|How Is PCOS Treated?
Generally treatment is aimed at relieving PCOS symptoms rather than curing the underlying cause. Treatments can be difficult, expensive and their success is not always assured. The option chosen needs to reflect the woman's end goal, whether that be to regularize periods, to reduce symptoms, lower her diabetes risk factors or to induce fertility. The mainstay of treatment for PCOS is still the oral contraceptive 'pill' for women who are not hoping for pregnancy. For those who are, and hope to treat infertility, options includes losing weight, taking ovulation drugs, undergoing ovarian drilling, In Vitro Fertilization (IVF) and embryo transfer. Other symptoms like excess facial hair have been managed by antiandrogen (male hormone) medications like spironolactone (a diuretic), flutamide and finasteride. Where insulin resistance or diabetes is a concern, metformin may be prescribed.
Regulating Menstruation Cycle
Where a woman has irregular periods, frequently absent (amenorrhea) or heavy periods for example, the ‘pill’ is usually a doctor's first choice. It contains both estrogen and progesterone hormones which help to stabilize the body and aid normal menstrual flow resumption. Although lack of menstruation bleeds may seem convenient, sustained lengths of time without periods increases a woman's risk of developing endometrial hyperplasia which predisposes them to endometrial cancer. Women who have been newly diagnosed with PCOS may want a ultrasound scan to check that their uterine lining has remained thin. A thickened lining is a sign of hyperplasia.
Women with irregular periods but with few other PCOS symptoms (like acne or hirsutism) may prefer cyclic progestin therapy. Provera, one of the most popular brands of progestin medications (also prescribed to postmenopause women taking estrogen supplements) is used to induce periods in women who have irregular menstrual cycles. It is used for 5 to 10 days and brings on a period. You may be required to take a pregnancy test first to ensure an all-clear.
Spironolactone (see diuretics), flutamide and finasteride are a group of medications which cannot be used if attempting pregnancy. They are used to help improve the skin problems that occur with PCOS like excess hair and acne. Women with hirsutism should consider cosmetic approaches for excess hair like tweezing, waxing and bleaching as it normally takes at least 6 months before the drugs kick-in. Antiandrogens are often taken in combination with oral contraceptives.
Insulin Lowering Drugs
As PCOS is often accompanied by insulin resistance some physicians diagnose drugs such as metformin (others include pioglitazone and rosiglitazone) to reduce insulin resistance and risks of developing diabetes. Metformin has not yet been approved by the FDA for the treatment of PCOS, and studies about its effectiveness remain inconclusive. However many women do report the reversal of many PCOS symptoms within 3 months of using insulin reducing drugs. Results shows regularized menses, reduction of facial hair, weight loss, normalization of blood pressure, reduce risk of miscarriage and returning fertility. Side effects include dizziness, sweating, headaches, mood swings, weakness and pale skin.
Useful: Natural Treatment for PCOS
Alternative techniques for reducing the symptoms of PCOS.
Women with PCOS who want to become pregnant should see an endocrinologist or gynecologist. Infertility treatment options include losing weight, taking ovulation stimulating infertility drugs, as well as ovarian drilling and IVF treatment. First read, how does a doctor test for infertility in women?
Studies show that losing weight can not only reverse symptoms of PCOS, but can also correct hyperinsulinemia (pre-diabetes) and even restore fertility. Weight loss improves hormone balance and sometimes returns menses. Weight loss does not however appear to affect hirsutism. See also, can I lose weight with PCOS?
Fertility Promoting Drugs
If a woman is not ovulating regularly, the first line therapy is usually clomiphene citrate (brand names Serophene or Clomid), a fertility drug which stimulates ovulation. Effective in 4 out of 5 anovulatory cases, it also slightly increases the chances of getting pregnant with twins. Sometimes clomiphene is combined with metformin which seems to increase fertility rates further. This treatment should not be used for more than 6 months, but fortunately 70 percent of women achieve pregnancy within 3 months. If pregnancy occurs in women with PCOS it will have to be closely monitored for signs of gestational diabetes.
IVF success rates are slightly lower for women with PCOS, but not significantly. The likelihood of success is increased if at least one ovary responded to ovulation stimulating drugs (like Clomid) and you reduce weight to a healthy level. See also, how long does it take to get pregnant with PCOS?
Ovarian drilling (image) is a surgery option for treating PCOS. Carried out by laparoscopy, it involves making small incisions in the abdomen, inserting a device to make small burns or punctures on the enlarged ovaries. The aim is to reduce the secretion of the hormones androgen and luteinizing hormone (LH). Studies show that up to 80 percent of patients show benefits. Women, who had not previously responded to clomiphene or metformin, usually do when these medications are reintroduced after surgery. Side effects are uncommon but there is a slight risk of ovarian malfunction if complications arise during surgery.
Ovarian Wedge Resection
This is a procedure where part of the ovary is removed and sewn back together. It was widely used to treat PCOS and helped reestablish periods in 75 percent of women, with a pregnancy success rate of 60 percent. However, it also caused pelvic adhesive disease in 30 percent of women and so it is no longer recommended.
New dermatological lasers are now available and used in many beauty salons. They are highly effective in helping to combat the often distressing appearance of hirsutism. Contrary to popular belief, shaving, plucking and tweezing does not cause hair to grow back faster or coarser. Electrolysis however can be painful and may cause scarring, infections and inflammation. Some women prefer to avoid it in favor of medical therapy.
Continual Medical Assessment
Another essential part of PCOS treatment is ongoing health assessment. The idea is to prevent major health issues occurring in the future, specially relating to raised levels of androgen and insulin resistance. In the initial evaluation after PCOS diagnosis the doctor is likely to evaluate metabolic risk factors such as body weight, blood pressure, and lipid levels. Obese women with PCOS will also be screened for glucose intolerance and diabetes with a 2 hour glucose tolerance test. They may also be assessed for cardiovascular disease risk factors including a family history of heart problems, smoking and high blood pressure. Once noted, any potential problems will be marked and monitored.