From the Research
Menstrual bleeding should be induced in patients with PCOS at least 3-4 times per year using oral progestins, as this reduces the risk of endometrial hyperplasia and cancer associated with chronic anovulation. The recommended regimen is:
- Medroxyprogesterone acetate 10 mg daily for 10-14 days
- Or norethindrone acetate 5 mg daily for 10-14 days This should be repeated every 3-4 months if spontaneous menses do not occur. Additional considerations:
- Start treatment after a negative pregnancy test
- Bleeding typically occurs 3-7 days after completing the progestin course
- Combine with lifestyle modifications and other PCOS treatments as needed Inducing regular withdrawal bleeds helps reduce the risk of endometrial hyperplasia and cancer associated with chronic anovulation in PCOS, as noted in a study published in 2021 1. The progestin opposes estrogen's effects on the endometrium, causing organized shedding, which mimics the natural menstrual cycle and maintains endometrial health in the absence of ovulation.
Other treatment options, such as combination low-dose hormonal contraception, may also be effective in regulating menstrual cycles and reducing the risk of endometrial hyperplasia and cancer, as noted in the same study 1. However, the use of oral progestins is a common and effective approach for inducing menstrual bleeding in patients with PCOS.
It is worth noting that other studies have explored alternative treatments for PCOS, such as acupuncture and herbal supplements 2, SGLT-2 inhibitors 3, and D-chiro-inositol 4, but these treatments are not directly related to the induction of menstrual bleeding. Additionally, the stair-step approach in treatment of anovulatory PCOS patients has been suggested as a way to simplify treatment and reduce the time to ovulation and pregnancy 5, but this approach is not directly related to the induction of menstrual bleeding.
In summary, inducing menstrual bleeding in patients with PCOS using oral progestins is a recommended approach to reduce the risk of endometrial hyperplasia and cancer, and should be repeated every 3-4 months if spontaneous menses do not occur.