From the Guidelines
Treatment for Polycystic Ovary Syndrome (PCOS) should prioritize lifestyle modifications, including a balanced diet, regular exercise, and weight loss if overweight, as the first-line approach, as recommended by the most recent evidence-based guidelines 1.
Lifestyle Modifications
- Lose weight if overweight (5-10% reduction can significantly improve symptoms)
- Regular exercise (150 minutes of moderate-intensity exercise per week)
- Balanced diet rich in whole grains, fruits, vegetables, and lean proteins
Medications
- For irregular periods: Combined oral contraceptive pills (e.g., Yaz, Yasmin) or cyclic progestin (e.g., medroxyprogesterone 10mg daily for 10-14 days each month)
- For excess hair growth: Spironolactone (start at 50mg daily, increase to 100-200mg daily as needed)
- For insulin resistance: Metformin (start at 500mg daily, increase to 1500-2000mg daily in divided doses)
- For ovulation induction: Clomiphene citrate (50-150mg daily for 5 days) or letrozole (2.5-7.5mg daily for 5 days)
Additional Treatments
- Hair removal methods: laser hair removal, electrolysis
- Acne treatments: topical retinoids, benzoyl peroxide, or oral antibiotics The combination of lifestyle changes and medications helps address the hormonal imbalances and metabolic issues associated with PCOS, as supported by recent studies 1. Weight loss and exercise improve insulin sensitivity, which can help regulate menstrual cycles and reduce androgen levels, as noted in the 2024 systematic review and meta-analysis 1. Medications target specific symptoms and help restore hormonal balance. Regular follow-ups with a healthcare provider are essential to monitor progress and adjust treatment as needed, considering the potential benefits and risks of bariatric surgery for patients with PCOS and excess weight 1.
From the FDA Drug Label
Clomiphene citrate is indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. Impediments to achieving pregnancy must be excluded or adequately treated before beginning clomiphene citrate therapy Those patients most likely to achieve success with clomiphene therapy include patients with polycystic ovary syndrome
- Treatment options for PCOS include clomiphene citrate therapy, which is indicated for the treatment of ovulatory dysfunction in women desiring pregnancy, including those with polycystic ovary syndrome (PCOS) 2.
- Clomiphene citrate should only be used in patients with demonstrated ovulatory dysfunction who meet specific conditions, including patients without ovarian cysts, except those with PCOS.
From the Research
Treatment Options for Polycystic Ovary Syndrome (PCOS)
The treatment options for PCOS can be categorized into lifestyle interventions, medications, and surgery.
- Lifestyle interventions include dietary changes, physical activity, and behavioral changes, which can improve reproductive, anthropometric, metabolic, and psychological outcomes in women with PCOS 3.
- Medications such as clomiphene citrate, metformin, and gonadotropins can be used to induce ovulation and improve fertility outcomes 4, 5, 6.
- Surgery, such as laparoscopic ovarian drilling, can be used to induce ovulation and improve fertility outcomes in women with PCOS who do not respond to medications 4, 5, 6.
Lifestyle Interventions
Lifestyle interventions are considered first-line treatments for PCOS.
- Dietary changes, such as a low glycemic index diet, caloric restriction, and high-fiber diet, can improve insulin sensitivity and hormonal balance in women with PCOS 3.
- Physical activity, such as aerobic and resistance exercise, can enhance insulin sensitivity, help with weight loss, and improve metabolic and reproductive outcomes in women with PCOS 3.
- Behavioral changes, such as stress reduction and sleep quality improvement, can also improve outcomes in women with PCOS 7.
Medications
Medications can be used to induce ovulation, reduce androgen levels, and improve fertility outcomes in women with PCOS.
- Clomiphene citrate is a commonly used medication for inducing ovulation in women with PCOS 4, 5, 6.
- Metformin can be used to improve insulin sensitivity and reduce androgen levels in women with PCOS 4, 5, 6.
- Gonadotropins can be used to induce ovulation in women with PCOS who do not respond to clomiphene citrate or metformin 4, 5, 6.
Alternative Therapies
Alternative therapies, such as acupuncture and herbal medicine, can be used to regulate hormone levels and improve outcomes in women with PCOS 7.
- Vagus nerve stimulation has also been used in the treatment of PCOS and regulation of hormone levels 7.
- Supplementation, such as omega-3 fatty acids and antioxidants, can be used to improve the quality of functioning in women with PCOS, but inappropriate doses or too long use may result in a toxic effect opposite to the therapeutic one 7.