in PCOS women . Two-hundred and fifty-four PCOS women , aged 14 - 44 yr , were prospect ively evaluated at 2 centers , 1 urban and ethnically diverse ( n = 110 ) and 1 rural and ethnically homogeneous ( n = 144 ) . The rural PCOS women were compared to 80 control women of similar weight , ethnicity , and age . A 75-g oral glucose challenge was administered after a 3-day 300-g carbohydrate diet and an overnight fast with 0 and 2 h blood sample s for glucose levels .  Diabetes was categorized according to WHO criteria . The prevalence of glucose intolerance was 31.1 % impaired glucose intolerance ( IGT ) and 7.5 % diabetes . In nonobese PCOS women ( body mass index , < 27 kg/m2 ) , 10.3 % IGT and 1.5 % diabetes were found . The prevalence of glucose intolerance was significantly higher in PCOS vs. control women ( chi2 = 7.0 ; P = 0.01 ; odds ratio = 2.76 ; 95 % confidence interval = 1.23 - 6.57 ) . Variables most associated with postchallenge glucose levels were fasting glucose levels ( P < 0.0001 ) , PCOS status ( P = 0.002 ) , waist/hip ratio ( P = 0.01 ) , and body mass index ( P = 0.021 ) . The American Diabetes Association criteria applied to fasting glucose significantly underdiagnosed diabetes compared to the WHO criteria ( 3.2 % vs. 7.5 % ; chi2 = 4.7 ; P = 0.046 ; odds ratio = 2.48 ; 95 % confidence interval = 1.01 - 6.69 ) . We conclude that 1 ) PCOS women are at significantly increased risk for IGT and type 2 diabetes mellitus at all weights and at a young age ; 2 ) these prevalence rates are similar in 2 different population s of PCOS women , suggesting that PCOS may be a more important risk factor than ethnicity or race for glucose intolerance in young women ; and 3 ) the American Diabetes Association diabetes diagnostic criteria failed to detect a significant number of PCOS women with diabetes by postchallenge glucose values STUDY OBJECTIVE To compare the effects of a hypocaloric low-fat diet with those of a very low carbohydrate diet on body mass index ( BMI ) , waist circumference ( WC ) , and menstrual function in overweight adolescent females with polycystic ovary syndrome ( PCOS ) . DESIGN R and omized pilot trial of two diets in a prospect i ve , 12-week study . SETTING A hospital-based , academic adolescent medicine division . PARTICIPANTS 24 females , age 12 - 22 years ( mean 15.8 ± 2.2 ) , with PCOS and a BMI above the 85(th ) percentile for age ( mean 35.7 ± 6.0 kg/m(2 ) ) . INTERVENTIONS Nutrition counseling was given biweekly , and dietary compliance , menstrual history , and weight were recorded . WC was measured at the beginning and end of the study . MAIN OUTCOME MEASURES Changes in weight , BMI , WC , and improvement in menstrual function over the course of the study period . RESULTS 16 participants completed the study . 12 completers menstruated during the study period , 8 with regularity . The number of periods over 3 months increased from 0.6 ± 0.6 pre-treatment to 1.6 ± 1.3 post-treatment ( P = 0.003 ) . Overall , weight loss averaged 6.5 % ( P < 0.0001 ) and the WC decreased by an average of 5.7 ± 7.7 cm ( P = 0.01 ) . Those who lost weight were 3.4 times more likely to have improved menstrual function ( P = 0.001 ) . There were no statistically significant differences between the two groups . CONCLUSIONS Weight loss is feasible in adolescents with PCOS and results in significant improvements in BMI , WC , and menstrual function . Weight management may be preferable as first-line treatment in adolescents , because it targets both the menstrual dysfunction and risk factors for long-term morbidity associated with PCOS Abstract Bressel , E , Wing , JE , Miller , AI , and Dolny , DG . High-intensity interval training on an aquatic treadmill in adults with osteoarthritis :  effect on pain , balance , function , and mobility . J Strength Cond Res 28(8 ) : 2088–2096 , 2014—Although aquatic exercise is considered a potentially effective treatment intervention for people with osteoarthritis ( OA ) , previous research has focused primarily on calisthenics in a shallow pool with the inherent limitations on regulating exercise intensity . The purpose of this study was to quantify the efficacy of a 6-week aquatic treadmill exercise program on measures of pain , balance , function , and mobility .  Eighteen participants ( age = 64.5 ± 10.2 years ) with knee OA completed a non-exercise control period followed by a 6-week exercise period . Outcome measures included visual analog scales for pain , posturography for balance , sit-to-st and test for function , and a 10-m walk test for mobility . The exercise protocol included balance training and high-intensity interval training ( HIT ) in an aquatic treadmill using water jets to destabilize while st and ing and achieve high ratings of perceived exertion ( 14–19 ) while walking . In comparison with pretests , participants displayed reduced joint pain ( pre = 50.3 ± 24.8 mm vs. post = 15.8 ± 10.6 mm ) , improved balance ( equilibrium pre = 66.6 ± 11.0 vs. post = 73.5 ± 7.1 ) , function ( rising index pre = 