A randomized controlled trial of a lifestyle intervention with longitudinal follow‐up on ovarian dysmorphology in women with polycystic ovary syndrome
Abstract
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).
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Both low GI pulse-based and Therapeutic Lifestyle Changes interventions improved ovarian dysmorphology (follicle numbers per ovary, ovarian volume), hyperandrogenism, and menstrual irregularity in women with PCOS, with some benefits maintained 6 months postintervention.
“Both interventions improved ovarian dysmorphology (follicle numbers per ovary, ovarian volume), hyperandrogenism, and menstrual irregularity, with some of the benefits maintained 6 months postintervention [31].”
From Ketogenic Diet as Medical Prescription in Women with Polycystic Ovary Syndrome (PCOS) (2023) · cites this paper as [31]
Cites
Azziz, R., Carmina, E., Dewailly, D., Diamanti-Kandarakis, E., Escobar-Morreale, H. F., Futterweit, W., Janssen, O. E., Legro, R. S., Norman, R. J., Taylor, A. E., et al. (2006) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-0178 · Cited by 2,143 · see citing works
Diamanti-Kandarakis, E., & Dunaif, A. (2012) · Endocrine Reviews · doi:10.1210/er.2011-1034 · Cited by 1,947 · see citing works
Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., & the International PCOS Network (2018) · Clinical Endocrinology · doi:10.1111/cen.13795 · Cited by 1,823 · see citing works
Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., International PCOS Network, Andersen, M., et al. (2018) · Human Reproduction · doi:10.1093/humrep/dey256 · Cited by 1,593 · see citing works
Lifestyle changes in women with polycystic ovary syndrome
Lim, S. S., Hutchison, S. K., Van Ryswyk, E., Norman, R. J., Teede, H. J., & Moran, L. J. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007506.pub4 · Cited by 725 · see citing works
Follicle dynamics and anovulation in polycystic ovary syndrome
Franks, S., Stark, J., & Hardy, K. (2008) · Human Reproduction Update · doi:10.1093/humupd/dmn015 · Cited by 581 · see citing works
Dewailly, D., Lujan, M. E., Carmina, E., Cedars, M. I., Laven, J., Norman, R. J., & Escobar-Morreale, H. F. (2014) · Human Reproduction Update · doi:10.1093/humupd/dmt061 · Cited by 551 · see citing works
Formation and early development of follicles in the polycystic ovary
Webber, L. J., Stubbs, S. A., Stark, J., Trew, G. H., Margara, R. A., Hardy, K., & Franks, S. (2003) · The Lancet · doi:10.1016/s0140-6736(03)14410-8 · Cited by 521 · see citing works
Ovarian antral folliculogenesis during the human menstrual cycle: A review
Baerwald, A. R., Adams, G. P., & Pierson, R. A. (2012) · Human Reproduction Update · doi:10.1093/humupd/dmr039 · Cited by 487 · see citing works
Self-citationLujan, M. E., Jarrett, B. Y., Brooks, E. D., Reines, J. K., Peppin, A. K., Muhn, N., Haider, E. A., Pierson, R. A., & Chizen, D. R. (2013) · Human Reproduction · doi:10.1093/humrep/det062 · Cited by 458 · see citing works
Self-citationTeede, H. J., Joham, A. E., Paul, E., Moran, L. J., Loxton, D., Jolley, D., & Lombard, C. (2013) · Obesity · doi:10.1002/oby.20213 · Cited by 351 · see citing works
Hoeger, K. M., Kochman, L., Wixom, N., Craig, K., Miller, R. K., & Guzick, D. S. (2004) · Fertility and Sterility · doi:10.1016/j.fertnstert.2004.02.104 · Cited by 278 · see citing works
Thomson, R. L., Buckley, J. D., Noakes, M., Clifton, P. M., Norman, R. J., & Brinkworth, G. D. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0751 · Cited by 277 · see citing works
Huber-Buchholz, M.-M. (1999) · Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.84.4.1470 · Cited by 269 · see citing works
Stamets, K., Taylor, D. S., Kunselman, A., Demers, L. M., Pelkman, C. L., & Legro, R. S. (2004) · Fertility and Sterility · doi:10.1016/j.fertnstert.2003.08.023 · Cited by 252 · see citing works
Palomba, S., Giallauria, F., Falbo, A., Russo, T., Oppedisano, R., Tolino, A., Colao, A., Vigorito, C., Zullo, F., & Orio, F. (2008) · Human Reproduction · doi:10.1093/humrep/dem391 · Cited by 235 · see citing works
Maciel, G. A. R., Baracat, E. C., Bénda, J., Markham, S. M., Hensinger, K., Chang, R. J., & Erickson, G. F. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-0643 · Cited by 228 · see citing works
Marsh, K. A., Steinbeck, K. S., Atkinson, F. S., Petocz, P., & Brand-Miller, J. C. (2010) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.2010.29261 · Cited by 228 · see citing works
Poretsky, L., Grigorescu, F., Seibel, M. J., Moses, A. C., & Flier, J. S. (1985) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-61-4-728 · Cited by 183 · see citing works
Granulosa cells of polycystic ovaries: are they normal or abnormal?
