Treatments for PCOS

Posted on August 15, 2018

PCOS treatments fall into three main categories: medication, lifestyle changes, and surgery. Since PCOS can cause such a wide variety of symptoms, many different kinds of drugs are used to treat it. Some of these are approved by the Food and Drug Administration (FDA) for PCOS, but several medications approved for other conditions are commonly prescribed off-label to treat PCOS.

Read more details about individual treatments in the Treatments A-Z.

Medications for PCOS

Birth control

Combination birth control pills contain two hormones: estrogen and progestin. Oral contraceptives containing both hormones make a woman’s period lighter, shorter, and more regular while controlling pain levels. There are a large number of branded and generic birth control pills on the market containing varying amounts of both hormones. Combination hormone therapy is also available as a skin patch or a vaginal ring.

Some women taking combination oral contraceptives experience mild side effects such as weight gain, bloating, and bleeding between periods, especially for the first few weeks or months of taking them.

Some birth control methods contain the single hormone progesterone or its synthetic version, progestin. Progestin-only treatments are administered as a pill, by injection such as Depo-Provera, or inserted as an intrauterine device (IUD) such as Mirena. Progestin-only therapies can shorten and lighten a woman’s period or stop it altogether. Oral forms include brands like Provera. Once a woman stops taking the progestin pill, symptoms can reappear.

Anti-androgen hormone therapy
Hormones regulate the reproductive system and the menstrual cycle. In women with PCOS, hormone-based treatments seek to lower the levels of androgens in the body. This can relieve or clear some of the symptoms of PCOS, such as acne and excess body and facial hair. Levothyroxine, a synthetic thyroid hormone approved by the Food and Drug Administration (FDA) to treat hypothyroidism, may be prescribed off-label to women with PCOS. Levothyroxine is sold under various brand names including Levothroid, Levoxyl, Synthroid, and Unithroid.

Treatments for hirsutism and hair loss

Vaniqa (Eflornithine) is a prescription drug approved by the FDA to reduce unwanted facial hair in women. Vaniqa is believed to work by interfering with hair growth. Another drug prescribed to treat hirsutism (excess hair growth elsewhere on the body) is Aldactone (Spironolactone). Taken daily as a tablet, Aldactone is believed to work by lowering the level of androgens in a woman’s body. It has been shown to decrease the amount of body and facial hair in cases of PCOS. Aldactone is not FDA-approved to treat PCOS, so this usage is considered off-label.

Some women with unwanted hair due to PCOS choose electrolysis or laser hair removal. Electrolysis permanently destroys hair follicles, while laser hair removal significantly reduces the amount of hair for an extended period of time.

To treat PCOS-induced alopecia (hair loss from the head) and hirsutism, Finasteride (sold under the brand names Propecia and Proscar) may be prescribed. Finasteride is believed to work by inhibiting the effects of androgenic hormones that contribute to alopecia and hirsutism. Women taking finasteride must use an effective form of contraception, as the drug has been linked to birth defects.

Fertility treatments

For women who have tried weight loss to improve fertility but still haven’t conceived, medical options are available. Clomid (Clomifene) is an oral medication that works by stimulating the production of more hormones that stimulate eggs to mature in the ovaries. Taken at the beginning of the menstrual cycle, Clomid causes ovulation in 80 percent of the women who take it. Of those who ovulate, about half will become pregnant. Ten percent of women who take Clomid have a multiple pregnancy, usually twins – in rare cases, triplets.

Some studies suggest that women with PCOS may have better fertility outcomes with Femara (Letrozole) than Clomid. Femara is also taken orally, but it is taken at the end of the menstrual cycle. It is believed to work for women with PCOS by decreasing estrogen production and stimulating the ovaries to release eggs. Because it was originally approved by the FDA as a breast cancer treatment, its use as a fertility medication is considered off-label.

If Clomid or Femara are not effective, another option is follicle stimulating hormone (FSH) injections. Gonal-F (Follitropin alfa for injection) is human FSH derived from recombinant DNA. Gonal-F is believed to work by stimulating egg growth in the ovaries and ovulation. A woman using FSH has a higher chance of a multiple pregnancy than a woman on Clomid – 30 percent of women on FSH have multiples. Approximately two-thirds will have twins, with the remaining third giving birth to triplets or larger multiple births.

Insulin regulating agents

Metformin is a prescription drug approved by the FDA to help improve blood glucose control in adults with type 2 diabetes. In cases of PCOS, Metformin is sometimes prescribed to combat insulin resistance, reduce levels of androgen in the body, and promote weight loss and regular menstruation cycles. Since Metformin is not FDA-approved to treat PCOS, this usage may be considered off-label. Metformin is considered an adjunct treatment to diet and exercise. Metformin is sold under brand names including Fortamet, Glumetza, Glucophage, and Riomet.

Liraglutide, sold under the brand names Saxenda and Victoza, is an incretin mimetic and a glucagon-like peptide-1 (GLP-1) receptor agonist. Liraglutide mimes the effects of incretin, which signals the pancreas to make more insulin and prevents the liver from releasing glucose. Liraglutide is sometimes prescribed to assist with weight loss in cases of PCOS.

Lifestyle changes for PCOS

Nutrition and dietary supplements

Women with PCOS generally feel their best when they consistently eat a healthy, balanced diet. For those with PCOS, nutrition is one of the most important ways you can control your blood glucose, keep weight and cholesterol in check, and help prevent the development of serious complications in the long term. Eating healthy can also help combat inflammation, which some researchers believe contributes to PCOS symptoms. People with prediabetes can avoid developing diabetes by improving their diets and making other lifestyle changes.

