From the Guidelines
Lifestyle modifications, including regular exercise and a balanced diet, are the first-line approach to managing high Amylase (Amy) levels in Polycystic Ovary Syndrome (PCOS), as they can help improve insulin sensitivity and reduce symptoms. To address high Amy levels in PCOS, it is essential to focus on lifestyle changes that promote weight loss and improve metabolic health.
Key Recommendations
- Regular exercise, such as at least 150 minutes of moderate activity weekly, can help improve insulin sensitivity and reduce symptoms of PCOS, as suggested by the international evidence-based guideline for the assessment and management of PCOS 1.
- A balanced diet focusing on whole foods while limiting processed carbohydrates can also help improve hormonal balance and reduce insulin resistance.
- Weight loss of even 5-10% can significantly improve hormonal balance and reduce symptoms of PCOS.
Medications and Supplements
- Medications like metformin (500-2000mg daily) can improve insulin sensitivity, while combined hormonal contraceptives help regulate menstrual cycles and reduce androgen levels, as noted in the ACOG guidelines for the diagnosis and management of PCOS 1.
- Inositol supplements (2-4g daily) may also help improve ovarian function and insulin sensitivity, although more research is needed to confirm their effectiveness.
Importance of Monitoring
- Regular monitoring with a healthcare provider is essential to adjust treatment as needed and ensure that the chosen interventions are effective in managing high Amy levels and improving overall health outcomes in women with PCOS.
Underlying Cause
- Insulin resistance is often the underlying cause of hormonal imbalances in PCOS, and addressing this through lifestyle modifications and medications can help improve symptoms and quality of life, as highlighted in the evidence-based guideline for PCOS management 1.
From the Research
Treatment Options for High Amy PCOS
- The treatment of polycystic ovary syndrome (PCOS) often involves a combination of therapies, including combined oral contraceptives (COC), antiandrogens, and insulin sensitizers 2.
- Studies have shown that COC and antiandrogens are more effective than metformin for hyperandrogenic symptoms and endometrial protection 2, 3.
- The combination of COC and/or antiandrogens with metformin has been shown to have a positive effect on BMI and glucose tolerance 2, 4, 5.
Comparison of Treatment Options
- A study comparing COC plus spironolactone with metformin found that COC plus spironolactone was more effective for symptoms of PCOS, with similar safety and neutral effects on cardiometabolic risk factors 3.
- Another study found that the combination of low-dose spironolactone and metformin was superior to either drug alone in terms of clinical benefits and compliance in women with PCOS 5.
- A pilot study found that the combination of low-dose spironolactone and metformin decreased insulin resistance to a greater extent than monotherapy 4.
Clinical Practice and Treatment Guidelines
- A study comparing clinical practice in the United States to treatment guidelines found that there is a gap between guidelines and practice, with some women receiving metformin solely for PCOS despite guidelines recommending its use only with impaired glucose tolerance 6.
- The study also found that concomitant use of drospirenone and spironolactone was common, despite guidelines suggesting that addition of antiandrogens to COCs has little treatment benefit 6.