From the Guidelines
Polycystic ovary syndrome (PCOS) treatment should prioritize lifestyle modifications, including weight loss through regular exercise and a balanced diet, as the first-line approach to manage symptoms and improve insulin sensitivity, as recommended by the most recent evidence-based guidelines 1.
Key Treatment Components
- Lifestyle modifications: weight loss, regular exercise (at least 150 minutes weekly), and a balanced diet to improve insulin sensitivity and reduce symptoms
- Medications:
- Combined hormonal contraceptives (e.g., Yasmin or Diane-35) to regulate periods and reduce excess hair growth
- Metformin (500-2000mg daily) to improve insulin resistance
- Anti-androgens like spironolactone (25-200mg daily) for hirsutism and acne
- Clomiphene citrate or letrozole for women seeking pregnancy
- Consideration of bariatric surgery as an adjunct therapy for PCOS patients with excess weight, as it has been shown to improve anthropometric, reproductive, hormonal, and metabolic outcomes 1
Individualized Treatment Approach
Treatment should be tailored to specific symptoms, whether the woman desires pregnancy, and the presence of other health conditions. Regular follow-up with healthcare providers is essential to monitor treatment effectiveness and adjust as needed.
Importance of Recent Evidence
The most recent studies, such as the 2024 systematic review and meta-analysis on the impact of bariatric surgery on PCOS outcomes 1, provide valuable insights into the effectiveness of various treatment approaches, emphasizing the need for evidence-based decision-making in PCOS management.
Lifestyle Interventions
Lifestyle interventions, including diet, exercise, and behavioral strategies, are central to PCOS management, with a focus on weight and healthy lifestyle behaviors, as highlighted in the international evidence-based guideline for the assessment and management of PCOS 1.
Medication and Surgery
Medications and surgical options, such as bariatric surgery, should be considered based on individual patient needs and in conjunction with lifestyle modifications, to optimize treatment outcomes and minimize risks.
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 modifications, pharmacological therapies, and assisted reproduction technologies.
- Lifestyle modifications:
- Dietary changes, such as 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, can improve insulin sensitivity and hormonal balance in women with PCOS 3.
- Physical activity, like aerobic and resistance exercise, enhances insulin sensitivity, helps weight loss, and improves metabolic and reproductive outcomes in women with PCOS 3, 4.
- Behavioral and education modules can also be used to improve awareness, adherence, and the effectiveness of conventional treatment and to manage mental health issues related to PCOS 3.
Pharmacological Therapies
- Metformin can be used as a second-line pharmacological therapy in combination with clomiphene citrate for ovulation induction in anovulatory women with PCOS 5, 6.
- Clomiphene citrate is a widely used treatment for PCOS, and combining it with metformin is more effective than either alone 6.
- Letrozole can be used as a first-line pharmacological treatment for ovulation induction in anovulatory women with PCOS, and it has better pregnancy and live birth rates compared to clomiphene citrate 7.
- Combination treatment of clomiphene citrate with letrozole may potentially improve fertility outcomes in PCOS subfertility in terms of the likelihood of ovulation and higher post-ovulatory progesterone levels 7.
Assisted Reproduction Technologies
- In vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) can be offered as a third-line therapy in women with PCOS in the absence of an absolute indication for IVF/ICSI 5.
- Gonadotropin-releasing hormone (GnRH) antagonist protocol is preferred for women with PCOS undergoing IVF/ICSI treatment, and an elective frozen embryo transfer strategy could be considered 5.
- In-vitro maturation (IVM) of oocytes could be offered to women with PCOS in assisted conception units with sufficient expertise 5.