Effectiveness of Comprehensive Lifestyle Interventions (Diet, Exercise, Sleep, and Stress Modification) in the Treatment of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Background: Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic disorder affecting women of reproductive age and is characterized by hyperandrogenism, ovulatory dysfunction, insulin resistance, obesity, and psychological distress. Lifestyle modification is recommended as first-line therapy; however, the comparative effectiveness of multidomain interventions integrating diet, exercise, sleep optimization, and supplementation remains unclear. This systematic review and meta-analysis evaluated the impact of comprehensive lifestyle interventions on metabolic, hormonal, reproductive, inflammatory, and psychosocial outcomes in women with PCOS. Methods: A systematic literature search of PubMed/MEDLINE was conducted according to PRISMA 2020 guidelines. Randomized controlled trials published in English within the previous 10 years were included if they enrolled reproductive-aged women with confirmed PCOS and evaluated at least one lifestyle intervention: dietary modification, supplementation, structured exercise, sleep-related therapy, or combined programs. Outcomes included anthropometric indices, insulin resistance markers, lipid profile, reproductive and hormonal parameters, inflammatory biomarkers, sleep quality, and mental health. Where sufficient homogeneity existed, pooled quantitative analyses were planned; otherwise, narrative synthesis was performed. Results: Comprehensive lifestyle interventions demonstrated significant benefits across multiple domains. Dietary strategies, particularly calorie-restricted, low-glycemic-load, Mediterranean-style, and ketogenic diets, improved body weight, body mass index, waist circumference, insulin resistance, lipid profile, and androgen excess. Structured exercise, including aerobic training and high-intensity interval training, improved body composition, insulin sensitivity, menstrual cyclicity, ovarian morphology, cardiovascular fitness, and psychological well-being, while reducing inflammatory markers (CRP, IL-6, TNF-α). Adjunctive supplementation (probiotics, synbiotics, coenzyme Q10, omega-3 fatty acids, vitamin D, magnesium, flaxseed, and melatonin) showed additional improvements in metabolic, hormonal, oxidative stress, and menstrual outcomes. Sleep-focused interventions, particularly melatonin supplementation and behavioral modification, improved sleep quality, anxiety, depression, insulin resistance, and lipid parameters. Conclusions: Comprehensive lifestyle intervention is an effective evidence-based strategy for PCOS management. Combined approaches targeting nutrition, exercise, sleep, and selected supplementation improve metabolic, endocrine, reproductive, and psychological outcomes. Given the heterogeneity of PCOS, individualized multidisciplinary lifestyle treatment should be considered a central component of long-term care and may complement pharmacological therapy.