Erickson, G. F., Magoffin, D. A., Garzo, V. G., Cheung, A. P., & Chang, R. J. (1992) · Human Reproduction · doi:10.1093/oxfordjournals.humrep.a137638 · Cited by 162 · see citing works
Mehrabani, H. H., Salehpour, S., Amiri, Z., Farahani, S. J., Meyer, B. J., & Tahbaz, F. (2012) · Journal of the American College of Nutrition · doi:10.1080/07315724.2012.10720017 · Cited by 141 · see citing works
Kazemi, M., McBreairty, L. E., Chizen, D. R., Pierson, R. A., Chilibeck, P. D., & Zello, G. A. (2018) · Nutrients · doi:10.3390/nu10101387 · Cited by 118 · see citing works
Self-citationLin, A., Kazemi, M., Jarrett, B. Y., Brink, H. V., Hoeger, K. M., Spandorfer, S. D., & Lujan, M. E. (2019) · Nutrients · doi:10.3390/nu11112711 · Cited by 112 · see citing works
Self-citationProlonged Survival in Culture of Preantral Follicles from Polycystic Ovaries
Webber, L. J., Stubbs, S. A., Stark, J., Margara, R. A., Trew, G. H., Lavery, S. A., Hardy, K., & Franks, S. (2007) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-1422 · Cited by 99 · see citing works
Christ, J. P., Brink, H. V., Brooks, E. D., Pierson, R. A., Chizen, D. R., & Lujan, M. E. (2015) · Fertility and Sterility · doi:10.1016/j.fertnstert.2014.12.094 · Cited by 54 · see citing works
Self-citationEtiology of Anovulation in Polycystic Ovary Syndrome
Franks, S., Mason, H. D., White, D. M., & Willis, D. (1998) · Steroids · doi:10.1016/s0039-128x(98)00035-x · Cited by 52 · see citing works
Kazemi, M., Pierson, R. A., Lujan, M. E., Chilibeck, P. D., McBreairty, L. E., Gordon, J. J., Serrao, S. B., Zello, G. A., & Chizen, D. R. (2019) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2018.11.026 · Cited by 51 · see citing works
Self-citationEndometrial development in association with ovarian follicular waves during the menstrual cycle
Baerwald, A., & Pierson, R. A. (2004) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.1123 · Cited by 50 · see citing works
Self-citationÖberg, E., Gidlöf, S. B., Jakson, I., Mitsell, M., Egnell, P. T., & Hirschberg, A. L. (2018) · Clinical Endocrinology · doi:10.1111/cen.13919 · Cited by 48 · see citing works
Lujan, M. E., Brooks, E. D., Kepley, A. L., Chizen, D. R., Pierson, R. A., & Peppin, A. K. (2010) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2010.02.008 · Cited by 42 · see citing works
Self-citationPlasma testosterone free index: A better indicator of plasma androgen activity?
CLARK, A. F., Marcellus, S., deLory, B., & BIRD, C. E. (1975) · Fertility and Sterility · doi:10.1016/s0015-0282(16)41415-9 · Cited by 42 · see citing works
Lujan, M. E., Kepley, A. L., Chizen, D. R., Lehotay, D. C., & Pierson, R. A. (2010) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.7751 · Cited by 11 · see citing works
Self-citationPulses and Prevention and Management of Chronic Disease
Kazemi, M., Buddemeyer, S., Fassett, C. M., Gans, W. M., Johnston, K., Lungu, E., Savelle, R. L., Tolani, P. N., & Dahl, W. J. (2019) · Springer eBooks · doi:10.1007/978-3-030-12763-3_5 · Cited by 10 · see citing works
Self-citationMcBreairty, L. E., Chilibeck, P. D., Chizen, D. R., Pierson, R. A., Tumback, L., Sherar, L. B., & Zello, G. A. (2017) · BMC Nutrition · doi:10.1186/s40795-017-0142-6 · Cited by 8 · see citing works
Self-citationKazemi, M., Jarrett, B. Y., Brink, H. V., Lin, A., Hoeger, K. M., Spandorfer, S. D., & Lujan, M. E. (2019) · Current Developments in Nutrition · doi:10.1093/cdn/nzz035.or36-03-19 · Cited by 7 · see citing works
Self-citationHuman Folliculogenesis Revisited: The Menstrual Cycle Visualized by Ultrasonography
Pierson, R. A. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-813209-8.00003-0 · Cited by 6 · see citing works
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Lifestyle management in polycystic ovary syndrome – beyond diet and physical activity
