Polycystic ovarian syndrome (PCOS) is an extremely common disorder affecting 4% to 12% of women of reproductive age. Despite being heterogeneous in nature, the hallmarks of the disease are hyperandrogenism ( excessive male hormones)and chronic anovulation(irregular periods)
Based on the current understanding of PCOS, it is important that the management is not only toward improving the often troublesome hirsutism and infertility but also toward the long-term risks associated with insulin resistance(IR). Indeed, the management of the PCOS patient often will vary over time as the patient enters different stages of life with different goals.
Generally, there are four issues that arise in the management of PCOS patients: regulation of menses, control of hirsutism, fertility issues, and the management of the insulin resistance syndrome and its associated risks (type 2 diabetes mellitus, dyslipidemia, and cardiovascular disease)
It is the first step of management which includes dietary restriction, exercise, and weight loss. It has been seen that just a 5% loss of total body weight reduces insulin resistance and testosterone levels with marked improvement in body composition and cardiovascular risk markers.
- Combination of birth control pills. Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Instead of pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin.
- Progestin therapy. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesn’t improve androgen levels and won’t prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.
- Clomiphene (Clomid). This oral anti-estrogen medication is taken during the first part of your menstrual cycle for ovulation induction. It is associated with multiple follicle development in 10-15% of women.
- Letrozole (Femara). This drug is used for ovulation induction especially in clomiphene resistance. It is known for monofollicular development and is currently the first-line drug in PCOS related fertility issues.
- Metformin (Glucophage, Fortamet, others). This oral medication used for type 2 diabetes improves insulin resistance and lowers insulin levels. If you don’t become pregnant using clomiphene, this might be recommended. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help with weight loss.
- Gonadotropins. These hormone medications are given by injection and are used as add on to the oral medicines for ovulation induction.
To reduce excessive hair growth
- Birth control pills. These pills decrease androgen production that can cause excessive hair growth.
- Spironolactone (Aldactone). This medication blocks the effects of androgen on the skin. Spironolactone can cause birth defects, so effective contraception is required while taking this medication. It isn’t recommended if you’re pregnant or planning to become pregnant.
- Eflornithine (Vaniqa). This cream can slow facial hair growth in women. Continuous use can cause a reversible reduction in up to 70% of hair growth. The drug takes 8 weeks to show clinical improvement; however, the benefit reverses after withdrawal in 8 weeks’ time. Monotherapy is not considered to be effective and it can be used along with medical treatment in mild cases.
- Electrolysis. A tiny needle is inserted into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments.
Lifestyle and home remedies
- Maintain a healthy weight. Weight loss can reduce insulin and androgen levels and may restore ovulation. Ask your doctor about a weight-control program, and meet regularly with a dietitian for help in reaching weight-loss goals.
- Limit carbohydrates. Low-fat, high-carbohydrate diets might increase insulin levels. Choose complex carbohydrates, which raise your blood sugar levels more slowly.
- Be active. Exercise helps lower blood sugar levels. If you have PCOS, increasing your daily activity and participating in a regular exercise program may treat or even prevent insulin resistance and help you keep your weight under control.