What is the treatment for Polycystic Ovary Disorder (PCOD)?

Treatment of Polycystic Ovary Syndrome (PCOD/PCOS)

Lifestyle modification is the first-line treatment for PCOS, focusing on healthy eating, regular physical activity, and behavioral strategies to achieve weight loss and improve metabolic and reproductive outcomes. 1

Lifestyle Interventions

Weight Management

• Even modest weight loss of 5-10% can significantly improve metabolic and reproductive abnormalities in women with PCOS, including improved ovulation and pregnancy rates 1
• Weight management should be recommended for all women with PCOS who have excess weight 1
• A caloric deficit of 30% or 500-750 kcal/day (1,200-1,500 kcal/day) is recommended for weight loss, considering individual energy requirements 1

Dietary Recommendations

• No specific diet type has proven superior for PCOS; various balanced dietary approaches can be effective 1
• General healthy eating principles should be followed, with dietary changes tailored to individual food preferences 1
• Low glycemic index foods, Mediterranean diets, and anti-inflammatory diets may help improve insulin sensitivity 2

Physical Activity Recommendations

• For adults (18-64 years): At least 150 minutes/week of moderate intensity or 75 minutes/week of vigorous intensity physical activity 1
• Include muscle-strengthening activities on 2 non-consecutive days/week 1
• For adolescents: At least 60 minutes of moderate to vigorous physical activity daily 1
• Both aerobic and resistance exercise can improve insulin sensitivity, promote weight loss, and enhance reproductive outcomes 3, 4

Behavioral Strategies

• Implement behavioral techniques including goal-setting, self-monitoring, stimulus control, problem-solving, and relapse prevention 1
• Use SMART (specific, measurable, achievable, realistic, timely) goal setting to achieve realistic lifestyle goals 1
• Consider psychological factors such as anxiety, depression, body image concerns, and disordered eating that may affect adherence 1

Medical Management

For Menstrual Irregularity and Anovulation

• Combined oral contraceptives can regulate menstrual cycles and reduce hyperandrogenism 1
• For women seeking pregnancy, treatment begins with weight control and exercise, followed by medication if needed 1
• Clomiphene citrate is recommended as first-line ovulation induction therapy (approximately 80% of women ovulate and 50% conceive) 1, 5
• If clomiphene fails, low-dose gonadotropin therapy is recommended over high-dose therapy to reduce risk of ovarian hyperstimulation 1
• Metformin improves ovulation frequency and insulin sensitivity but its effects on early pregnancy are not fully established 1

For Hirsutism and Androgen-Related Symptoms

• Combined medical interventions are most effective for hirsutism management 1
• Options include:
  • Oral contraceptives for ovarian suppression 1
  • Antiandrogen drugs (spironolactone, flutamide, finasteride) 1
  • Topical eflornithine hydrochloride cream (FDA-approved for hirsutism) 1
  • Insulin-sensitizing agents 1
• Mechanical hair removal (shaving, waxing), electrolysis, and laser treatments may be used alongside medical management 1

For Metabolic Complications

• Interventions that improve insulin sensitivity (weight loss, metformin, thiazolidinediones) may positively impact risk factors for diabetes and cardiovascular disease 1
• Regular screening for metabolic disorders is important due to increased risk of type 2 diabetes and cardiovascular disease 2, 4

Special Considerations

• Ethnic-specific BMI and waist circumference categories should be considered when optimizing lifestyle and weight management 1
• Ethnic groups with PCOS who are at high cardiometabolic risk require greater consideration for lifestyle interventions 1
• For morbid obesity unresponsive to lifestyle-medical treatment, bariatric surgery may be considered when BMI ≥40 kg/m² 6
• Multidisciplinary care involving dietitians, psychologists, gynecologists, and endocrinologists may enhance outcomes 1