From the Guidelines
Polycystic ovary syndrome (PCOS) treatment should start with lifestyle modifications, including regular exercise and a balanced diet, as the first-line management approach, according to the most recent evidence 1.
Key Components of PCOS Treatment
- Lifestyle modifications:
- Regular exercise (at least 150 minutes weekly of moderate activity)
- Balanced diet emphasizing whole foods while limiting refined carbohydrates
- Weight loss: even 5-10% can significantly improve symptoms in overweight individuals
Medications and Other Treatments
- Combined hormonal contraceptives (like Yaz or Ortho Tri-Cyclen) to regulate periods and reduce excess hair growth
- Metformin (500-2000mg daily) to improve insulin sensitivity
- Spironolactone (50-200mg daily) for addressing hirsutism
- Clomiphene citrate or letrozole for those trying to conceive
- Topical treatments like minoxidil for hair loss or prescription retinoids for acne may help
Importance of Regular Monitoring
Regular monitoring is essential, including:
- Blood pressure checks
- Blood sugar testing
- Lipid panels as PCOS increases risks for diabetes, heart disease, and endometrial cancer.
Treatment Goals
Treatment works by addressing the hormonal imbalances (particularly excess androgens) and insulin resistance that underlie PCOS, helping to restore more normal ovarian function and hormone levels, as supported by recent studies 1.
Recent Findings on Bariatric Surgery
Recent research also suggests that bariatric surgery may be a promising intervention for PCOS in individuals with excess weight, improving reproductive, metabolic, and hormonal features, although more high-quality studies are needed to inform clinical recommendations 1.
From the FDA Drug Label
Clomiphene citrate is indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. Impediments to achieving pregnancy must be excluded or adequately treated before beginning clomiphene citrate therapy Those patients most likely to achieve success with clomiphene therapy include patients with polycystic ovary syndrome (see WARNINGS: Ovarian Hyperstimulation Syndrome), amenorrhea-galactorrhea syndrome, psychogenic amenorrhea, post-oral-contraceptive amenorrhea, and certain cases of secondary amenorrhea of undetermined etiology.
To treat PCOS, clomiphene citrate can be used. The treatment should be started on or about the 5th day of the cycle, and the lowest dose consistent with expected clinical results should be used. Patients with polycystic ovary syndrome should be started on the lowest recommended dose and shortest treatment duration for the first course of therapy.
- Key considerations:
- Patients should have adequate levels of endogenous estrogen.
- Primary pituitary or ovarian failure should be ruled out.
- Endometrial biopsy should be performed prior to therapy in patients with endometriosis or endometrial carcinoma.
- Other impediments to pregnancy, such as thyroid disorders or male factor infertility, should be evaluated.
- Uterine fibroids should be cautiously managed due to the potential for further enlargement. 2
From the Research
Treatment Options for PCOS
- The treatment of PCOS is mainly symptom-orientated, with the overall aims of inducing ovulation, reducing androgen levels, reducing body weight, and reducing long-term health risks of diabetes mellitus and cardiovascular disease 3.
- Clomiphene citrate (CC) is recommended as first line treatment for induction of ovulation in patients with PCOS, with alternatives including gonadotrophin therapy and laparoscopic ovarian diathermy for CC-resistant patients 3.
- Metformin and cabergoline are also under investigation as potential treatments for PCOS 3.
- For hirsutism, treatment options include inhibitors of androgen production, peripheral androgen blockers, and insulin-sensitizing agents such as metformin 3.
Lifestyle Modifications and Alternative Therapies
- Lifestyle modification, including weight reduction and exercise, can improve menstrual disturbances, infertility, insulin resistance, and metabolic consequences 3, 4.
- Phytochemicals and plant extracts, such as curcumin, have emerged as promising complementary therapies for PCOS due to their antioxidant, anti-inflammatory, insulin-sensitizing, and ovulation-inducing properties 5.
- Novel therapeutic modalities, including inositols, glucagon-like peptide-1 (GLP-1) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sodium-glucose transport protein 2 (SGLT2) inhibitors, are being investigated for the treatment of PCOS 6.
- Vitamin D, statins, and letrozole are also being explored as emerging therapies for PCOS 6.
Comparison of Treatment Efficiencies
- A retrospective study compared the efficacy of combinations of clomiphene citrate-metformin and letrozole-metformin in obese patients with PCOS who were resistant to clomiphene citrate alone, finding that letrozole-metformin therapy resulted in a higher pregnancy rate after the third cycle of intrauterine insemination (IUI) 7.
- The study also found that letrozole-metformin therapy resulted in a thicker endometrium compared to clomiphene citrate-metformin therapy 7.