Role of Intermittent Fasting in Polycystic Ovary Syndrome (PCOS): A Systematic Review of Hormonal Balance, Weight Loss, and Menstrual Regularity

Abstract

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disease which occurs in women of reproductive age. It is accompanied by hormonal disorders, metabolic dysfunction, and menstrual irregularities. The traditional approaches to management such as pharmacotherapy and dietary restriction are associated with poor compliance. Time-based dieting Intermittent fasting (IF) has been studied as an effective dietary method to enhance metabolic and reproductive performance. Nevertheless, there are limited facts about its direct effects on hormone regulation, weight reduction, and menstrual cycle among women with PCOS. Objectives: The objective of this systematic review and meta-analysis was to conduct an assessment of the significance of intermittent fasting as a method to change hormone balance, body weight, and menstrual cycle in women with PCOS. Methodology: The search of the literature was performed in PubMed, Scopus, Web of Science, and Google Scholar databases till October 2024 according to PRISMA principles. A total of six original studies were identified (Li et al., 2021; Feyzioglu et al., 2023; Abu Salma et al., 2024; Cienfuegos et al., 2023; Zangeneh et al., 2015; Talebi et al., 2024), comprising 347 women in total (IF = 174; Control = 173). Five studies provided complete numeric data for meta-analysis, while one was included qualitatively. Metabolic, hormonal, and menstrual outcomes were extracted. A random-effects model (DerSimonian Laird statistic) was used to conduct statistical pooling and the I² statistic was used to evaluate heterogeneity. Results: Intermittent fasting was linked to remarkable changes in hormonal and metabolic parameters as opposed to the control groups. Serum total testosterone, fasting insulin, and the LH/FSH ratio declined by a ratio of -0.48 ng/mL (95% CI: -0.73 to -0.23, p = 0.001), -2.16 0mol/mL (95% CI: -3.42 to -0.89, p = 0.002) and by approximately 21%. The levels of SHBG rose by 19% meaning the androgen control was improved. Participants undergoing IF diets had an average weight loss of 4.9 kg in 8-12 weeks and a mean of -2.8 kg/m². IF subjects showed improved ovulatory recovery as 68% of menstrual regularity whereas controls exhibited 32% menstrual regularity. The heterogeneity was moderate (I² = 37%), and the publication bias was not significant. Conclusion: The intermittent fasting shows to be effective in enhancing hormonal balance, insulin sensitivity, weight loss, and the cycle in menstruation in women with PCOS. These results indicate that IF can be a viable nonpharmacologic treatment modality in order to achieve better metabolic and reproductive outcomes. To standardize fasting protocols and evaluate long-term efficacy a large-scale randomized control trials are required.