Non-Pharmaceutical Interventions for Women with Polycystic Ovary Syndrome:a Systematic Review and Meta-Analysis

Background and Purpose: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder with physical and psychological discomforts. PCOS is often accompanied by mental health issues such as depression, anxiety, and low quality of life. Non-pharmaceutical interventions can help maintain and manage the disease to achieve good health and improve the psychological well-being of women with PCOS. Therefore, a review of studies over the past 20 years was conducted to examine the impact of non-pharmaceutical interventions on improving depression, anxiety, quality of life, and other psychological outcomes in women with PCOS.

Methods: This systematic review followed the Cochrane Handbook for Systematic Reviews. A literature search was performed on the seven English databases (i.e., PubMed, Web of Science, EBSCO, Medline, Scopus, PsyINFO, and Biomed Central) and the three most important Chinese databases (i.e., CNKI, Wangfang, and VIP) up to 12/11/2023. The Newcastle-Ottawa Quality Assessment Scale (NOS) was used to assess the quality of studies. A systematic review and meta-analysis of published literature were conducted to compare the mental health of women with PCOS who received the intervention to those who did not. Studies were reviewed and checked by two authors to determine whether the inclusion and exclusion criteria were satisfied. Each study included in the meta-analysis was coded by the two authors to extract the major outcomes such as depression, anxiety and quality of life. Discrepancies were addressed through discussion. Random-effect models were introduced, and sensitivity tests were carried out to determine the source of heterogeneity among studies. The Egger regression test for funnel plot asymmetry was used to evaluate possible publication biases in the included studies.

Results: Of the 102 studies that met the initial inclusion criteria, we included 24 studies for full-text review. Twenty-four studies, including 1,670participants (959 women with PCOS receive intervention and 711 controls), were qualified for review according to the inclusion criteria. Of the 24 studies,12 studies reported intervention effects on depression,12 studies on anxiety,11studies on emotional quality of life,5 studies on mental health,3 studies on stress, and 3 studies on sexual functioning. Women with PCOS following non-pharmaceutical interventions reported significantly lower depression (SMD = - 2.47; 95% CI: [-3.48, -1.46]), anxiety (SMD = - 2.12; 95% CI: [-3.06, -1.18]), and higher emotional quality of life (SMD = 2.31; 95% CI: [0.81, 3.81]).

Conclusions and Discussion: This review concludes that non-pharmaceutical interventions can be effective for PCOS-related mental health issues. The results of this study can guide the clinical work of counselors and social workers in selecting different intervention therapies based on various goals, adherence, and other considerations. The multidisciplinary cooperation model should be considered in future practice. Future research should provide comprehensive care for conditions in which PCOS affects women's health and well-being.