From the Guidelines

Lifestyle modification, including diet and exercise, is the first-line treatment for Polycystic Ovary Syndrome (PCOS).

The treatment of PCOS involves a multicomponent lifestyle intervention including diet, exercise, and behavioral strategies, with a focus on weight and healthy lifestyle behaviors 1.
Weight loss is recommended as part of management in individuals with PCOS with higher body mass index (BMI), with weight reduction shown to improve reproductive and metabolic consequences of PCOS 2, 3.
As little as 5% weight loss can improve PCOS features such as menstrual dysfunction and infertility 2.

Metformin was recommended in the 2018 International Evidence-based Guidelines on PCOS as an adjunct to lifestyle management for treatment of weight, hormonal, and metabolic outcomes, with a focus on prevention of weight gain 3.
Anti-obesity pharmacological agents, such as glucagon-like peptide 1 receptor agonists (GLP-1 RAs), orlistat, phentermine, and topiramate, may be considered as adjunctive treatments to promote weight loss in PCOS, although their effects on PCOS-specific outcomes are still being studied 3.

Bariatric surgery is emerging as a potential adjunct therapy for PCOS for patients with excess weight, with improvements in hirsutism, menstrual regularity, and fertility reported in some studies 2. However, the efficacy and safety of bariatric surgery compared to existing strategies for weight reduction in PCOS are not well described, and more research is needed to fully understand its potential benefits and risks.

From the Research

The treatment for PCOS is mainly symptomatic and involves lifestyle interventions and medications. Some of the treatment options include:

Lifestyle interventions such as nutritional plans, physical activity, and stress management to improve reproductive hormones and metabolic health 4
Novel pharmacotherapies targeting hormonal, metabolic, and reproductive abnormalities for individualized treatment 4
Combination therapies and lifestyle interventions like acupuncture, high-intensity interval training, and vitamin D3 supplementation to manage symptoms of PCOS and enhance overall health outcomes 4, 5
Medications such as Metformin, Oral contraceptives, and Antiandrogens to treat symptoms of PCOS 5, 6
Insulin-sensitizing agents like Metformin to improve insulin resistance and hyperandrogenism 6
Hormonal drugs like Fezolinetant to suppress hyperandrogenism 7
Drugs used to treat diabetes, such as Liraglutide, for weight loss 7
Alternative approaches like osteopathic manipulative therapy and acupuncture to decrease sympathetic tone and androgen levels 7

Lifestyle modifications are considered the first-line treatment for PCOS, regardless of fertility status. These modifications include:

Weight reduction and exercise to improve menstrual disturbances, infertility, insulin resistance, and metabolic consequences 6, 8
Dietary changes to improve nutritional intake and reduce symptoms of PCOS 4

Pharmacological treatments for PCOS include:

Clomiphene citrate (CC) as first-line treatment for induction of ovulation in patients with PCOS 6
Gonadotrophin therapy and laparoscopic ovarian diathermy as alternatives for CC-resistant patients 6
Recombinant FSH (rFSH) for induction of ovulation 6
Oral contraceptive (OC) pills for long-term management of patients with no reproductive requirements 8
Ovulation therapy for patients with fertility requirements 8