Integrating evidence-based lifestyle and adjunct therapies for long-term management of polycystic ovary syndrome: mechanistic insights and clinical implications.

Background: Polycystic ovary syndrome (PCOS) is a complex multisystem disorder affecting 6%-13% of reproductive-aged women, characterized by hormonal and metabolic dysregulation. Driven by hyperandrogenism and insulin resistance, it contributes to reproductive and cardiometabolic complications. Current management remains largely symptom-focused, often limiting long-term effectiveness and comprehensive disease control. Objective and rationale: This narrative review critically evaluates current evidence on lifestyle-based and adjunct therapeutic strategies in PCOS management, with emphasis on dietary interventions, physical activity, nutraceuticals, and traditional remedies, focusing on their potential to modulate metabolic, endocrine, and inflammatory pathways alongside conventional clinical treatments. Search strategy: A structured narrative literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar to identify studies published in English-language. Keywords related to PCOS, insulin resistance, hyperandrogenism, oxidative stress, lifestyle-interventions, dietary strategies, physical activity, traditional medicine, phytotherapy and mind-body interventions were combined using Boolean operators. Relevant original studies, clinical trials, systematic reviews, and meta-analyses were selected based on scope and relevance. Key findings: Emerging evidence highlights the multifaceted role of lifestyle and adjunct interventions in improving the clinical outcomes in PCOS. Dietary approaches, including Mediterranean, low-glycemic index, ketogenic, and anti-inflammatory diets, are associated with improvements in metabolic parameters and insulin sensitivity. Structured physical activity comprising aerobic exercise, resistance training, high-intensity interval training, and mind-body practices such as yoga and Pilates demonstrates beneficial effects on metabolic and hormonal outcomes. Adjunct strategies, including nutraceuticals and selected phytochemicals, show potential in modulating insulin signalling, inflammation, and endocrine function. Psychological interventions, particularly mindfulness-based therapy and cognitive behavioural therapy, may alleviate psychosocial burden and enhance treatment adherence. Complementary cultural systems, including Ayurveda, Unani, and Traditional Chinese Medicine, have been explored as supportive approaches. Overall, heterogeneity in study design and quality necessitates cautious interpretation and further high-quality clinical validation. Conclusion: Effective PCOS management requires a balanced, evidence-based, and individualized approach in which lifestyle strategies form the foundation, pharmacological therapies remain central, and adjunct interventions are judiciously integrated as supportive measures rather than replacements for established care. Further well-designed high-quality clinical trials, standardized intervention protocols, and personalized therapeutic frameworks are needed to better establish the efficacy and safety of these strategies.