While there is no cure for PCOS, it can be managed to prevent problems through lifestyle changes and medications to address the symptoms. Treatment is usually focused to manage your main concerns, whether that’s infertility, obesity, hirsutism, acne, or any of the effects of PCOS.
- Weight loss. As a first step, your doctor may recommend weight loss through healthier eating and an increase in exercise. Even a modest amount of weight loss, such as five percent of your body weight, can improve your condition. Importantly, losing weight helps to lower your blood glucose levels and improve your body’s use of insulin. Losing weight can also help normalize your hormone levels. A ten percent loss in body weight can make your cycle more regular and restore a normal period.
- Improving your diet. Because low-fat, high-carb diets are believed to increase insulin levels, a low-carb diet is something to consider if you have PCOS, and if your doctor recommends it. Completely avoiding, or even severely restricting, carbohydrates is not advised; rather, it’s better to work a moderate amount of complex carbohydrates, which are high in fiber, into your diet. High-fiber foods are digested more slowly, which means they cause your blood sugar levels to rise more slowly than low-fiber foods like simple carbs (such as cake, candy, juice, soda, ice cream, cookies, etc.). Examples are complex carbs include whole-grain cereals and breads, bulgur wheat, brown rice, barley, and beans.
- Increasing your activity levels. Exercising helps lower your blood sugar levels – if you have PCOS, regular exercise can treat or even prevent insulin resistance. It will also help you keep your weight under control. Plus, it’s also heart-healthy, and can mitigate feeling of depression or anxiety.
Medications may be prescribed to…
- Regulate your menstrual cycle: If you’re not trying to get pregnant, your doctor may recommend combination birth control pills. Combination birth control pills contain both estrogen and progestin, which will decrease your androgen production and give your body relief from the effects of continuous estrogen production. This, in turn, lowers your risk of endometrial cancers and can correct abnormal bleeding. As an alternative to a daily pill, your doctor can prescribe a skin patch or vaginal ring containing the combination of estrogen and progestin. While on any of these treatments, you will not be able to conceive.
If for any reason you’re not a good candidate for combination birth control pills, another approach is to take progesterone every day for 10- 14 days, every one or two months. This progesterone therapy can regulate your periods and decrease your risk of endometrial cancer, but it does not improve your androgen levels, and it will not prevent pregnancy.
Your doctor may also prescribe a metformin (such as Glucophage, Fortamet, and others), which is an oral medication for type 2 diabetes that improves insulin resistance and lowers insulin levels. Taking this drug may help with ovulation and lead to regular menstrual cycles. Additionally, if you are pre-diabetic, Metformin slows the progression to type 2 diabetes and aids in weight loss (if you also follow a diet and an exercise program).
Help you ovulate / address infertility: Fertility problems in women with PCOS usually stem from a lack of ovulation, so fertility medications may be prescribed. These include:
- Clomiphene (Clomid, Serophene) — is an oral anti-estrogen medication that you take in the first part of your menstrual cycle. It’s usually the first choice of therapy to stimulate ovulation for most patients.
- Metformin combined with clomiphene — if clomiphene alone fails, this combination may help women with PCOS ovulate on lower doses of medication.
- Gonadotropins — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications that are administered by injection may be used if the above options don’t work.
- Letrozole (Femara) — doctors don’t know exactly how letrozole works to stimulate the ovaries, but, when other medications fail, it may help with ovulation.
- IVF — in vitro fertilization is also an option, as it offers the best chance of becoming pregnant in a given cycle, but it is extremely costly.
All of the above fertility therapies come with the risk of multiple births, and should always be undertaken under the supervision of a reproductive specialist.
Reduce excessive hair growth. Birth control pills may be recommended to decrease androgen production, which can in turn reduce excessive hair growth. Another medication, spironolactone (Aldactone), blocks the effects of androgens on the skin, but because spironolactone can cause birth defects, effective contraception is required when using the drug. It’s of course not recommended if you’re pregnant or planning to become pregnant. The cream Eflornithine (Vaniqa) is another option, as it slows facial hair growth in women.
Surgery and procedures
There are several surgeries and procedures that may be recommended to treat the symptoms of PCOS. All of these procedure option should be thoroughly discussed with your doctor:
“Ovarian drilling” is a surgical treatment used to trigger ovulation in women who have PCOS. IT is employed when a woman is not responding to fertility medicines, after having lost weight to lessen the effects of her PCOS. The goal of the procedure is to restore ovulation cycles, and lower male hormone levels. During the laparoscopic procedure, a doctor inserts either a laser or small electrocautery tool into the abdomen, through a small incision above or below the navel, which carries an electrical current that punctures the ovary and destroys a small portion of it. The surgery does carry the risk of developing scar tissue on the ovary, and it is important to note that the benefits are not permanent – they will generally last a few months to a couple of years. Typically, cycles become irregular again over time. This treatment does not address the issues of excess body hair or thinning hair on the scalp.
Oophorectomy. Done only when other treatment methods have failed, and only if the woman is either past childbearing age, or does not want to have children, an oophorectomy is a surgical procedure where one or both ovaries are removed, which therefore will reduce or eliminate the hormones that your body receives from your ovaries. If both ovaries are removed, this is called a bilateral Oophorectomy. This surgery is generally performed along with other procedures, such as a hysterectomy. Both this procedure and a hysterectomy can manage the hormonal symptoms of PCOS, but would not be recommended for a woman trying to conceive. There are significant risks with this surgery and should only be considered for those with severely symptomatic PCOS, and should be discussed at length with your doctor.
Hysterectomy. Done only when other treatment methods have failed, and only if the woman is either past childbearing age, or does not want to have children, in a hysterectomy, a doctor removes a woman’s uterus and cervix. If only the uterus is removed, it’s called a partial hysterectomy. This will send a woman into instant menopause, and can come with other significant risks. Hysterectomy should only be considered for those with severely symptomatic PCOS, and should be discussed at length with your doctor.
Laser hair removal or electrolysis. Laser hair removal or electrolysis can be recommended to remove unwanted body hair.