Dietary supplements are very popular among women with PCOS. Some women with PCOS may benefit from supplements containing folic acid, vitamin D, or inositol. A few supplements claim to be specially formulated to improve ovulation, hormonal balance, insulin sensitivity, or chances for pregnancy. However, there is no scientific evidence that most nutritional supplements can reduce the symptoms of PCOS or improve fertility.


Some popular diets and dietary supplements may contain toxic levels of some nutrients or dangerously low levels of others. Always consult your doctor before making significant changes to your diet.

Exercise

For women with PCOS, exercise is one of the most important ways to control blood sugar, keep weight and cholesterol in check, and prevent serious complications such as diabetes and heart disease from developing or growing worse.

It can be difficult for women with PCOS to lose weight. Even if you do not lose any weight, physical activity is still highly beneficial. Regular exercise does not necessarily mean going to the gym or playing sports. Nearly any physical activity that gets you up and moving can provide significant benefits to those with PCOS.

Always check with your doctor before beginning a new exercise regimen. If you have physical challenges, consider consulting with a physical therapist to develop a customized exercise plan. There are exercises and physical activities appropriate for any level of ability.

Surgery for PCOS

Bariatric surgery

Some people with obesity undergo bariatric surgery such as gastric bypass (Roux-en-Y), adjustable gastric band (also known as the lap-band or LABG), or sleeve gastrectomy to lose weight. To be eligible for bariatric surgery, it is usually necessary to have a body mass index (BMI) over 35, or a lower BMI with medical complications such as poorly controlled diabetes. Bariatric surgery has been proven effective for weight loss and can reverse diabetes in many people, enabling them to control blood glucose without insulin or diabetes medication.

Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery. Weight loss surgery can cause reflux, incisional hernias, leaks, and bowel obstructions. After bariatric surgery, you must drastically change when and how much you eat and increase your exercise levels to avoid side effects. Some people experience poor food absorption in the intestines after bariatric surgery that results in nutritional deficiencies and symptoms such as gas, constipation, and diarrhea.

Reproductive surgery

Women who continue to have heavy menstrual bleeding and fertility problems despite medication may consider surgical options.

Two outpatient surgical options are available in women for whom fertility medications have been ineffective: cyst aspiration and dilation and curettage (D&C). Cyst aspiration involves inserting a needle through the vaginal wall and suctioning out the contents of the cysts, which then collapse. In D&C, dilation refers to the opening of the cervix and curettage is the removal of the contents of the uterus, either by scraping the uterine lining with a spoon-shaped instrument or with a suction device. D&C may be recommended for some women with PCOS to help treat heavy bleeding and potentially improve fertility, dependending on the individual’s circumstances. Neither of these procedures is a cure for PCOS, and your PCOS symptoms and fertility may not improve after undergoing cyst aspiration or dilation and curettage (D&C).

Another type of surgery used for PCOS is endometrial ablation, a procedure that destroys the endometrium, or lining of the uterus. Some women will have no further periods after endometrial ablation, while others will have lighter periods. The results of endometrial ablation may be temporary or permanent. Ablation may also be referred to as cauterization. Endometrial ablation is an alternative to hysterectomy in women whose menorrhagia (heavy menstrual bleeding) does not respond to hormonal therapies.

Ovarian drilling is a type of surgery intended to restore regular periods and improve fertility in women with PCOS. Ovarian drilling may be considered in cases where fertility medications have been ineffective. In some women with PCOS, the outer surface of the ovaries is thickened. Ovarian drilling penetrates the thickened layer, which results in decreased testosterone production. The goal of ovarian drilling is to restore regular menstruation and improve chances for pregnancy. Ovarian drilling is not a cure for PCOS. Your PCOS symptoms may not improve after undergoing ovarian drilling.

Oophorectomy is surgery to remove the ovaries. Oophorectomy may be unilateral (one ovary removed) or bilateral (both ovaries removed). Oophorectomy may also be referred to as an ovariectomy. Hysterectomy is surgery to remove the uterus. Hysterectomy may or may not include oophorectomy and excision of the cervix.

Both hysterectomy and oophorectomy cause many permanent changes in the body, including infertility. These surgeries are options of last resort for treatment in women whose polycystic ovary syndrome (PCOS) is severe and who have not responded to medication or less invasive surgeries such as ovarian drilling. Oophorectomy and hysterectomy are not appropriate for women who want to have children in the future. Neither procedure will cure PCOS.

After a hysterectomy, a woman will no longer be able to have children. If the ovaries are also removed, a woman will immediately enter menopause no matter what age she is. Hysterectomy, especially before the age of 35, has been shown to raise long-term risk for developing high blood pressure, obesity, and heart disease.

Resources

External resources

myPCOSteam resources

FAQ

Are there any natural treatments for PCOS?

Some women report that a complementary or alternative treatment reduces their PCOS symptoms or improves fertility. However, most natural treatments have not been studied in rigorous clinical trials to establish their safety and effectiveness. Some complementary therapies may cause dangerous interactions with medications or other health conditions.

If you choose to try one or more natural or alternative therapies, it is important to maintain the traditional drug regimen established by your doctor. These treatments have been proven effective in rigorous, scientific trials. It is also vital to check with your doctor before beginning a complementary treatment so that they can warn you about any potential interactions and correctly interpret any side effects.

Is there a cure for PCOS?

At present, there is no cure for PCOS.

A myPCOSteam Member said:

I been on birth control been 2 years I'm 29 my periods stop when I was 26 years old ...doc prescribed me birth control + metformin to see if I can get… read more

posted 9 days ago

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