Cowan, S., Lim, S. S., Alycia, C., Pirotta, S., Thomson, R. L., Gibson‐Helm, M. E., Blackmore, R., Naderpoor, N., Bennett, C., Ee, C., et al. (2023) · BMC Endocrine Disorders · doi:10.1186/s12902-022-01208-y · Cited by 285 · see citing works
Kazemi, M., Hadi, A., Pierson, R. A., Lujan, M. E., Zello, G. A., & Chilibeck, P. D. (2020) · Advances in Nutrition · doi:10.1093/advances/nmaa092 · Cited by 104 · see citing works
Self-citationKazemi, M., Kim, J. Y., Wan, C., Xiong, J. D., Michalak, J., Xavier, I. B., Ganga, K., Tay, C. T., Grieger, J. A., Parry, S. A., et al. (2022) · Human Reproduction Update · doi:10.1093/humupd/dmac023 · Cited by 89 · see citing works
Self-citationKetogenic Diet as Medical Prescription in Women with Polycystic Ovary Syndrome (PCOS)
Barrea, L., Verde, L., Camajani, E., Cernea, S., Frias-Toral, E., Lamabadusuriya, D., Ceriani, F., Savastano, S., Colao, A., & Muscogiuri, G. (2023) · Current Nutrition Reports · doi:10.1007/s13668-023-00456-1 · Cited by 62 · see citing works
Shang, Y., Zhou, H., He, R., & Lu, W. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.735954 · Cited by 61 · see citing works
Kazemi, M., Jarrett, B. Y., Vanden Brink, H., Lin, A. W., Hoeger, K. M., Spandorfer, S. D., & Lujan, M. E. (2020) · Nutrients · doi:10.3390/nu12071953 · Cited by 53 · see citing works
Self-citationNeubronner, S., Indran, I. R., Chan, Y. H., Thu, W. P. P., & Yong, E. (2021) · BMC Women s Health · doi:10.1186/s12905-021-01277-6 · Cited by 50 · see citing works
Haudum, C. W., Lindheim, L., Ascani, A., Trummer, C., Horvath, A., Münzker, J., & Obermayer-Pietsch, B. M. (2020) · Nutrients · doi:10.3390/nu12061622 · Cited by 48 · see citing works
Kazemi, M., Jarrett, B. Y., Parry, S. A., Thalacker‐Mercer, A. E., Hoeger, K. M., Spandorfer, S. D., & Lujan, M. E. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa426 · Cited by 29 · see citing works
Self-citationAli, S. E., Badawy, S. A. E., Elmosalamy, S. H., Emam, S. R., Azouz, A. A., Galal, M. K., Abd‐Elsalam, R. M., Issa, M. Y., & Hassan, B. B. (2021) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2021.114318 · Cited by 27 · see citing works
Kazemi, M., Kim, J. Y., Wan, C., Xiong, J. D., Parry, S. A., Azziz, R., & Lujan, M. E. (2021) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2021.07.032 · Cited by 27 · see citing works
Self-citationKazemi, M., Pierson, R. A., Parry, S. A., Kaviani, M., & Chilibeck, P. D. (2021) · Obesity Reviews · doi:10.1111/obr.13255 · Cited by 24 · see citing works
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Self-citationCao, Y., Li, G., & Ren, Y. (2023) · BMC Women s Health · doi:10.1186/s12905-023-02222-5 · Cited by 13 · see citing works
Choi, Y.-J., Kang, K., Je, M., Lee, Y., & Kim, Y. (2025) · Nutrients · doi:10.3390/nu17040674 · Cited by 12 · see citing works
ZareMobini, F., Farajzadegan, Z., Kazemi, A., & Salehi, M. (2022) · Scientific Reports · doi:10.1038/s41598-022-26274-z · Cited by 10 · see citing works
Kazemi, M., McBreairty, L. E., Chilibeck, P. D., Pierson, R. A., Chizen, D. R., & Zello, G. A. (2021) · Sexes · doi:10.3390/sexes2010008 · Cited by 9 · see citing works
Self-citationNaz, M. S. G., Jahanfar, S., & Tehrani, F. R. (2022) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2022.11.007 · Cited by 7 · see citing works
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Zhang, L., Jin, Y., Yang, A., Yu, X., Li, Y., Wang, X., Heng, C., Qi, B., Gao, B., & Zhao, G. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1578459 · Cited by 6 · see citing works
Brink, H. V., Pea, J., & Lujan, M. E. (2020) · Current Opinion in Biotechnology · doi:10.1016/j.copbio.2020.10.008 · Cited by 6 · see citing works
Colonetti, L., Uggioni, M. L. R., Prestes, G. D. S., Stangherlin, L., Denoni, J. C., Moura, R., Sipriano, É. D. S., Madeira, K., Cardoso, H. S., Ferraz, S. D., et al. (2025) · Nutrition · doi:10.1016/j.nut.2025.112696 · Cited by 3 · see citing works
