From the Guidelines
Treatment for Polycystic Ovary Syndrome (PCOS) should prioritize lifestyle modifications, including a 5-10% weight loss through regular exercise and a balanced diet, as this can significantly improve symptoms by reducing insulin resistance, as supported by the most recent evidence 1.
Introduction to PCOS Treatment
PCOS is a complex disorder with implications for reproductive, metabolic, and psychological health, affecting 8%–13% of women of reproductive age according to the Rotterdam criteria 1. The current understanding of PCOS suggests that insulin resistance plays a crucial role in many symptoms, and lifestyle modification or weight loss is postulated to improve many symptoms of PCOS.
Lifestyle Modifications
Weight loss and regular exercise are crucial for managing PCOS symptoms. A systematic review and meta-analysis found that bariatric surgery can improve anthropometric, metabolic, and reproductive outcomes in PCOS patients with excess weight 1. However, first-line treatment involves adopting healthy lifestyle behaviors to achieve and maintain a healthy weight, with diet and exercise being the main pillars of weight reduction in PCOS.
Medications for PCOS
For women with PCOS, hormonal contraceptives like combined oral contraceptives are first-line treatments to regulate menstrual cycles and reduce androgen levels. Metformin may be prescribed for insulin resistance, and anti-androgen medications like spironolactone can help with hirsutism and acne. For women seeking pregnancy, ovulation induction with medications such as clomiphene citrate or letrozole may be recommended, as supported by earlier guidelines 1.
Key Recommendations
- Lifestyle modifications, including weight loss and regular exercise, should be the primary approach for managing PCOS symptoms.
- Hormonal contraceptives and metformin may be used to regulate menstrual cycles, reduce androgen levels, and improve insulin resistance.
- Ovulation induction with medications such as clomiphene citrate or letrozole may be recommended for women seeking pregnancy.
- Regular follow-up with healthcare providers is essential to monitor treatment effectiveness and adjust as needed, based on the most recent and highest quality evidence available 1.
From the FDA Drug Label
Clomiphene citrate is indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. Those patients most likely to achieve success with clomiphene therapy include patients with polycystic ovary syndrome
Treatment for PCOS: Clomiphene citrate is indicated for the treatment of ovulatory dysfunction in women with polycystic ovary syndrome (PCOS) who desire pregnancy.
- The patient should not be pregnant and should have demonstrated ovulatory dysfunction.
- Pelvic examination is necessary prior to the first and each subsequent course of clomiphene citrate treatment.
- Clomiphene citrate should not be used in patients with ovarian enlargement except those with polycystic ovary syndrome 2.
From the Research
Treatment Options for PCOS
- The treatment for PCOS is mainly symptomatic and involves lifestyle interventions and medications such as Metformin, Oral contraceptives, and Antiandrogens 3.
- Pharmacologic therapy should be considered when initial lifestyle changes and dietary modifications do not suffice or fail 4.
- Combined oral contraceptives (COCs) are the first-line medical treatment for the long-term management of PCOS, and they restore menstrual cyclicity, improve hyperandrogenism, and provide additional benefits such as reducing the risk of endometrial cancer 5.
Medications Used in PCOS Treatment
- Metformin has been shown to improve ovarian function and glucose metabolism in women with PCOS, and it may be used in combination with oral contraceptives to improve insulin sensitivity 6, 7.
- Oral contraceptive pills (OC) are usually the first choice of treatment for PCOS, but they do not improve, or may even further induce impairment of insulin sensitivity 6.
- Antiandrogens may be used to treat hyperandrogenism in women with PCOS 3.
Lifestyle Interventions
- Lifestyle modifications, such as diet and exercise, are an essential part of PCOS treatment and may help improve insulin sensitivity and reduce the risk of long-term complications 3, 4.
- Weight loss may also be beneficial for women with PCOS, particularly those who are overweight or obese 7.