From the Guidelines
Polycystic ovary syndrome (PCOS) management should prioritize lifestyle modifications, including weight loss through regular exercise and a balanced diet, as this can significantly improve symptoms and restore ovulation in many cases, as supported by the most recent evidence 1.
Symptoms of PCOS
The symptoms of PCOS include:
- Irregular periods
- Excess androgen levels
- Polycystic ovaries
- Hirsutism (excess hair growth)
- Acne
- Male pattern baldness
Treatment Options for PCOS
Treatment options for PCOS typically involve:
- Lifestyle modifications, such as weight loss through regular exercise and a balanced diet
- Medications, including:
- Combined hormonal contraceptives to regulate periods and reduce excess hair growth
- Metformin (500-2000mg daily) to improve insulin sensitivity
- Anti-androgens, such as spironolactone (25-200mg daily), to address hirsutism
- Clomiphene citrate or letrozole for fertility treatment
- Bariatric surgery, which has been shown to improve anthropometric, reproductive, hormonal, and metabolic outcomes in women with PCOS, as demonstrated in a systematic review and meta-analysis 1
Importance of Regular Monitoring
Regular monitoring with a healthcare provider is essential for adjusting treatment as needed, as PCOS requires long-term management and increases the risk of type 2 diabetes, cardiovascular disease, and endometrial cancer. The underlying cause of PCOS involves insulin resistance leading to increased androgen production by the ovaries, which disrupts normal follicular development and causes the characteristic symptoms.
Additional Recommendations
For immediate symptom management, it is recommended to:
- Establish a consistent sleep schedule
- Manage stress
- Maintain a low-glycemic diet to help stabilize blood sugar levels As supported by recent guidelines 1, metformin, in addition to lifestyle modification, is likely to improve menstrual cyclicity and hyperandrogenism in female individuals with type 2 diabetes.
From the Research
Symptoms of Polycystic Ovary Syndrome (PCOS)
- Hyperandrogenism
- Anovulation
- Polycystic ovaries 2
- Insulin resistance, which drives hyperandrogenism and anovulatory infertility 3
- Hirsutism and acne 4
Treatment Options for PCOS
- Lifestyle modifications, including dietary changes and physical activity, as first-line interventions 2, 5
- Metformin to ameliorate insulin resistance, resolve hormonal and metabolic disturbances, and increase ovulation, pregnancy, and live birth rates 3
- Combination of metformin with clomifene citrate for women with clomifene-resistant PCOS 3
- Letrozole as a first-line agent for ovation induction in women with PCOS and no other infertility risk factors 3, 4
- Oral contraceates containing oestrogen and progesterone to regularize menstration 4
- Antiandrogens like spironolactone and d-chiro-inositol to improve hirsutism and acne 4, 6
- Aromatase inhibitors, low-dose gondotropins, and ovarian drilling procedure for clomiphene-resistant cases 4
- Combination of low-dose spironolactone and metformin for improved efficacy in managing PCOS 6