Subscribe to RSS
DOI: 10.1055/s-0041-1735575
An Analysis on the Implementation of the Evidence-based PCOS Lifestyle Guideline: Recommendations from Women with PCOS
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrinological disorder affecting women of reproductive age, affecting 8–13% in this group. Women with PCOS are more likely to have excess BMI, which in turn exacerbates the symptoms of PCOS in these women. The latest evidence-based guideline recommends lifestyle management as the first-line treatment for PCOS. However, the implementation of this recommendation through health services faces a significant challenge. As part of the mapping of the implementation plan for lifestyle management in PCOS, citizen panels and semi-structured interviews were conducted to capture the voices of consumers. Women with PCOS expressed the need for multidisciplinary, integrated care as a recurrent theme. Other important considerations included health professionals who listen and are open to learning about PCOS, the empowerment of women to self-manage PCOS and the provision of peer support. Women with PCOS also expressed the key recommendation of focusing on practical skills when providing lifestyle advice. Within that, both individual and group lifestyle sessions were valued for privacy and peer support respectively and delivery by a dietitian is preferred. These recommendations by women with PCOS should be considered when developing the implementation plan for the PCOS lifestyle guideline.
Publication History
Article published online:
30 August 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2016; 31 (12) 2841-2855
- 2 Broekmans FJ, Knauff EA, Valkenburg O, Laven JS, Eijkemans MJ, Fauser BC. PCOS according to the Rotterdam consensus criteria: Change in prevalence among WHO-II anovulation and association with metabolic factors. BJOG 2006; 113 (10) 1210-1217
- 3 Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2010; 16 (04) 347-363
- 4 Lim SS, Kakoly NS, Tan JWJ. et al. Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Obes Rev 2019; 20 (02) 339-352
- 5 Elsenbruch S, Hahn S, Kowalsky D. et al. Quality of life, psychosocial well-being, and sexual satisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003; 88 (12) 5801-5807
- 6 Himelein MJ, Thatcher SS. Depression and body image among women with polycystic ovary syndrome. J Health Psychol 2006; 11 (04) 613-625
- 7 Yin X, Ji Y, Chan CLW, Chan CHY. The mental health of women with polycystic ovary syndrome: a systematic review and meta-analysis. Arch Womens Ment Health; 2020
- 8 Pirotta S, Barillaro M, Brennan L. et al. Disordered Eating Behaviours and Eating Disorders in Women in Australia with and without Polycystic Ovary Syndrome: A Cross-Sectional Study. J Clin Med 2019; 8 (10) E1682
- 9 Kakoly NS, Khomami MB, Joham AE. et al. Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression. Hum Reprod Update 2018; 24 (04) 455-467
- 10 Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2012; 18 (06) 618-637
- 11 Teede HJ, Joham AE, Paul E. et al. Longitudinal weight gain in women identified with polycystic ovary syndrome: results of an observational study in young women. Obesity (Silver Spring) 2013; 21 (08) 1526-1532
- 12 Lim SS, Norman RJ, Davies MJ, Moran LJ. The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Rev 2013; 14 (02) 95-109
- 13 Barbieri RL, Makris A, Randall RW, Daniels G, Kistner RW, Ryan KJ. Insulin stimulates androgen accumulation in incubations of ovarian stroma obtained from women with hyperandrogenism. J Clin Endocrinol Metab 1986; 62 (05) 904-910
- 14 Zheng Y, Manson JE, Yuan C. et al. Associations of Weight Gain From Early to Middle Adulthood With Major Health Outcomes Later in Life. JAMA 2017; 318 (03) 255-269
- 15 Kataoka J, Tassone EC, Misso M. et al. Weight Management Interventions in Women with and without PCOS: A Systematic Review. Nutrients 2017; 9 (09) E996
- 16 Larsson I, Hulthén L, Landén M, Pålsson E, Janson P, Stener-Victorin E. Dietary intake, resting energy expenditure, and eating behavior in women with and without polycystic ovary syndrome. Clin Nutr 2016; 35 (01) 213-218
- 17 Moran LJ, Noakes M, Clifton PM. et al. Postprandial ghrelin, cholecystokinin, peptide YY, and appetite before and after weight loss in overweight women with and without polycystic ovary syndrome. Am J Clin Nutr 2007; 86 (06) 1603-1610
- 18 Moran LJ, Noakes M, Clifton PM. et al. Ghrelin and measures of satiety are altered in polycystic ovary syndrome but not differentially affected by diet composition. J Clin Endocrinol Metab 2004; 89 (07) 3337-3344
- 19 Georgopoulos NA, Saltamavros AD, Vervita V. et al. Basal metabolic rate is decreased in women with polycystic ovary syndrome and biochemical hyperandrogenemia and is associated with insulin resistance. Fertil Steril 2009; 92 (01) 250-255
- 20 Romualdi D, Versace V, Tagliaferri V. et al. The resting metabolic rate in women with polycystic ovary syndrome and its relation to the hormonal milieu, insulin metabolism, and body fat distribution: a cohort study. J Endocrinol Invest 2019; 42 (09) 1089-1097
- 21 Moran LJ, Ranasinha S, Zoungas S, McNaughton SA, Brown WJ, Teede HJ. The contribution of diet, physical activity and sedentary behaviour to body mass index in women with and without polycystic ovary syndrome. Hum Reprod 2013; 28 (08) 2276-2283
- 22 Banting LK, Gibson-Helm M, Polman R, Teede HJ, Stepto NK. Physical activity and mental health in women with polycystic ovary syndrome. BMC Womens Health 2014; 14 (01) 51
