What are the treatments for Polycystic Ovary Syndrome (PCOS), including medications and lifestyle modifications?

From the Guidelines

Polycystic ovary syndrome (PCOS) treatment should involve a combination of medications and lifestyle changes, with a focus on lifestyle management as the first-line treatment, as recommended by the international evidence-based guideline for the assessment and management of PCOS 1. The treatment approach should be individualized based on specific symptoms, whether fertility is desired, and other health factors. Medication options may include:

• Combined hormonal contraceptives (like Yaz, Yasmin, or Ortho Tri-Cyclen) to regulate periods and reduce androgen levels
• Metformin (500-2000mg daily) to improve insulin sensitivity
• Anti-androgens such as spironolactone (25-200mg daily) for hirsutism and acne
• Clomiphene citrate or letrozole for women seeking pregnancy Lifestyle modifications are equally important and include:
• Maintaining a healthy weight through regular exercise (150 minutes of moderate activity weekly) and following a low-glycemic diet rich in whole foods while limiting processed carbohydrates
• Weight loss of even 5-10% can significantly improve symptoms and restore ovulation in many women
• Stress management techniques like yoga or meditation can also help, as stress may worsen hormonal imbalances These approaches work by addressing the underlying hormonal imbalances and insulin resistance common in PCOS, helping to reduce symptoms and prevent long-term complications like diabetes and heart disease 1. Key recommendations for healthy lifestyle behaviors in PCOS management include:
• Healthy lifestyle behaviors should be recommended to all individuals with PCOS to achieve and maintain a healthy weight and optimize hormonal outcomes, general health, and quality of life
• Lifestyle intervention, preferably multicomponent, including diet, exercise, and behavioral strategies, should be recommended to all individuals with PCOS and excess weight
• Achievable goals, such as 5-10% weight loss, can yield significant clinical improvements and are considered successful weight reduction within 6 months 1. It is essential to consider psychological factors, such as anxiety and depressive symptoms, body image concerns, and disordered eating, when optimizing engagement and adherence to lifestyle interventions 1. Health professionals should provide respectful and patient-centered interactions around healthy lifestyle, including diet and exercise, and consider individualized healthy lifestyle preferences and cultural, socio-economic, and ethnic differences 1. Ultimately, a comprehensive treatment plan that incorporates both medication and lifestyle changes can help improve symptoms, quality of life, and long-term health outcomes for individuals with PCOS 1.

From the FDA Drug Label

While measured visual acuity usually has not been affected, a study patient taking 200 mg clomiphene citrate daily developed visual blurring on the 7th day of treatment, which progressed to severe diminution of visual acuity by the 10th day. Some patients with polycystic ovary syndrome who are unusually sensitive to gonadotropin may have an exaggerated response to usual doses of clomiphene citrate. Therefore, patients with polycystic ovary syndrome should be started on the lowest recommended dose and shortest treatment duration for the first course of therapy

The treatment for PCOS with clomiphene citrate involves starting with the lowest recommended dose and shortest treatment duration for the first course of therapy.

• Medications: Clomiphene citrate
• Lifestyle: No specific lifestyle modifications are mentioned in the provided drug label. 2

From the Research

Treatments for PCOS

Treatments for Polycystic Ovary Syndrome (PCOS) can be categorized into lifestyle modifications and medications.

• Lifestyle modifications are considered the first-line treatment for PCOS, regardless of fertility status 3.
• Medications such as Metformin, Oral contraceptives, and Antiandrogens are used to treat symptoms of PCOS 4.

Medications for PCOS

Medications used to treat PCOS include:

• Metformin: improves insulin resistance, menstrual regularity, and androgen levels, particularly in those with obesity or insulin resistance 5.
• Oral contraceptives: used as a first-line treatment for long-term management for patients with no reproductive requirements 3.
• Antiandrogens: used to treat symptoms of hyperandrogenism such as hirsutism and acne 4.
• Insulin-sensitising drugs: such as D-chiro-inositol, rosiglitazone, and pioglitazone may be effective in treating PCOS-related anovulation 6.

Lifestyle Modifications for PCOS

Lifestyle modifications for PCOS include:

• Weight loss: can improve insulin sensitivity and menstrual regularity 3.
• Dietary modifications: a healthy diet can help improve insulin sensitivity and reduce symptoms of PCOS 7.
• Exercise: regular exercise can improve insulin sensitivity and reduce symptoms of PCOS 3.

Novel Therapies for PCOS

Novel therapies for PCOS include:

• Inositols: may be effective in improving insulin sensitivity and menstrual regularity 4.
• Glucagon-like peptide-1 (GLP-1) agonists: may be effective in improving insulin sensitivity and reducing symptoms of PCOS 4.
• Dipeptidyl peptidase-4 (DPP-4) inhibitors: may be effective in improving insulin sensitivity and reducing symptoms of PCOS 4.
• Sodium-glucose transport protein 2 (SGLT2) inhibitors: may be effective in improving insulin sensitivity and reducing symptoms of PCOS 4.