From the Guidelines
Polycystic Ovary Syndrome (PCOS) is primarily caused by a combination of genetic factors, insulin resistance, and hormonal imbalances, and its treatment should focus on lifestyle modifications and medications to manage symptoms and prevent complications, with the most recent evidence suggesting that bariatric surgery may be a potential adjunct therapy for patients with excess weight. The exact cause of PCOS remains unclear, but insulin resistance plays a central role in about 70% of cases, causing the ovaries to produce excess testosterone and disrupting normal ovulation 1.
Causes of PCOS
- Genetic factors
- Insulin resistance
- Hormonal imbalances
Treatment Options
- Lifestyle modifications, including weight loss of even 5-10% to improve symptoms in overweight women with PCOS 1
- First-line medications, such as combined hormonal contraceptives (like Yasmin or Diane-35) to regulate periods and reduce excess hair growth, and metformin (500-2000mg daily) to improve insulin sensitivity 1
- For women seeking pregnancy, ovulation induction with letrozole (2.5-7.5mg for 5 days) is preferred over clomiphene citrate
- Anti-androgens, such as spironolactone (25-200mg daily), may be added for hirsutism and acne
- Additional treatments, including inositol supplements (2-4g daily), which can improve ovulation and insulin sensitivity, and regular screening for diabetes, high blood pressure, and depression, which commonly accompany PCOS
Recent Evidence on Bariatric Surgery
A recent systematic review and meta-analysis found that bariatric surgery may be a potential adjunct therapy for PCOS patients with excess weight, improving anthropometric, reproductive, hormonal, and metabolic outcomes 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.
Individualized Treatment
Treatment should be individualized based on a woman's specific symptoms, fertility desires, and metabolic profile, with a focus on managing symptoms and preventing complications to improve morbidity, mortality, and quality of life.
From the Research
Causes of PCOS
- The exact cause of Polycystic Ovary Syndrome (PCOS) is not clear, but it may be related to heredity, environment, and internal embryonic factors 2
- PCOS is closely linked to obesity, and increased adiposity enhances the severity and expression of the PCOS phenotype 3
Treatment Options for PCOS
- Lifestyle modification (LSM) is considered the first-line treatment for PCOS, regardless of fertility status, without the addition of metformin 2
- Oral contraceptive (OC) pills should be used as a first-line treatment for long-term management for patients with no reproductive requirements 2
- For patients with fertility requirements, ovulation therapy is an effective treatment, and letrozole is considered the first-line medical ovulation induction therapy 4
- Metformin combined with clomiphene citrate may also be considered for ovulation induction, and is more effective than clomiphene citrate alone 4
- Weight loss is associated with improved metabolic, endocrine, reproductive, cardiovascular, and psychological features in overweight and obese women with PCOS 3
- Lifestyle interventions, including diet and exercise, anti-obesity medications, and bariatric surgery, have been used as therapeutic approaches for short-term management of obesity in PCOS with varying success rates 3
- Metformin is effective in regularizing menstrual cycles, decreasing body mass index, and treating hyperandrogenism in women with PCOS 5
Lifestyle Modifications in PCOS
- Lifestyle modification is widely considered to be the cornerstone of PCOS treatment 6
- However, there is a significant gap in knowledge, and many women with PCOS have reported that they have never been provided information about lifestyle management 6
- Health professionals should develop effective action plans utilizing the available evidence to provide comprehensive guidance on lifestyle modification for women with PCOS 6