A randomized controlled trial of a lifestyle intervention with longitudinal follow-up on ovarian dysmorphology in women with polycystic ovary syndrome

Objective: Effects of lifestyle modification on reproductive function in polycystic ovary syndrome (PCOS) remain poorly elucidated. We compared the effects of a pulse-based diet (lentils, beans, split peas and chickpeas) with Therapeutic Lifestyle Changes (TLC) diet on ultrasonographic markers of ovarian morphology, hyperandrogenism and menstrual irregularity in PCOS. Design: Randomized controlled trial. Patients: Women with PCOS (18-35 years). Measurements: Thirty women randomized to the pulse-based and 31 to TLC groups completed a 16-week intervention without energy restriction. Groups performed aerobic exercise (minimum of 5 days/wk; 45 minutes/d) and received health counselling (monthly) and longitudinal follow-up. Follicle numbers per ovary (FNPO, 2-9 mm), ovarian volume (OV), free androgen index (FAI) and menstrual cycle length were measured pre- and postintervention. Results: Follicle numbers per ovary (mean change ± SD, −10 ± 15), OV (−2.7 ± 4.8 mL), FAI (−3 ± 2) and menstrual cycle length (−13 ± 47 days) decreased over time in both groups (All: P <.01), without group-by-time interactions (All: P ≥.13). Attrition rate was 33.7% and comparable between groups (P =.94). Adherence to diet intervention negatively correlated with changes in FNPO (r=−0.54), OV (r=−0.35) and FAI (r = −.29) in pooled groups (All: P ≤.04). Groups maintained reduced OV, FNPO, FAI and menstrual cycles 6 months postintervention; however, decreased FNPO and FAI at 16 weeks tended to revert to baseline levels 12 months postintervention in both groups (All: P ≤.05). Conclusions: Both interventions improved ovarian dysmorphology, hyperandrogenism and menstrual irregularity in PCOS, and no diet appeared to be superior at improving reproductive outcomes. Our observations highlight the importance of longitudinal surveillance for sustainable adherence to newly adopted healthy lifestyle behaviours and reproductive health in PCOS (ClinicalTrials.gov identifier, NCT01288638).