0.49 ± 0.19 % vs. post = 0.33 ± 0.11 % ) , and mobility ( walk pre = 8.6 ± 1.4 s vs. post = 7.8 ± 1.1 s ) after participating in the exercise protocol ( p = 0.03–0.001 ) . The same benefits were not observed after the non-exercise control period . Adherence to the exercise protocol was exceptional and no participants reported adverse effects , suggesting that aquatic treadmill exercise that incorporates balance and HIT training was well tolerated by patients with OA and may be effective at managing symptoms of OA BACKGROUND Lifestyle modifications are successfully employed to treat obese and overweight women with polycystic ovary syndrome ( PCOS ) . The aims of the current pilot study were ( i ) to compare the efficacy on reproductive functions of a structured exercise training ( SET ) programme with a diet programme in obese PCOS patients and ( ii ) to study their clinical , hormonal and metabolic effects to eluci date potentially different mechanisms of action . METHODS Forty obese PCOS patients with anovulatory infertility underwent a  SET programme ( SET group , n = 20 ) and a hypocaloric hyperproteic diet ( diet group , n = 20 ) . Clinical , hormonal and metabolic data were assessed at baseline , and at 12- and 24-week follow-ups . Primary endpoint was cumulative pregnancy rate . RESULTS The two groups had similar demographic , anthropometric and biochemical parameters . After intervention , a significant improvement in menstrual cycles and fertility was noted in both groups , with no differences between groups . The frequency of menses and the ovulation rate were significantly ( P < 0.05 ) higher in the SET group than in diet group but the increased cumulative pregnancy rate was not significant . Body weight , body mass index , waist circumference , insulin resistance indexes and serum levels of sex hormone-binding globulin , and rostenedione and dehydroepi and rosterone sulphate changed significantly ( P < 0.05 ) from baseline and were significantly different ( P < 0.05 ) between the two groups . CONCLUSIONS Both SET and diet interventions  improve fertility in obese PCOS patients with anovulatory infertility . We hypothesize that in both interventions an improvement in insulin sensitivity is the pivotal factor involved in the restoration of ovarian function but potentially acting through different mechanisms This study compared the psychological effects of a low-protein high-carbohydrate ( LPHC ) diet and a high-protein low-carbohydrate ( HPLC ) diet in women with polycystic ovary syndrome ( PCOS ) . Twenty-five overweight women with PCOS were matched for age , weight , and whether they were trying to conceive . They were r and omly allocated to the LPHC or HPLC diet for 16 weeks . All participants attended a weekly exercise , group support and educational program . The Hospital Anxiety and Depression Scale and the Rosenberg Self Esteem Scale were administered at the beginning and end of the study . The HPLC diet was associated with significant reduction in depression and improvement in self-esteem . There was no change in any psychological measures for the LPHC group . There was no difference in weight loss between the groups . Due to enhanced feelings of well-being , it is possible that HPLC diets may be associated with better compliance and hence be more successful in the long term treatment of obesity BACKGROUND Anti-Müllerian hormone ( AMH ) has been proposed as a clinical predictor of improvements in reproductive function following weight loss in overweight and obese women with polycystic ovary syndrome ( PCOS ) . This study aim ed to assess whether baseline and /or change in AMH levels with weight loss predict improvements in reproductive function in overweight and obese women with PCOS . METHODS Fifty-two overweight and obese women with PCOS and reproductive impairment ( age 29.8 + /- 0.8 years , BMI 36.5 + /- 0.7 kg/m(2 ) ) followed a 20-week weight loss programme .  AMH , weight , menstrual cyclicity and ovulatory function were assessed at baseline and post-intervention . RESULTS Participants who responded with improvements in reproductive function ( n = 26 ) had lower baseline AMH levels ( 23.5 + /- 3.7 versus 32.5 + /- 2.9 pmol/l ; P = 0.03 ) and experienced greater weight loss ( -11.7 + /- 1.2 versus -6.4 + /- 0.9 kg ; P = 0.001 ) compared with those who did not respond ( n = 26 ) . Logistic regression analysis showed that weight loss and baseline AMH were independently related to improvements in reproductive function ( P = 0.002 and P = 0.013 , respectively ) . AMH levels did not change with weight loss in both responders and non-responders . CONCLUSIONS In overweight and obese women with PCOS and reproductive dysfunction , a 20-week weight loss intervention result ed in improvements in reproductive function but no change in AMH levels . CLINICAL TRIALS REGISTRATION NUMBER ACTRN12606000198527 OBJECTIVE To compare the effect of clomiphene citrate , metformin , and lifestyle modification on treatment of patients with polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve