How Polycystic Ovary Syndrome Is Treated

Polycystic ovary syndrome (PCOS) does not have a cure, but its symptoms and complications can be treated. Work with your health care team to find which lifestyle changes, medications, and procedures can help you manage the condition and maintain the best health.

Home Remedies and Lifestyle

Lifestyle modifications are the first line of treatment for PCOS. Not only do they address the reproductive problems in PCOS, but also reduce the risks of common complications such as metabolic syndrome, Type 2 diabetes, heart disease, and stroke.

Healthy Weight

The single most important PCOS treatment is to lose weight if you are overweight. By reducing calories and simple sugars, increasing lean protein and fiber, and beginning a regular exercise routine, you can help your body increase its response to insulin, and possibly decrease androgen production. This may help reduce symptoms, restore normal menses and make it easier to conceive. While there are medications that can help manage the symptoms you are experiencing, losing weight is the best thing you can do to help treat the disease.

While weight loss is challenging when you have PCOS, losing as little as 5 percent of your body weight can improve your condition. A 10 percent loss can help improve your chances of becoming pregnant.

Healthy Diet

A healthy diet is important in PCOS even if you are at a normal weight. Enjoy lots of fruits and vegetables, moderate amounts of high-fiber unprocessed low glycemic index grains (oats, quinoa), and foods rich in omega-3 fats such as fish (salmon, tuna, trout), nutsseeds, and avocados. Keep the amount of carbohydrate foods per meal moderate and in balance with protein so your blood sugar levels are stabilized.

Exercise

No matter what your weight, being sedentary and not exercising can raise your risk of metabolic syndrome and Type 2 diabetes. This is where the extra testosterone seen in PCOS can work for you. You will build muscle more easily, so two days of weight training each week will build muscle mass that can help your body use insulin more effectively. Aim to get 30 minutes per day of cardiovascular exercise most days of the week.

Reduce the time you spend sitting. Find ways to break up long times at your desk or watching television or videos in the evening. Add more activity throughout the day. Many fitness trackers now alert you when you have been sitting for an hour without activity.

Over-the-Counter (OTC) Therapies

Excessive facial and body hair can be removed with OTC facial hair removal creams. Waxing and threading can also be done at home or by estheticians. Laser hair removal and electrolysis can give you longer-lasting results and you can find these treatments at clinics and spas. These are usually performed by technicians under the supervision of a doctor but without a prescription.

OTC acne and skin care products may also be useful. But depending on your amount of acne, it can be best to consult a dermatologist.

Prescriptions

A variety of prescription medications can treat the symptoms of PCOS.

Regulating the Menstrual Cycle

For women who are currently not interested in having a baby, oral contraceptives ("the pill") are usually a practitioner’s first choice. The pill contains a combination of estrogen and progesterone which aids in regulating a woman’s hormones. This will help normalize your cycle, thereby making your periods more regular. Even though the lack of periods may seem convenient, sustained lengths of time without a period may increase your risk of endometrial cancer.

Your doctor may feel it necessary to give you a medication called Provera (medroxyprogesterone) which will induce bleeding if you have not had a period in a while. Provera is an oral medication which is taken for five to 10 days and will bring on a period. You may need a blood test prior to beginning this medication to confirm that you are not pregnant.

Androgen Suppressors

Medications which suppress androgen secretion are one option that your doctor may give you. Oral contraceptives may help, or the doctor may prescribe an antiandrogenic medication, such as Spironolactone (aldactone). Spironolactone inhibits the testosterone secreted by the body, and also competes for hormone receptors in the hair follicles. Receptors are sites on cells which allow hormones or chemical to bind to them, creating a reaction. If another chemical is in the receptor site, androgens cannot bind to them and stimulate the reaction causing hair growth.

Another medicine which works in the same fashion is Flutamide, which is not typically used due to the effect that the medication has on the liver. If you are taking this medication, it is important to follow up with the appropriate blood tests as your doctor orders to help early detection of liver problems. No anti-androgen medication is approved by the FDA for PCOS symptoms, and these medications are not safe to use during pregnancy.

