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A Commentary on the New Evidence-Based Lifestyle Recommendations for Patients with Polycystic Ovary Syndrome and Potential Barriers to Their Implementation in the United States

Published:December 12, 2018DOI:https://doi.org/10.1016/j.jand.2018.10.001
      Polycystic ovary syndrome (PCOS) is a complex endocrine condition that represents a lifelong health concern for 1 in 10 women worldwide.
      • Bozdag G.
      • Mumusoglu S.
      • Zengin D.
      • Karabulut E.
      • Yildiz B.
      The prevalence and phenotypic features of polycystic ovary syndrome: A systematic review and meta-analysis.
      PCOS is commonly diagnosed by the presence of ovulatory dysfunction, androgen excess, and/or ovaries with polycystic morphology on ultrasound examination.
      Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group
      Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).
      Half of patients experience overweight or obesity.
      • Lim S.
      • Davies M.
      • Norman R.
      • Moran L.
      Overweight, obesity and central obesity in women with polycystic ovary syndrome: A systematic review and meta-analysis.
      Most are at increased risk for serious comorbidities, including infertility, pregnancy complications (eg, gestational diabetes mellitus), impaired glucose tolerance, insulin resistance, type 2 diabetes mellitus, cardiovascular disease, gynecological cancers, anxiety, depression, eating disorders, and poor health-related quality of life.
      • Fauser B.
      • Tarlatzis B.
      • Rebar R.
      • et al.
      Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): The Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group.
      • Dokras A.
      • Stener-Victorin E.
      • Yildiz B.
      • et al.
      Androgen Excess-Polycystic Ovary Syndrome Society: Position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome.
      Over the past decade, clinicians and researchers have increasingly recommended lifestyle modifications to achieve and maintain healthy weight and improve metabolic outcomes in women with PCOS.
      • Moran L.
      • Pasquali R.
      • Teede H.
      • Hoeger K.
      • Norman R.
      Treatment of obesity in polycystic ovary syndrome: A position statement of the Androgen Excess and Polycystic Ovary Syndrome Society.
      Now, with the recent publication of the first international evidence-based guideline for PCOS, diet and exercise have been solidified as fundamental components of the condition’s management.

      Teede H, Misso M, Costello M, et al. International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Melbourne, Australia; 2018. www.monash.edu/medicine/sphpm/mchri/pcos. Accessed July 10, 2018.

      • Teede H.
      • Misso M.
      • Costello M.
      • et al.
      Recommendations from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.
      It is clear that the expertise of a registered dietitian nutritionist (RDN) is essential to provide adequate nutrition care for this patient population. However, accumulating survey evidence suggests that RDNs receive limited referrals for PCOS and generally feel uninformed about its specific sequelae and treatments.
      • Jeanes Y.
      • Barr S.
      • Smith K.
      • Hart K.
      Dietary management of women with polycystic ovary syndrome in the United Kingdom: The role of dietitians.
      • Conway G.
      • Dewailly D.
      • Diamanti-Kandarakis E.
      • et al.
      European survey of diagnosis and management of the polycystic ovary syndrome: Results of the ESE PCOS Special Interest Group’s Questionnaire.
      • Lin A.
      • Bergomi E.
      • Dollahite J.
      • Sobal J.
      • Hoeger K.
      • Lujan M.
      Trust in physicians and medical experience beliefs differ between women with and without polycystic ovary syndrome.
      This commentary aims to address these two gaps by summarizing the new international recommendations for lifestyle management of PCOS

      Teede H, Misso M, Costello M, et al. International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Melbourne, Australia; 2018. www.monash.edu/medicine/sphpm/mchri/pcos. Accessed July 10, 2018.

      • Teede H.
      • Misso M.
      • Costello M.
      • et al.
      Recommendations from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome.
      and exploring some challenges that the current referral and knowledge landscapes might pose to their implementation in the United States. It concludes with a call to action for RDNs and provides additional recommendations and resources for those that care for women with PCOS.

      Keywords

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      Biography

      B. Y. Jarrett is a postdoctoral fellow, Division of Nutritional Sciences, Cornell University, Ithaca, NY.

      Biography

      A. W. Lin is a research consultant, Division of Nutritional Sciences, Cornell University, Ithaca, NY.

      Biography

      M. E. Lujan is an associate professor, Division of Nutritional Sciences, Cornell University, Ithaca, NY.