Which intervention is described as first-line for metabolic abnormalities in PCOS?

• A. Metformin therapy
• B. Dietary counseling only
• C. Exercise program without dietary changes
• D. Lifestyle modification

Answer: (D)

First-line management for metabolic abnormalities in PCOS is lifestyle modification. This means a comprehensive program that combines weight-reducing dietary changes with regular physical activity and behavior strategies. Weight loss, even as little as 5–10%, consistently improves insulin sensitivity, lowers circulating insulin and androgens, and can improve menstrual regularity and ovulation, along with better lipid and glucose profiles.

Metformin is often added if lifestyle changes aren’t enough or if there is glucose intolerance or higher diabetes risk, but it’s not the primary approach for addressing metabolic issues. Dietary counseling alone or an exercise program without integrating both diet and activity doesn’t produce the same broad metabolic and reproductive benefits as a full lifestyle modification plan.