Metformin

Because of the connection between PCOS and insulin resistance, medications that are normally used to treat diabetes, namely metformin, may be used to increase insulin sensitivity. While many doctors prescribe it for patients with PCOS, the FDA has not approved metformin for this use.

By increasing the body’s response to insulin, it is thought that the ovary may not make as many androgens, which increases the likelihood that ovulation will occur. Metformin may also reduce the levels of circulating androgens. This will help regulate your menstrual cycle and may help you lose weight.

Vaniqa

Vaniqa (eflornithine hydrochloride) is a prescription facial cream that can slow the growth of facial hair in women. It doesn't permanently remove hair, so you need to apply it daily and continue to do so indefinitely. It takes four to eight weeks to become effective. It should not be used while you are pregnant.

Acne Treatment

Prescription acne treatments often use retinoids. While these will be the most effective way to quell acne, they can cause birth defects and may not be allowed if you want to become pregnant.

Surgeries and Specialist-Driven Procedures

While rarely performed, there is a surgical option to help treat PCOS. Called ovarian drilling, the doctor makes tiny incisions into your abdomen and using a very small camera to assist him in visualizing your internal organs, makes small burns on the enlarged ovarian follicles. The hope is to reduce androgen and LH secretion, thereby inducing ovulatory cycles.

Even less common is ovarian wedge resection. Due to the increased risk of scarring and permanent ovarian damage, if your doctor suggests this procedure, please get a second opinion. It is no longer recommended in the treatment of PCOS.

Infertility Treatment

If you want to try to have a baby, there are many options. The medication that your doctor will probably prescribe first is Clomid, which may help you ovulate. Towards the middle of your cycle, you may be able to use an ovulation predictor kit which can help you time the best days to begin trying. Keep in mind that some women with PCOS have persistently high LH levels (the hormone detected in ovulation kits), making this method of timing inappropriate.

Some women may need to take both Clomid and Metformin in order to ovulate. Clomid is a medication that is given to stimulate ovulation in women who do not regularly ovulate. Losing weight can also help accomplish this. In some people, moderate weight loss can help restore ovulation and greatly increase your odds of pregnancy.

If these do not work, the next step will most likely be injectable medications known as gonadotropins. Each month, follicle stimulating hormone (FSH) is secreted by the pituitary which makes an egg follicle grow. Gonadotropins directly increase the amount of FSH circulating in the body, promoting the growth and development of a mature egg. The doctor will most likely monitor your progress through ultrasound and blood tests. Once the doctor feels that you are close to ovulating, s/he may have you take an injection of human chorionic gonadotropin (HCG) which will trigger your ovulation within 36 hours. This will allow you to more precisely time when to have intercourse or have intrauterine insemination (IUI). Your doctor will help you identify which choice is better for you.

Finally, your last choice is in vitro fertilization (IVF), a complex process where you will undergo controlled hyperstimulation of your ovaries through injectable medications. This produces many eggs which the doctor will then remove through a surgical procedure. Fertilization takes place outside of the body and in the more controlled environment of the lab. Growing embryos are then transferred back into the body, where they will hopefully implant in the uterus and form a viable pregnancy. There are many treatment protocols within the IVF process and your doctor will choose the best one, based on your medical history, age, and diagnosis. If standard IVF does not work for you, it can be used with donor eggs, donor sperm, or with a surrogate as necessary.

Complementary Alternative Medicine (CAM)

Some studies have shown a slight correlation between acupuncture and the success of fertility therapy. It is thought that it may help regulate the menstrual cycle and even induce ovulation in some women.

Studies of nutritional supplements and herbal remedies such as calcium plus vitamin D, Camellia sinensis (tea plant), and cinnamon have not found any to be effective for PCOS.

Before beginning any therapy, make sure to speak with your doctor and find a qualified practitioner with experience in women’s health issues. Some herbal supplements may interact with prescription medications and some may be harmful during pregnancy.

A Word From Verywell

Each woman with PCOS will have different symptoms, so the course of treatment will be unique. Talk to your doctor about what will work best for you. Be sure to ask for any needed help with lifestyle modifications. You may need support from a registered dietitian, nutritionist, physical trainer, or therapist.

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