From the Guidelines
Lifestyle modification, including weight loss through diet and regular exercise, is the first-line treatment for Polycystic Ovary Syndrome (PCOS), as it can significantly improve symptoms, according to the most recent evidence 1.
Treatment Options for PCOS
The treatment of PCOS involves a multifaceted approach, addressing the hormonal, reproductive, and metabolic aspects of the syndrome.
- Weight loss: Even a 5-10% reduction in body weight can improve symptoms, as noted in a systematic review and meta-analysis 1.
- Hormonal contraceptives: Combined oral contraceptives, such as Yasmin, Yaz, or Diane-35, are commonly prescribed to regulate menstrual cycles, reduce androgen levels, and improve acne and hirsutism.
- Ovulation induction medications: Clomiphene citrate (50-150 mg daily for 5 days) or letrozole (2.5-7.5 mg daily for 5 days) may be used for women seeking pregnancy.
- Metformin: Helps improve insulin sensitivity and may aid in weight management and ovulation, as recommended in the 2023 International evidence-based guideline 1.
- Anti-androgens: Spironolactone (50-200 mg daily) can be effective for hirsutism but must be avoided during pregnancy due to potential feminization of male fetuses.
- Inositol supplements: May help improve ovulation and metabolic parameters.
Recent Developments in PCOS Treatment
Recent studies have explored the potential benefits of anti-obesity pharmacological agents in PCOS management, including glucagon-like peptide 1 receptor agonists, orlistat, phentermine, and topiramate, as well as centrally acting anti-obesity agents like naltrexone/bupropion and locarserin 1. However, the most recent and highest quality study, a systematic review and meta-analysis published in 2024, highlights the importance of lifestyle modification as the first-line treatment for PCOS, with pharmacotherapy serving as an adjunct to optimize weight loss success and efficacy in obesity 1.
Monitoring and Screening
Regular monitoring by healthcare providers is essential to adjust treatments as needed and screen for associated conditions like diabetes and cardiovascular disease. The 2023 International evidence-based guideline recommends evaluating for polycystic ovary syndrome in female adolescents with type 2 diabetes, including laboratory studies when indicated, and notes that oral contraceptive pills for treatment of polycystic ovary syndrome are not contraindicated for female individuals with type 2 diabetes 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 Options for PCOS:
- Clomiphene citrate is a treatment option for ovulatory dysfunction in women with PCOS who desire pregnancy 2 Key Considerations:
- Patients should have adequate levels of endogenous estrogen and normal liver function
- Clomiphene citrate should not be used in patients with ovarian enlargement except those with polycystic ovary syndrome
- Pelvic examination is necessary prior to the first and each subsequent course of clomiphene citrate treatment
From the Research
Treatment Options for PCOS
The treatment options for Polycystic Ovary Syndrome (PCOS) vary depending on the symptoms and can include:
- Weight loss, which improves the endocrine profile and increases the likelihood of ovulation and pregnancy 3
- Medications such as clomiphene citrate, tamoxifen, aromatase inhibitors, metformin, glucocorticoids, or gonadotropins to treat anovulation 3
- Surgical treatment, such as laparoscopic ovarian drilling, to induce ovulation 3
- In vitro fertilization as a last option to achieve pregnancy when others fail 3
- Lifestyle modifications, including dietary changes and physical activity, to improve reproductive, anthropometric, metabolic, and psychological outcomes 4
Lifestyle Interventions
Lifestyle interventions, such as:
- Dietary changes, including foods with low glycemic index scores, caloric restrictions, high-fiber, omega three fatty acid-rich diets, ketogenic diets, Mediterranean diets, antioxidant-rich food, and anti-inflammatory diets 4
- Physical activity, including aerobic and resistance exercise, to enhance insulin sensitivity, help with weight loss, and improve metabolic and reproductive outcomes 4
- Behavioral and education modules to improve awareness, adherence, and the effectiveness of conventional treatment and to manage mental health issues related to PCOS 4
Fertility Treatment
For fertility treatment, options include:
- Clomiphene citrate, which has been traditionally used as first-line treatment for ovulation induction in PCOS 5, 6
- Letrozole, which has been recommended as first-line therapy for ovulation induction in anovulatory PCOS women due to better pregnancy and live birth rates 5, 6
- Combination treatment of clomiphene citrate and letrozole, which may potentially improve fertility outcomes in PCOS subfertility 5
Metabolic Characteristics
PCOS is associated with metabolic characteristics, including:
- Insulin resistance and increased risk of dyslipidemia, diabetes, and cardiovascular disease 7
- Abdominal obesity, which stimulates ovarian and adrenal androgen production and decreases SHBG levels 7
- Increased inflammation, which can be measured as decreased adiponectin levels and increased levels of adipokines, chemokines, and interleukins 7