The effects of lifestyle interventions (LSIs) on cardiometabolic risk factors in women with polycystic ovary syndrome (PCOS) are controversial. We conducted a systematic review and meta-analysis to assess the effectiveness of LSI on cardiometabolic risk in women with PCOS. We reviewed five databases for randomized controlled trials (RCTs) published between 2012 and December 2016, evaluating the effect of LSI among adult, reproductive age group, overweight, and obese women with PCOS. Outcome measures included weight change, homeostatic model assessment-insulin resistance index (HOMA-IR), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL). A total of 564 studies were screened; 35 full text studies assessed for eligibility, 20 excluded with reasons, 15 included in the systematic review, and 9 studies from 8 RCTs included in a meta-analysis. LSI resulted in significant reduction in weight in sensitivity analyses [study 5 dietary arm as intervention: standardized mean difference (SMD) = -0.81 (95% confidence interval {CI} = -1.24 to -0.39); study 5 combination arm as intervention: SMD = -0.85 (95% CI = -1.26 to -0.45)], HOMA-IR overall [study 5 dietary arm: SMD = -1.46 (95% CI = -2.72 to -0.20); study 5 combination arm SMD = -1.50 (95% CI = -2.76 to -0.23)], and LDL overall [SMD = -1.06 (95% CI = -2.00 to -0.12)]. LSI was more beneficial than Metformin in decreasing LDL [SMD = -2.60 (95% CI = -5.15 to -0.05)] but similar to comparator group in terms of TC, TG, and HDL (P > 0.05). Short-term LSI can effectively improve weight, insulin resistance, and lipid profile and could be recommended as first-line therapy in overweight and obese PCOS women to reduce cardiometabolic risk.