EFFECTIVENESS OF COMPREHENSIVE LIFESTYLE INTERVENTIONS (DIET, EXERCISE, SLEEP, AND STRESS MODIFICATION) IN THE TREATMENT OF POLYCYSTIC OVARY SYNDROME: A SYSTEMATIC REVIEW AND META-ANALYSIS
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5667Keywords:
PCOS, Diet, Exercise, Sleep, Systematic Review, WomenAbstract
Background: Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disorder affecting women of reproductive age and is characterized by hyperandrogenism, ovulatory dysfunction, insulin resistance, obesity, and psychological distress. Lifestyle modification is recommended as first-line therapy; however, the comparative effectiveness of multidomain interventions integrating diet, exercise, sleep optimization, and supplementation remains unclear. This systematic review and meta-analysis evaluated the impact of comprehensive lifestyle interventions on metabolic, hormonal, reproductive, inflammatory, and psychosocial outcomes in women with PCOS.
Methods: A systematic literature search of PubMed/MEDLINE was conducted according to PRISMA 2020 guidelines. Randomized controlled trials published in English within the previous 10 years were included if they enrolled reproductive-aged women with confirmed PCOS and evaluated at least one lifestyle intervention: dietary modification, supplementation, structured exercise, sleep-related therapy, or combined programs. Outcomes included anthropometric indices, insulin resistance markers, lipid profile, reproductive and hormonal parameters, inflammatory biomarkers, sleep quality, and mental health. Where sufficient homogeneity existed, pooled quantitative analyses were planned; otherwise, narrative synthesis was performed.
Results: Comprehensive lifestyle interventions demonstrated significant benefits across multiple domains. Dietary strategies, particularly calorie-restricted, low-glycemic-load, Mediterranean-style, and ketogenic diets, improved body weight, body mass index, waist circumference, insulin resistance, lipid profile, and androgen excess. Structured exercise, including aerobic training and high-intensity interval training, improved body composition, insulin sensitivity, menstrual cyclicity, ovarian morphology, cardiovascular fitness, and psychological well-being, while reducing inflammatory markers (CRP, IL-6, TNF-α). Adjunctive supplementation (probiotics, synbiotics, coenzyme Q10, omega-3 fatty acids, vitamin D, magnesium, flaxseed, and melatonin) showed additional improvements in metabolic, hormonal, oxidative stress, and menstrual outcomes. Sleep-focused interventions, particularly melatonin supplementation and behavioral modification, improved sleep quality, anxiety, depression, insulin resistance, and lipid parameters.
Conclusions: Comprehensive lifestyle intervention is an effective evidence-based strategy for PCOS management. Combined approaches targeting nutrition, exercise, sleep, and selected supplementation improve metabolic, endocrine, reproductive, and psychological outcomes. Given the heterogeneity of PCOS, individualized multidisciplinary lifestyle treatment should be considered a central component of long-term care and may complement pharmacological therapy.
References
Benham, J. L., et al. (2023). Self-reported sleep quality and exercise in polycystic ovary syndrome: A secondary analysis of a pilot randomized controlled trial. Clinical Endocrinology, 98(5), 700–708. https://pubmed.ncbi.nlm.nih.gov/36843192/
Benham, J., et al. (2021). Exercise training and reproductive outcomes in women with polycystic ovary syndrome: A pilot randomized controlled trial. Clinical Endocrinology, 95(2), 332–343. https://pubmed.ncbi.nlm.nih.gov/33638879/
Bozbulut, R., Döğer, E., Çamurdan, M. O., & Bideci, A. (2024). Beneficial effects of RESMENA diet on anthropometric, metabolic, and reproductive profile in adolescents with obesity and polycystic ovary syndrome: A randomized controlled intervention study. Hormone Research in Paediatrics, 97(5), 483–495. https://doi.org/10.1159/000535053
Cheshmeh, S., et al. (2022). Green cardamom plus low-calorie diet can decrease the expression of inflammatory genes among obese women with polycystic ovary syndrome: A double-blind randomized clinical trial. Eating and Weight Disorders, 27(2), 821–830. https://pubmed.ncbi.nlm.nih.gov/34057705/
Chudzicka-Strugała, I., et al. (2025). Six-month randomized, placebo-controlled trial of synbiotic supplementation in women with polycystic ovary syndrome undergoing lifestyle modifications. Archives of Gynecology and Obstetrics, 311(2), 499–506. https://pubmed.ncbi.nlm.nih.gov/39636391/
Costa, E. C., et al. (2018). Aerobic training improves quality of life in women with polycystic ovary syndrome. Medicine & Science in Sports & Exercise, 50(7), 1357–1366. https://pubmed.ncbi.nlm.nih.gov/29443823/
