Treatment of Polycystic Ovary Syndrome

The earlier treatment is started in this condition, the lower the risk of complications in the future. Also, the follow-up will be very valuable. We'll tell you about it in detail below.

Polycystic ovary syndrome (PCOS) is one of the most common disorders in women. In fact, it is one of the main reasons for consultation in adolescents and young adults. However, it can affect any woman of childbearing age in a number of different ways. Hence, the treatment of polycystic ovary syndrome isn’t universal.

We often think that the treatment for gynecological problems (including PCOS) is mainly based on the prescription of birth control pills for a certain period of time. While these have proven useful in some cases, in others they are not enough or not useful.

Given the variety of symptoms of PCOS and their degree of intensity, it isn’t possible to perform the approach only from the perspective of contraceptive pills. To understand more about it, below we’ll take a more in-depth look at what the treatment of polycystic ovary syndrome can include.

First line treatment

Depending on the symptoms, the current state of health and whether or not the woman wishes to become pregnant, the doctor will decide on one therapeutic strategy or another.

In the first instance, the doctor will suggest that the patient makes some lifestyle changes. These changes can also be called non-pharmacological measures and, according to Dr. Carla Faivovich, include the following:

• Hypocaloric and low-fat diet: To help achieve or maintain a healthy weight, according to the body mass index.
• Regular physical exercise (at least 150 minutes a week): To support the above measure and contribute to health and well-being in a comprehensive way.
• Cosmetic measures: Hair removal (in its different variants) to reduce the aesthetic impact of hirsutism and over-the-counter acne treatments (although this would only be in mild cases).

Although they seem simple measures, these can be very beneficial, since they can help to regulate menstrual cycles, induce ovulation, improve fertility, reduce hirsutism and acanthosis nigricans, and increase insulin sensitivity, in addition to promoting a healthy weight.

Prescriptions

In addition to making lifestyle changes and resorting to some cosmetic measures, your doctor might consider prescribing birth control pills for a time. Regarding this, the MSD Manual explains the following:

• Hormonal contraceptives are the first-line therapy for menstrual abnormalities, hirsutism, and acne in women who have PCOS and don’t want to become pregnant.
• An intermittent progestin (such as medroxyprogesterone) is usually prescribed.
  • Specifications: 5 to 10 milligrams; 1 time a day for 10-14 days every 1-2 months.
• Oral contraceptives help regulate menstrual cycles and androgen activity (due to its combination of estrogen and progesterone), and may also be helpful in reducing the risk of endometrial hyperplasia.
• Women who want to get pregnant may need infertility treatment (such as clomiphene).

Androgen suppressors

Dr. Faivovich explains that, even though combined oral contraceptives (containing a progestogen with antiandrogenic effect) are usually used, if there’s a contraindication, antiandrogenic drugs could be used. The latter require stricter control, given the risk of side effects.

One of the antiandrogens that could be prescribed would be spironolactone (also known as Aldactone), which is also indicated for hypertension.

Metformin

Metformin is a glycemic control drug. It’s recommended in the treatment of type 2 diabetes mellitus, especially in overweight patients.

Vaniqa

To treat facial hirsutism that is difficult to control with hair removal techniques and other cosmetic measures, Vaniqa, – a cream medication – could be prescribed.

Acne treatment

Treatment for acne can vary considerably, depending on the case. However, it often includes retinoids.

Surgical treatment

Although it isn’t usually necessary except in very rare cases, it may be necessary to resort to surgical treatment (ovarian perforation) to reduce the secretion of androgens and LH, and therefore, induce ovulation and treat PCOS.

Wedge ovarian resection may be another necessary procedure in very rare cases. However, a second option is usually considered before resorting to it, given the consequences it can have.

Fertility treatment

As we mentioned before, there are women with PCOS who want to get pregnant who cannot be prescribed a treatment with contraceptive pills. For them, the strategy will be aimed at preserving or improving fertility.

• Some of the most commonly prescribed medications are clomiphene or letrozole.
• In some cases it may be necessary to resort to gonadotropin injections.

Alternative medicine: acupuncture

According to what was stated in a review published in 2017, there’s little evidence to show that acupuncture is useful in the treatment of polycystic ovary syndrome. The studies carried out to date not only had limited samples, but they showed little evidence of significant changes. Most of them showed slight improvements.

Final recommendations

In sum, the treatment of PCOS can vary from woman to woman. For this reason, it’s important to follow the doctor’s instructions, always ask the questions you need, attend all your appointments, and, at the same time, maintain a healthy lifestyle. All this will contribute to the well-being in the short and long term.