r and omized double-blind study . SETTING University-based infertility clinic and research center . PATIENT(S ) Three hundred forty-three overweight infertile women with PCOS . INTERVENTION(S ) The participating women were assigned to four groups : clomiphene ( n = 90 ) , metformin ( n = 90 ) , clomiphene + metformin ( n = 88 ) , and lifestyle modification ( n = 75 ) . The patients in each group received st and ardized dietary and exercise advice from a dietitian . MAIN OUTCOME MEASURE(S ) The primary outcome variables were change in menstrual cycle , waist circumference measurements , endocrine parameters , and lipid profile . The main secondary outcome variable was clinical pregnancy rate . RESULT ( S ) The clinical pregnancy rate was 12.2 % in clomiphene group , 14.4 % in metformin group , 14.8 % in clomiphene + metformin group , and 20 % in lifestyle modification group . Lifestyle modification group achieved a significant reduction in waist circumference , total and rogen , and lipid profile . CONCLUSION ( S ) Lifestyle modification improves the lipid profile in PCOS patients . Therefore , lifestyle modification may be used as the first line of ovulation induction in PCOS patients OBJECTIVES The objectives of this trial were to compare the effects of a holistic yoga program with the conventional exercise program in adolescent polycystic ovarian syndrome ( PCOS ) . DESIGN This was a prospect i ve , r and omized , active controlled trial . SETTING Ninety ( 90 ) adolescent ( 15 - 18 years ) girls from a residential college in And hra Pradesh who satisfied the Rotterdam criteria were r and omized into two groups . INTERVENTION The yoga group practice d a holistic yoga module , while the control group practice d a matching set of physical exercises ( 1 hour/day , for 12 weeks ) . OUTCOME MEASURES Anti-müllerian hormone ( AMH- primary outcome ) , luteinizing hormone ( LH ) , follicle-stimulating hormone ( FSH ) , testosterone , prolactin , body-mass index ( BMI ) , hirsutism , and menstrual frequency were measured at inclusion and after 12 weeks . RESULTS Mann-Whitney test on difference score shows that changes in AMH ( Y=-2.51 , C=-0.49 , p=0.006 ) , LH , and LH/FSH ratio ( LH : Y=-4.09 , C=3.00 , p=0.005 ; LH/FSH : Y=-1.17 , C=0.49 , p=0.015 ) were significantly different between the two intervention groups . Also , changes in testosterone ( Y=-6.01 , C=2.61 , p=0.014 ) and Modified Ferriman and Gallway ( mFG ) score ( Y=-1.14 , C=+0.06 , p=0.002 ) were significantly different between the two groups . On the other h and , changes in FSH and prolactin postintervention were nonsignificantly different between the two groups . Also , body weight and BMI showed nonsignificantly different changes between the two groups , while changes in menstrual frequency were significantly different between the two groups ( Y=0.89 , C=0.49 , p=0.049 ) . CONCLUSIONS A holistic yoga program for 12 weeks is significantly better than physical exercise in reducing AMH , LH , and testosterone , mFG score for hirsutism , and improving menstrual frequency with nonsignificant changes in body weight , FSH , and prolactin in adolescent PCOS OBJECTIVE To assess the impact of adding exercise to dietary restriction on depressive symptoms and health-related quality of life ( HRQOL ) in women with polycystic ovary syndrome ( PCOS ) . DESIGN Analysis of depression and quality of life outcomes from a r and omized , controlled prospect i ve clinical intervention that evaluated the effects on a range of health outcomes in women with PCOS . SETTING Clinical research unit . PATIENT(S ) One hundred four overweight/obese PCOS women ( aged 29.3 ± 0.7 years ; body mass index [ BMI ] 36.1 ± 0.5 kg/m(2 ) ) . INTERVENTION(S ) R and omized to one of three 20-week lifestyle programs : diet only , diet and aerobic exercise , or diet and combined aerobic-resistance exercise . MAIN OUTCOME MEASURE(S ) Depression and PCOS-specific HRQOL . RESULT ( S ) Forty-nine women completed the intervention ( diet only = 14 , diet and aerobic exercise = 15 , diet and combined aerobic-resistance exercise = 20 ) . By week 20 all groups achieved weight loss and had improvements in depression and PCOS-specific HRQOL scores , except for body hair domain score . There was no difference between treatments for all outcomes . CONCLUSION ( S ) This study demonstrated that dietary restriction alone and combined with exercise had similar benefits for improving depression and HRQOL scores in overweight and obese women with PCOS
Background Typically , management of PCOS focuses on lifestyle changes ( exercise and diet ) , aim ing to alleviate symptoms , and lower the associated risk of type 2 diabetes and cardiovascular disease .
Our objective was to analyse evidence on the effectiveness of exercise in the management of PCOS , when compared to ( i ) usual care , ( ii ) diet alone , and ( iii ) exercise combined with diet , and also exercise combined with diet , compared to ( i ) control or usual care and ( ii ) diet alone .