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PCOS treatment primarily focuses on lifestyle changes and medication. While surgery, like ovarian cyst cauterization or wedge resection, was once common, it's less frequent today due to the effectiveness of ovulation-stimulating drugs. Surgery is usually recommended only if a cyst is suspected to be cancerous.
As the underlying cause of PCOS remains unclear, treatment mainly targets its symptoms. For many women, excessive facial and body hair (hirsutism), acne, and oily skin are the most troublesome symptoms, all linked to the overproduction of androgens. Spironolactone (Aldactone or Spironol), a diuretic with minimal side effects, can help alleviate these issues by blocking testosterone's effects at the hair follicle level. If you're trying to conceive, however, anti-androgen medications like spironolactone are not recommended as they can harm a male fetus.
It may take up to nine months to notice improvements in hair growth, with the full effects typically visible after a year. While hair will still grow, it will tend to be slower, lighter, and finer. Electrolysis and laser treatments are the only effective methods for long-term or permanent hair removal.
The FDA recently approved Vaniqa (eflornithine hydrochloride), a topical cream designed to reduce unwanted facial hair. Applied twice daily like a moisturizer, it works by inhibiting an enzyme responsible for hair growth. For continuous results, it must be used consistently, as hair growth will resume once discontinued.
For treating acne, a combination of spironolactone and birth control pills, which help reduce ovarian androgen production, is often highly effective. Other medications, like oral or topical antibiotics, Accutane (which can cause birth defects), or peeling agents like Retin-A, may also be prescribed for acne management.
If excess androgens are primarily coming from the adrenal glands (indicated by high DHEA-S levels), steroids such as dexamethasone or prednisone might be recommended. These steroids are typically used in very low doses, minimizing the risk of the usual side effects associated with steroid use.
Polycystic Ovarian Syndrome (PCOS) Treatment (<i>cont'd</i>)
There is ongoing speculation about the use of finasteride (Propecia), a drug designed to treat enlarged prostate and baldness in men, for managing hyperandrogenism symptoms like hirsutism in women. Finasteride works by inhibiting the enzyme 5-alpha reductase, which converts testosterone into its more potent form, dihydrotestosterone. However, this medication is not safe during pregnancy and can cause birth defects, so women who are pregnant should avoid handling crushed tablets.
For women experiencing irregular or infrequent periods, birth control pills (containing estrogen and progestin) are a common solution to regulate menstruation. Regular periods, occurring at least four times a year, are essential for protecting against uterine cancer. If daily medication isn't desirable, progestogen may be prescribed periodically to induce menstruation in women with amenorrhea. However, oral contraceptives can come with side effects like migraines, blood clots (especially in smokers), high blood pressure, and gallbladder disease.
Infertility is a common result of PCOS. For women with the condition who are struggling to conceive, the primary treatment option is typically an ovulation-inducing medication called clomiphene citrate, commonly sold under the brand name Clomid.
Until recently, if clomiphene failed to result in pregnancy, the next step was often a combination of injectable chorionic gonadotropin and gonadotropin. However, this treatment is not only costly and inconvenient but also carries risks such as ovarian hyperstimulation syndrome, which is more common in women with PCOS, as well as enlarged ovaries, fluid buildup in the abdomen, reduced blood volume, and even stroke.
A new alternative for treating PCOS symptoms, especially infertility, involves insulin-sensitizing drugs. These medications, originally designed for Type II diabetes, are increasingly prescribed when clomiphene does not result in pregnancy. They include metformin (sold under the brand name Glucophage), pioglitazone (Actos), and rosiglitazone (Avandia). Clinical trials are currently underway and could eventually lead to FDA approval for their use specifically for PCOS.
Polycystic Ovarian Syndrome (PCOS) Treatment (<i>cont'd</i>)
Some doctors prescribe metformin to women with PCOS, not just those dealing with infertility. Many women who take metformin see a return of regular menstrual cycles. However, only one long-term study has been conducted, and it found that male hormone symptoms did not improve. Women with severe androgen issues may need additional anti-androgens. The use of insulin-sensitizing drugs in women not trying to conceive remains a topic of debate among healthcare professionals.
If you're prescribed an insulin sensitizer, make sure to inform your healthcare provider about all other medications you're taking, including over-the-counter drugs, to avoid any potential drug interactions.
For the 7 to 8 percent of women with PCOS who also have type II diabetes, metformin is an effective treatment option.
For women who don't respond to clomiphene or metformin therapy or who are unable or unwilling to use gonadotropins (or can't afford them), laparoscopic ovarian drilling is another option. This procedure involves using a laser or electrosurgical needle to puncture each ovary several times, which leads to a significant drop in male hormone levels within days. Studies show that up to 80 percent of women with PCOS benefit from this treatment. Many who didn't ovulate with clomiphene or metformin will respond when these medications are tried again after ovarian drilling. Success rates are higher for those at or near their ideal body weight, and smokers tend to have poorer results. While side effects are rare, the procedure may cause adhesions or general surgical complications.
While PCOS is linked to insulin resistance and diabetes, not all women with PCOS are insulin-resistant or diabetic. If you have PCOS, it's recommended to get screened for diabetes with both a fasting glucose test and a glucose challenge test with insulin levels. The fasting glucose test is the standard, but it misses about half of women who have elevated insulin levels but no elevated blood glucose, which could indicate insulin resistance or diabetes.
Long-term treatment for PCOS focuses on managing risk factors for conditions often associated with the syndrome, such as diabetes, weight gain, and heart disease. A balanced, low-sugar diet along with regular exercise can help stabilize your weight and reduce these risks.
Some PCOS-related issues can be managed without medication. Unwanted hair can be removed through shaving, tweezing, waxing, or depilatory creams. Additionally, professional treatments like electrolysis or laser hair removal can be used. However, because lasers target skin pigment, they should be used with caution by individuals with darker skin tones.
If you're overweight and dealing with PCOS, losing weight is recommended. Shedding pounds can reduce levels of androgens and insulin, helping to lower your risk of insulin resistance and diabetes. Research has shown that even a modest weight loss of seven percent can significantly lower androgen levels and improve menstrual regularity in obese women.
Copyright 2003
National Women's Health Resource Center Inc. (NWHRC).