Deshmukh, H., et al. (2023). The effect of a very-low-calorie diet versus a moderate energy deficit diet in obese women with polycystic ovary syndrome: A randomized controlled trial. Nutrients, 15. https://pubmed.ncbi.nlm.nih.gov/37764656/
Dou, P., et al. (2024). A randomized trial of the efficacy of three weight loss diet interventions in overweight/obese with polycystic ovary syndrome. Endocrine, Metabolic & Immune Disorders Drug Targets, 24(14), 1686–1697. https://pubmed.ncbi.nlm.nih.gov/38988067/
Eisenberg, E., et al. (2021). Sleep habits of women with infertility. The Journal of Clinical Endocrinology & Metabolism, 106(11), e4414–e4426. https://pubmed.ncbi.nlm.nih.gov/34180998/
Elbandrawy, A. M., et al. (2022). Effect of aerobic exercise on inflammatory markers in polycystic ovary syndrome: A randomized controlled trial. European Review for Medical and Pharmacological Sciences, 26(10), 3506–3513. https://pubmed.ncbi.nlm.nih.gov/35647831/
Hooshmandi, H., et al. (2024). Effects of licorice extract in combination with a low-calorie diet on obesity indices, glycemic indices, and lipid profiles in overweight/obese women with polycystic ovary syndrome (PCOS): A randomized, double-blind, placebo-controlled trial. Journal of Ovarian Research, 17(1), 157. https://pubmed.ncbi.nlm.nih.gov/39080737/
Izadi, A., Shirazi, S., Taghizadeh, S., & Gargari, B. P. (2019). Independent and additive effects of coenzyme Q10 and vitamin E on cardiometabolic outcomes and visceral adiposity in women with polycystic ovary syndrome. Archives of Medical Research, 50(2), 1–10. https://pubmed.ncbi.nlm.nih.gov/31349945/
Jafari-Sfidvajani, S., et al. (2018). The effect of vitamin D supplementation in combination with low-calorie diet on anthropometric indices and androgen hormones in women with polycystic ovary syndrome: A double-blind, randomized, placebo-controlled trial. Journal of Endocrinological Investigation, 41(5), 597–607. https://pubmed.ncbi.nlm.nih.gov/29110281/
Kaur, I., et al. (2022). Efficacy of multi-strain probiotic along with dietary and lifestyle modifications on polycystic ovary syndrome: A randomised, double-blind placebo-controlled study. European Journal of Nutrition, 61(8), 4145–4154. https://pubmed.ncbi.nlm.nih.gov/35857132/
Kazemi, M., et al. (2020). A randomized controlled trial of a lifestyle intervention with longitudinal follow-up on ovarian dysmorphology in women with polycystic ovary syndrome. Clinical Endocrinology, 92(6), 525–535. https://pubmed.ncbi.nlm.nih.gov/32092167/
Kazemi, M., et al. (2021). Effects of dietary glycemic index and glycemic load on cardiometabolic and reproductive profiles in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. Advances in Nutrition, 12(1), 161–178. https://doi.org/10.1093/advances/nmaa092
Khalid, K., et al. (2023). Effects of ketogenic diet on reproductive hormones in women with polycystic ovary syndrome. Journal of the Endocrine Society, 7(10), bvad112. https://doi.org/10.1210/jendso/bvad112
Lopes, I. P., et al. (2018). Comparison of the effect of intermittent and continuous aerobic physical training on sexual function of women with polycystic ovary syndrome: Randomized controlled trial. The Journal of Sexual Medicine, 15(11), 1609–1619. https://pubmed.ncbi.nlm.nih.gov/30316737/
Lu, C., et al. (2018). Influence of sleep stage on LH pulse initiation in the normal late follicular phase and in polycystic ovary syndrome. Neuroendocrinology, 107(1), 60–72. https://pubmed.ncbi.nlm.nih.gov/29506013/
Łagowska, K., & Drzymała-Czyż, S. (2022). A low glycemic index, energy-restricted diet but not Lactobacillus rhamnosus supplementation changes fecal short-chain fatty acid and serum lipid concentrations in women with overweight or obesity and polycystic ovary syndrome. European Review for Medical and Pharmacological Sciences, 26(3), 917–926. https://doi.org/10.26355/eurrev_202202_28001
Manzoor, F., et al. (2022). Effect of sodium alginate supplementation on weight management and reproductive hormones in polycystic females. Food & Function, 13(19), 9847–9855. https://doi.org/10.1039/d2fo01539k
Mousavi, R., et al. (2022). Effects of melatonin and/or magnesium supplementation on biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial. Biological Trace Element Research, 200, 1010–1019. https://doi.org/10.1007/s12011-021-02725-y
Nadjarzadeh, A., et al. (2021). Effect of hypocaloric high-protein, low-carbohydrate diet supplemented with fennel on androgenic and anthropometric indices in overweight and obese women with polycystic ovary syndrome: A randomized placebo-controlled trial. Complementary Therapies in Medicine, 56, 102633. https://pubmed.ncbi.nlm.nih.gov/33271298/
Najdgholami, Z., Sedgi, F. M., Ghalishourani, S. S., Feyzpour, M., & Rahimlou, M. (2025). Flaxseed intervention and reproductive endocrine profiles in patients with polycystic ovary syndrome: An open-labeled randomized controlled clinical trial. Frontiers in Endocrinology, 16, 1531762. https://doi.org/10.3389/fendo.2025.1531762
