From the Guidelines
Polycystic Ovary Syndrome (PCOS) treatment should prioritize lifestyle modifications, including a balanced diet and regular exercise, as the first-line approach to improve symptoms and reduce morbidity, as recommended by the 2020 international evidence-based guideline 1.
Symptoms of PCOS
The symptoms of PCOS include irregular periods, excess androgen levels, and polycystic ovaries. These symptoms can lead to various health complications, such as diabetes, cardiovascular disease, and endometrial cancer, if left untreated or poorly managed.
Treatment Options
Treatment options for PCOS typically involve lifestyle modifications and medications tailored to symptoms.
- Weight loss of 5-10% through a balanced diet and regular exercise can significantly improve symptoms, as supported by the 2020 guideline 1.
- For menstrual irregularity, combined hormonal contraceptives like ethinyl estradiol with drospirenone or norgestimate (20-35mcg daily in cyclic regimen) are first-line treatments.
- Metformin (500mg twice daily, increasing to 1000mg twice daily as tolerated) helps with insulin resistance and may improve ovulation.
- For excess hair growth, spironolactone (50-200mg daily) can be effective.
- Clomiphune citrate (50-150mg on cycle days 3-7) or letrozole (2.5-7.5mg on cycle days 3-7) may be prescribed for ovation induction in women seeking pregnancy.
Recent Developments in Treatment
Recent studies, such as the 2024 systematic review and meta-analysis 1, have explored the potential benefits of anti-obesity pharmacological agents, including glucagon-like peptide 1 receptor agonists (GLP-1 RAs), orlistat, phentermine, and topiramate, in managing PCOS symptoms.
- These agents have been shown to promote weight loss and improve metabolic outcomes in individuals with PCOS.
- Bariatric surgery has also emerged as a potential adjunct therapy for PCOS in patients with excess weight, with a 2024 systematic review and meta-analysis 1 finding improvements in anthropometric, reproductive, hormonal, and metabolic outcomes among women with PCOS who underwent bariatric surgery.
Prioritizing Lifestyle Modifications
Despite these recent developments, lifestyle modifications, including a balanced diet and regular exercise, should remain the primary approach to managing PCOS symptoms, as they can significantly improve symptoms and reduce morbidity, as recommended by the 2020 international evidence-based guideline 1. Regular monitoring is essential to manage the risks associated with PCOS, including diabetes, cardiovascular disease, and endometrial cancer.
From the Research
Symptoms of Polycystic Ovary Syndrome (PCOS)
- Hyperandrogenism
- Anovulation
- Polycystic ovaries
- Hirsutism
- Acne
- Weight gain
- Irregular menstrual cycles
Treatment Options for PCOS
- Lifestyle modifications, including dietary changes and physical activity, as first-line interventions in managing PCOS 2
- Oral contraceptive pills (OCPs) to regulate menstrual cycles and reduce hyperandrogenism 3, 4
- Metformin to improve insulin sensitivity and reduce the risk of cardiovascular disease 3, 5
- Combination therapy of OCPs and metformin to improve clinical and biochemical hyperandrogenism, as well as insulin sensitivity 3, 5
- Dietary modifications, such as a balanced diet with 40% energy from carbohydrates, 30% from fats, and 30% from protein, to reduce severe PCOS symptoms and improve metabolic balance 6
Benefits of Treatment Options
- Lifestyle modifications can improve reproductive, anthropometric, metabolic, and psychological outcomes in women with PCOS 2
- OCPs can improve clinical and biochemical hyperandrogenism, as well as regulate menstrual cycles 3, 4
- Metformin can improve insulin sensitivity and reduce the risk of cardiovascular disease 3, 5
- Combination therapy of OCPs and metformin can improve clinical and biochemical hyperandrogenism, as well as insulin sensitivity, and reduce the risk of cardiovascular disease 3, 5