From the Guidelines
Treatment for Polycystic Ovary Syndrome (PCOS) should prioritize lifestyle changes, including a 5-10% weight loss through diet and regular exercise, as the first-line treatment to improve hormone levels and restore ovulation. This approach is supported by the most recent and highest quality study, which emphasizes the importance of lifestyle management in PCOS treatment 1.
Key Components of PCOS Treatment
- Weight loss of 5-10% through diet and regular exercise to improve hormone levels and restore ovulation
- Medications, such as combined hormonal contraceptives, metformin, anti-androgens, and clomiphene citrate or letrozole, tailored to individual symptoms and reproductive goals
- Lifestyle modifications, including a low-glycemic diet for those with insulin resistance
Rationale for Lifestyle Changes
The current understanding of PCOS pathophysiology highlights the crucial role of insulin resistance, which is present regardless of body mass index (BMI) and affects both lean and overweight women with PCOS 1. Hyperinsulinemia resulting from insulin resistance contributes to hyperandrogenism, and obesity exacerbates these symptoms. Therefore, lifestyle changes aimed at weight loss and improving insulin sensitivity are essential for managing PCOS symptoms.
Medication Options
Medications commonly prescribed for PCOS include:
- Combined hormonal contraceptives (like Yasmin or Diane-35) to regulate periods and reduce excess hair growth
- Metformin (500-2000mg daily) to improve insulin sensitivity
- Anti-androgens such as spironolactone (50-200mg daily) for hirsutism and acne
- Clomiphene citrate or letrozole for women seeking pregnancy
Importance of Individualized Treatment
PCOS treatment should be individualized based on symptoms and reproductive goals, as the condition stems from hormonal imbalances involving insulin resistance and elevated androgens 1. Regular monitoring is essential, as PCOS increases risks for diabetes, heart disease, and endometrial cancer over time.
Emerging Therapies
Bariatric surgery is emerging as a potential adjunct therapy for PCOS in patients with excess weight, with studies showing improvements in hirsutism, menstrual regularity, and fertility 1. However, more research is needed to fully understand the efficacy and safety of bariatric surgery compared to existing strategies for weight reduction in PCOS.
From the Research
PCOS Treatment Options
- Lifestyle modifications, including dietary changes and physical activity, are suggested as first-line interventions in managing PCOS 2, 3, 4
- Dietary interventions such as foods with low glycemic index scores, caloric restrictions, and high-fiber diets can improve insulin sensitivity and hormonal balance in women with PCOS 2, 4
- Physical activity, like aerobic and resistance exercise, enhances insulin sensitivity, helps weight loss, and improves metabolic and reproductive outcomes in women with PCOS 2
Medical Treatment Options
- Oral contraceptive (OC) pills can be used as a first-line treatment for long-term management of PCOS in patients with no reproductive requirements 3
- Metformin can be used to improve insulin sensitivity and hormonal balance in women with PCOS, particularly in those with insulin resistance 5, 6
- A combination of metformin and OC pills may be more effective in suppressing hyperandrogenemia and improving insulin sensitivity in women with PCOS 6
Alternative Treatment Options
- Ovulation therapy can be an effective treatment for patients with fertility requirements 3
- Assisted reproductive technology can be considered for patients with refractory ovulation disorders 3
- Herbal extracts and other dietary supplements may have a positive correlation in reducing PCOS symptoms, but more research is needed to confirm their effectiveness 4