Carter, F. E., Jarrett, B. Y., Oldfield, A. L., Brink, H. V., Kim, J. Y., & Lujan, M. E. (2025) · Nutrients · doi:10.3390/nu17132223 · Cited by 3 · see citing works
Nutrition interventions in women with polycystic ovary syndrome: a systematic review
Akbaş, E., Samancı, M., & Öztürk, Y. E. (2026) · European Journal of Nutrition · doi:10.1007/s00394-026-04030-7 · Cited by 2 · see citing works
Mitsunami, M., Kazemi, M., Nichols, A. R., Mínguez‐Alarcón, L., Fitz, V. W., Souter, I. C., Hauser, R. B., & Chavarro, J. E. (2025) · Nutrients · doi:10.3390/nu17030382 · Cited by 2 · see citing works
Self-citationBahloul, B., Bnina, E. B., Hamdi, A., Henríquez, L. C., Baccar, D., Kalboussi, N., Abbassi, A., Mignet, N., Flamini, G., & Vega‐Baudrit, J. R. (2023) · Preprints.org · doi:10.20944/preprints202308.0150.v1 · Cited by 1 · see citing works
Latour, M., Laska, Z., Juniewicz, H., Kudlińska, Z., Heryć, P., Kananowicz, K., Łagowski, R., Kosęda, J., Jędrasiak, A., & Piotrowski, J. (2025) · International Journal of Innovative Technologies in Social Science · doi:10.31435/ijitss.4(48).2025.4234 · Cited by 1 · see citing works
Shahid, R., Maqsood, M., Ashraf, N., Asghar, F., & Khalid, N. (2026) · Legume Science · doi:10.1002/leg3.70144 · Cited by 1 · see citing works
Impacto das mudanças de estilo de vida na Síndrome do Ovário Policístico – uma revisão integrativa
Gonçalves, G. C., Moreira, F. P., Fonseca, I. F., Borges, G. D., & de Siqueira, E. C. (2024) · Brazilian Journal of Health Review · doi:10.34119/bjhrv7n1-447 · Cited by 1 · see citing works
Ovarian Ultrasonography in Polycystic Ovary Syndrome
Brink, H. V., & Lujan, M. E. (2022) · Cambridge University Press eBooks · doi:10.1017/9781108989831.004
ZareMobini, F., Farajzadegan, Z., Kazemi, A., & Salehi, M. (2022) · Research Square · doi:10.21203/rs.3.rs-1747634/v1
Vizza, L. (2023) · Obstetrics and gynecology. · doi:10.5772/intechopen.113149
Metabolic aspects of polycystic ovary syndrome
Pappas, D., Kandaraki, E., Kalogirou, A., & Diamanti‐Kandarakis, E. (2026) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2026.2656240
Czerniewska, J., Jurkowska, K., Madrzak, J., Endler, O., Dybicz, M., Ciastoń, M., Filuk, M., Fidelus, J., Dutkiewicz, D., & Handzel, M. (2026) · International Journal of Innovative Technologies in Social Science · doi:10.31435/ijitss.2(50).2026.5667
Arif, A., & Ferdosh, J. (2025) · Islami Bank Medical College Journal · doi:10.70945/ibmcj.v020i01.046
Hammad, S. S., AbuLaban, A. R., & Abudawood, R. R. (2026) · International Journal of Clinical Practice · doi:10.1155/ijcp/4214280
- Authors
- Kazemi, M., Pierson, R. A., McBreairty, L. E., Chilibeck, P. D., Zello, G. A., & Chizen, D. R.
- Affiliations
- University of Saskatchewan (CA)
- Corresponding author
- Chizen, Donna R.
- ORCID
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2020-03-16
- Volume
- 92
- Issue
- 6
- Pages
- 525-535
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W3008012589
- Cited by
- 36
- References
- 38
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 1 · 2023: 6 · 2022: 5 · 2021: 6 · 2020: 6
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Saskatchewan Health Research Foundation
- Saskatchewan Pulse Growers (G00014962 ‐ SPCD ‐ Effect of a Pulse‐Based Diet)
- Canada Foundation for Innovation (29638)
- Agriculture and Agri-Food Canada (G00011676)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Keywords
- polycystic ovary syndrome, lifestyle intervention, aerobic exercise, ovarian morphology, ovarian volume, free androgen index, hyperandrogenism, menstrual irregularity, dietary adherence, reproductive function, longitudinal follow-up
- MeSH terms
- Female, Follow-Up Studies, Humans, Life Style, Polycystic Ovary Syndrome, Hyperandrogenism
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