EVALUATING INSULIN RESISTANCE AND HORMONAL IMBALANCE IN WOMEN WITH PCOS UNDERGOING LIFESTYLE MODIFICATION VERSUS PHARMACOLOGICAL THERAPY

Abstract

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age, frequently associated with insulin resistance and hormonal imbalance. Although pharmacological therapies like metformin are routinely used, lifestyle interventions targeting diet and physical activity remain the cornerstone of PCOS management. Comparative evidence on the effectiveness of these approaches is essential for guiding optimal treatment strategies.

Objective: To compare the effects of lifestyle modification versus pharmacological therapy using metformin on insulin resistance and hormonal regulation in women diagnosed with PCOS.

Methods: This randomized controlled trial enrolled 140 women with PCOS from private tertiary hospitals in Lahore, Faisalabad, and Islamabad. Participants were randomly assigned to receive either structured lifestyle intervention or metformin (500 mg three times daily) for 12 weeks. Insulin resistance was assessed using HOMA-IR, while hormonal parameters (testosterone, SHBG, LH/FSH ratio) were measured using ELISA-based assays. Anthropometric data and menstrual patterns were also evaluated. Data were analyzed using SPSS version 26 with independent and paired t-tests and repeated measures ANOVA.

Results: Both groups demonstrated significant improvements in HOMA-IR, but the reduction was greater in the lifestyle group (mean change: 1.23 vs. 0.98; p=0.032). Lifestyle intervention also led to superior reductions in testosterone (0.63 vs. 0.69 ng/mL; p=0.040), higher SHBG levels (36.8 vs. 32.2 nmol/L; p=0.031), and greater menstrual regularity (61% vs. 47%; p=0.048). Weight loss and BMI reductions were also significantly higher in the lifestyle group.

Conclusion: Lifestyle modification produced more favorable outcomes than metformin in improving insulin resistance, hormonal profile, and menstrual regularity among women with PCOS, supporting its role as the preferred first-line therapy.