- 23 Domecq JP, Prutsky G, Mullan RJ. et al. Lifestyle modification programs in polycystic ovary syndrome: systematic review and meta-analysis. J Clin Endocrinol Metab 2013; 98 (12) 4655-4663
- 24 Moran LJ, Noakes M, Clifton PM, Tomlinson L, Galletly C, Norman RJ. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab 2003; 88 (02) 812-819
- 25 Farnsworth E, Luscombe ND, Noakes M, Wittert G, Argyiou E, Clifton PM. Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsulinemic men and women. Am J Clin Nutr 2003; 78 (01) 31-39
- 26 American College of Cardiology/American Heart Association Task Force on Practice Guidelines, Obesity Expert Panel, 2013. Expert Panel Report: Guidelines (2013) for the management of overweight and obesity in adults. Obesity (Silver Spring) 2014; 22 (Suppl. 02) S41-S410
- 27 National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: National Health and Medical Research Council; 2013
- 28 Jeanes YM, Barr S, Smith K, Hart KH. Dietary management of women with polycystic ovary syndrome in the United Kingdom: the role of dietitians. J Hum Nutr Diet 2009; 22 (06) 551-558
- 29 Nasiri Amiri F, Ramezani Tehrani F, Simbar M, Montazeri A, Mohammadpour Thamtan RA. The experience of women affected by polycystic ovary syndrome: a qualitative study from iran. Int J Endocrinol Metab 2014; 12 (02) e13612
- 30 Teede HJ, Misso ML, Costello MF. et al; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018; 33 (09) 1602-1618
- 31 Conway G, Dewailly D, Diamanti-Kandarakis E. et al; ESE PCOS Special Interest Group. European survey of diagnosis and management of the polycystic ovary syndrome: results of the ESE PCOS Special Interest Group's Questionnaire. Eur J Endocrinol 2014; 171 (04) 489-498
- 32 Sharma A, Walker DM, Atiomo W. National survey on management of weight reduction in PCOS women in the United Kingdom. Eur J Obstet Gynecol Reprod Biol 2010; 152 (02) 181-185
- 33 Mulquiney KJ, Tapley A, van Driel ML. et al. Referrals to dietitians/nutritionists: A cross-sectional analysis of Australian GP registrars' clinical practice. Nutr Diet 2018; 75 (01) 98-105
- 34 Arasu A, Moran LJ, Robinson T, Boyle J, Lim S. Barriers and Facilitators to Weight and Lifestyle Management in Women with Polycystic Ovary Syndrome: General Practitioners' Perspectives. Nutrients 2019; 11 (05) E1024
- 35 Dowell A, Stubbe M, Macdonald L. et al. A Longitudinal Study of Interactions Between Health Professionals and People With Newly Diagnosed Diabetes. Ann Fam Med 2018; 16 (01) 37-44
- 36 D'Ovidio T. Public deliberation for health system decision-making: An evaluative case study of the McMaster Health Forum's citizen panels. Clinical Epidemiology/Clinical Epidemiology & Biostatistics: McMaster University; 2016
- 37 Harrison CL, Lombard CB, Teede HJ. Limiting postpartum weight retention through early antenatal intervention: the HeLP-her randomised controlled trial. Int J Behav Nutr Phys Act 2014; 11: 134
- 38 Gubrium JF, Holstein JA, Marvasti AB, McKinney KD. The SAGE handbook of interview research: The complexity of the craft. USA: SAGE; 2012
- 39 Boyatzis RE. Transforming qualitative information: Thematic analysis and code development. USA: SAGE; 1998
- 40 Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed Diagnosis and a Lack of Information Associated With Dissatisfaction in Women With Polycystic Ovary Syndrome. J Clin Endocrinol Metab 2017; 102 (02) 604-612
- 41 March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010; 25 (02) 544-551
- 42 Khan NN, Vincent A, Boyle JA. et al. Development of a question prompt list for women with polycystic ovary syndrome. Fertil Steril 2018; 110 (03) 514-522
- 43 Blackshaw LCD, Chhour I, Stepto NK, Lim SS. Barriers and Facilitators to the Implementation of Evidence-Based Lifestyle Management in Polycystic Ovary Syndrome: A Narrative Review. Med Sci (Basel) 2019; 7 (07) E76
- 44 Hadjiconstantinou M, Mani H, Patel N. et al. Understanding and supporting women with polycystic ovary syndrome: a qualitative study in an ethnically diverse UK sample. Endocr Connect 2017; 6 (05) 323-330
- 45 Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2019; 3: CD007506
- 46 Kothari AR, Bickford JJ, Edwards N, Dobbins MJ, Meyer M. Uncovering tacit knowledge: a pilot study to broaden the concept of knowledge in knowledge translation. BMC Health Serv Res 2011; 11: 198
- 47 Michie S, Richardson M, Johnston M. et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013; 46 (01) 81-95
- 48 Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011; 6 (01) 42
- 49 Foster D. 'Keep complaining til someone listens': Exchanges of tacit healthcare knowledge in online illness communities. Soc Sci Med 2016; 166: 25-32
- 50 Stubbs B, Williams J, Shannon J, Gaughran F, Craig T. Peer support interventions seeking to improve physical health and lifestyle behaviours among people with serious mental illness: A systematic review. Int J Ment Health Nurs 2016; 25 (06) 484-495
- 51 Krishnamoorthy Y, Sakthivel M, Sarveswaran G, Eliyas SK. Effectiveness of peer led intervention in improvement of clinical outcomes among diabetes mellitus and hypertension patients-A systematic review and meta-analysis. Prim Care Diabetes 2019; 13 (02) 158-169
- 52 Lim S, Smith CA, Costello MF. et al. Health literacy needs in weight management of women with Polycystic Ovary Syndrome. Health Promot J Austr 2020