Nasiri, M., Monazzami, A., Alavimilani, S., & Asemi, Z. (2025). Modulation of hormonal, metabolic, inflammatory and oxidative stress biomarkers in women with polycystic ovary syndrome following combined (resistant and endurance) training: A randomized controlled trail. BMC Endocrine Disorders, 25(1), 1. https://pubmed.ncbi.nlm.nih.gov/39748376/
Nybacka, Å., Hellström, P. M., & Hirschberg, A. L. (2017). Increased fibre and reduced trans fatty acid intake are primary predictors of metabolic improvement in overweight polycystic ovary syndrome: Substudy of a randomized trial between diet, exercise and diet plus exercise for weight control. Clinical Endocrinology, 87(6), 680–688. https://pubmed.ncbi.nlm.nih.gov/28727165/
Oberg, E., Blomberg, L., Åkerstedt, T., & Hirschberg, A. L. (2023). Different sleep pattern in over-weight/obese women with polycystic ovary syndrome. Frontiers in Endocrinology, 14, 1068045. https://pubmed.ncbi.nlm.nih.gov/36843616/
Orio, F., et al. (2016). Oral contraceptives versus physical exercise on cardiovascular and metabolic risk factors in women with polycystic ovary syndrome: A randomized controlled trial. Clinical Endocrinology, 85(5), 764–771. https://pubmed.ncbi.nlm.nih.gov/27219465/
Patten, R. K., et al. (2022). High-intensity training elicits greater improvements in cardio-metabolic and reproductive outcomes than moderate-intensity training in women with polycystic ovary syndrome: A randomized clinical trial. Human Reproduction, 37(5), 1018–1029. https://pubmed.ncbi.nlm.nih.gov/35325125/
Patten, R. K., et al. (2023). Efficacy of high-intensity interval training for improving mental health and health-related quality of life in women with polycystic ovary syndrome. Scientific Reports, 13(1), 3025. https://pubmed.ncbi.nlm.nih.gov/36810865/
Patten, R. K., et al. (2023). Longitudinal affective response to high-intensity interval training and moderate-intensity continuous training in overweight women with polycystic ovary syndrome: A randomised trial. Psychology of Sport and Exercise, 64, 102325. https://pubmed.ncbi.nlm.nih.gov/37665810/
Philbois, S. V., et al. (2022). Cardiovascular autonomic modulation differences between moderate-intensity continuous and high-intensity interval aerobic training in women with PCOS: A randomized trial. Frontiers in Endocrinology, 13, 1024844. https://pubmed.ncbi.nlm.nih.gov/36568110/
Ribeiro, V. B., et al. (2020). Effects of continuous and intermittent aerobic physical training on hormonal and metabolic profile, and body composition in women with polycystic ovary syndrome: A randomized controlled trial. Clinical Endocrinology, 93(2), 173–186. https://pubmed.ncbi.nlm.nih.gov/32286711/
Ribeiro, V. B., et al. (2021). Short-term aerobic exercise did not change telomere length while it reduced testosterone levels and obesity indexes in PCOS: A randomized controlled clinical trial study. International Journal of Environmental Research and Public Health, 18(21), 11274. https://pubmed.ncbi.nlm.nih.gov/34769797/
Sadeghi, F., Alavi-Naeini, A., Mardanian, F., Ghazvini, M. R., & Mahaki, B. (2020). Omega-3 and vitamin E co-supplementation can improve antioxidant markers in obese/overweight women with polycystic ovary syndrome. International Journal for Vitamin and Nutrition Research, 90(5–6), 477–483. https://doi.org/10.1024/0300-9831/a000588
Samimi, M., et al. (2017). The effects of coenzyme Q10 supplementation on glucose metabolism and lipid profiles in women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial. Clinical Endocrinology, 86(4), 560–566. https://doi.org/10.1111/cen.13288
Shabani, A., et al. (2019). Effects of melatonin administration on mental health parameters, metabolic and genetic profiles in women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial. Journal of Affective Disorders, 250, 51–56. https://pubmed.ncbi.nlm.nih.gov/30831541/
Sharifi, M., Saber, A., Moludi, J., Salimi, Y., & Jahan-Mihan, A. (2024). The effects of portfolio moderate-carbohydrate and ketogenic diets on anthropometric indices, metabolic status, and hormonal levels in overweight or obese women with polycystic ovary syndrome: A randomized controlled trial. Nutrition Journal, 23(1), 152. https://doi.org/10.1186/s12937-024-01056-7
Shokrpour, M., & Asemi, Z. (2019). The effects of magnesium and vitamin E co-supplementation on hormonal status and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome. Biological Trace Element Research, 191(1), 54–60. https://pubmed.ncbi.nlm.nih.gov/30565017/
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Copyright (c) 2026 Julia Czerniewska, Klaudia Jurkowska, Julia Mądrzak, Olga Endler, Mikołaj Dybicz, Marianna Ciastoń, Magdalena Filuk, Jakub Fidelus, Dominika Dutkiewicz, Marta Handzel
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