From the Guidelines
Treatment for Polycystic Ovary Syndrome (PCOS) should prioritize lifestyle changes, including a weight loss of 5-10% through diet and regular exercise, as the first-line treatment to improve symptoms and restore ovulation. This approach is supported by the most recent and highest quality study, which emphasizes the importance of lifestyle management in PCOS treatment 1.
Key Components of PCOS Treatment
- Weight loss through diet and exercise (at least 150 minutes weekly) to improve symptoms and restore ovulation
- Medications, such as:
- Combined hormonal contraceptives (e.g., Yaz or Ortho Tri-Cyclen) to regulate periods and reduce excess hair growth
- Metformin (500-2000mg daily) to improve insulin sensitivity
- Anti-androgens (e.g., spironolactone, 50-200mg daily) for hirsutism and acne
- Clomiphene citrate or letrozole for women seeking pregnancy
- Cyclic progesterone (e.g., medroxyprogesterone acetate, 10mg for 10-14 days monthly) for those with irregular periods not seeking pregnancy to protect the uterine lining
Rationale for Treatment Approach
The treatment approach is based on the understanding that PCOS is a complex disorder with implications for reproductive, metabolic, and psychological health, and that insulin resistance plays a key role in many symptoms of PCOS 1. The use of anti-obesity pharmacological agents, such as glucagon-like peptide 1 receptor agonists, may also be considered as an adjunct to lifestyle management for weight loss and improvement of metabolic outcomes in PCOS 1.
Individualized Treatment
Treatment should be individualized based on symptoms, fertility desires, and metabolic risks, with regular monitoring for diabetes, high blood pressure, and other complications. Bariatric surgery may be considered for patients with clinically severe obesity and PCOS, as it has been shown to improve anthropometric, reproductive, hormonal, and metabolic outcomes 1.
From the Research
PCOS Treatment Options
- Lifestyle modifications, including dietary changes and physical activity, are suggested as first-line interventions in managing PCOS 2, 3
- Dietary interventions such as foods with low glycemic index scores, caloric restrictions, and high-fiber diets can improve insulin sensitivity and hormonal balance in women with PCOS 2
- Physical activity, like aerobic and resistance exercise, enhances insulin sensitivity, helps weight loss, and improves metabolic and reproductive outcomes in women with PCOS 2
Medical Treatment
- Metformin can be used to regularize menstrual cycles, decrease body mass index, and treat hyperandrogenism in women with PCOS 4
- Oral contraceptives, such as ethinyl estradiol-drospirenone, can improve clinical and biochemical hyperandrogenism in lean PCOS patients 5
- Combining metformin with oral contraceptives may improve insulin sensitivity in women with PCOS 5
Weight Management
- Weight loss is associated with improved metabolic, endocrine, reproductive, cardiovascular, and psychological features in overweight and obese women with PCOS 6
- Lifestyle interventions, including diet and exercise, anti-obesity medications, and bariatric surgery, have been used as therapeutic approaches for short-term management of obesity in PCOS 6
- Large and sufficiently powered studies are required to determine long-term effects of weight management strategies and potential benefits beyond weight loss in PCOS 6