Types of Drugs Used to Treat PCOS

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Polycystic ovary syndrome (PCOS) is a complex condition affecting approximately 10% of women of childbearing age. Women with PCOS can experience a variety of symptoms ranging from mood changes and skin conditions (acne, excess facial hair) to irregular periods and fertility problems.

The medications used to treat PCOS aim to alleviate the symptoms of the disease. While there is currently no cure for PCOS, you can minimize the impact of the disease by maintaining a healthy lifestyle and managing symptoms with the selective use of drugs.

Medications Used to Regulate the Menstrual Cycle

PCOS is characterized by hormonal abnormalities that can result in infrequent periods (oligomenorrhea) or absent periods (amenorrhea). These and other hormonal irregularities can undermine a woman's ability to get pregnant. Drug treatment is aimed at regulating hormones to better restore a normal menstrual cycle.

The two options commonly used are birth control pills and Provera, both of which regulate your menstrual cycle by providing the progesterone your body needs. By regulating hormone levels, the uterine lining can be shed more routinely, preventing the thickening of tissues caused by missed or irregular periods.

Glucophage (metformin), a diabetes drug, offers the dual benefit of reducing insulin resistance commonly seen in women with PCOS while improving menstrual regularity.

Medications Used to Treat Infertility

PCOS-related hormonal dysfunction can result in irregular or absent ovulation (anovulation). A variety of drugs can be used to treat this, enhancing the quality of both the egg (oocyte) and ovulation. Typical, first-line treatments include the fertility drugs Clomid (clomiphene citrate) and Femara (letrozole). While Clomid is commonly used to enhance ovulation, Femara may work better in women with PCOS as it neither raises estrogen levels nor increases the risk of multiple births to the same degree as Clomid.

Various hormonal therapies can also be used to stimulate ovulation, including:

  • Follicle stimulating hormone (FSH), which stimulates the growth the egg.
  • Luteinizing hormone (LH), which triggers the release of the egg from the ovary.
  • Human chorionic gonadotropin (HCG), which ensures the maturation of the egg.
  • Estrace (estrogen), which prepares the uterus to receive the egg.
  • Provera (progesterone), which prepares the uterus of implantation.
  • Menopur (menotropins), which deliver FSH and LH by injection.
  • Bravelle (urofollitropin), which delivers FSH by injection.

Meanwhile, the non-hormonal supplement inositol has been shown to improve oocyte and embryo quality while increasing pregnancy rates in women with PCOS.

Medications to Treat Insulin Resistance

Around 50% of women with PCOS will develop diabetes or pre-diabetes by the age of 40. Moreover, they are at greater risk for developing gestational diabetes, a condition caused by the impaired ability to process glucose (sugar) during pregnancy.

Diabetes medications are regularly used to reduce glucose and insulin levels in women with PCOS-related insulin resistance. In addition, the modification of lifestyle choices, including exercise and diets low in fats and refined sugars, are considered central to treatment.

Medication options include:

  • Glucophage (metformin), which can control diabetes and assist with weight loss.
  • Victoza (liraglutide), an injectable drug used to control insulin and glucose levels.
  • Actos (pioglitazone), a class of injectable drug used to reduce high blood sugar.
  • Avandia (rosiglitazone), an injectable drug of the same class as pioglitazone.
  • Avandamet, a combination of rosiglitazone and metformin.

Medications to Assist With Weight Loss

Roughly half of women with PCOS are overweight or obese. Not only does PCOS contribute to weight gain, it makes it far more difficult for women to lose weight. In addition to exercise and diet, drug therapies are sometimes used assist with weight loss, although they do tend to come with significant side effects.

Current options include:

  • Xenical (orlistat), a drug that can prevent the absorption of fat.
  • Qsymia (phentermine/topiramate), an appetite suppressant.
  • Belviq (lorcaserin), another appetite suppressant. 
  • Contrave (naltrexone/bupropion), which can curb food cravings.
  • Saxenda (liraglutide), used to treat insulin resistance and obesity.
  • Inositol, a natural supplement associated with weight loss in women with PCOS.

Medications Used to Treat Facial Hair Growth and Acne

Women with PCOS often have elevated levels of male hormones (androgens), including testosterone. Anti-androgen medications work by blocking the synthesis of these hormones and minimizing secondary male characteristics, including hirsutism (excessive facial and body hair) or hair loss.

Treatment options include:

  • Aldactone (spironolactone), a diuretic which has anti-androgenic effects.
  • Vaniqa (eflornithine hydrochloride), a topical cream used to block hair growth.
  • Propecia (finasteride), used off-label to treat hair loss in women with PCOS.

In addition to changes in hair growth, androgen overproduction can result in the development of acne. This is most commonly treated with topical creams that include benzoyl peroxide, salicylic acid, retinoids, or antibiotics.

A Word From Verywell

In coping with your PCOS symptoms, you will need to work with your doctor. There may be some medications that are not appropriate for you due to other health conditions, medication interactions, and other factors. Be sure you understand the treatments recommended and how to take the prescription appropriately.

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Article Sources

  • Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine (19th edition). New York: McGraw-Hill Education, 2015.