There are many nonpharmacologic treatment options, including electrolysis, waxing, bleaching, plucking, depilatory creams a form of hair removal that dissolves the hair , thermolysis use of heat , and laser therapy. Several medications have been studied for the treatment of hirsutism in women with PCOS. First-line agents include spironolactone Aldactone 22 , 23 , 28 — 30 and metformin, 13 , 16 , 20 , 22 , 31 — 33 as well as eflornithine Vaniqa for facial hirsutism.
Combination oral contraceptives, especially those with progestins of norgestimate, desogestrel, or drospirenone because of their low androgenic effects , are among the most commonly used medications for hirsutism in women with PCOS. Because of its antiandrogenic effects, spironolactone is effective, but not FDA-approved, for this indication.
Insulin-sensitizing agents, including metformin, 31 acarbose Precose , 24 and rosiglitazone Avandia , 20 may be used to treat hirsutism in women with PCOS. Spironolactone 22 and rosiglitazone 32 have been shown to be more effective than metformin, based on Ferriman-Gallwey hirsutism scores. A Cochrane review suggested that metformin is as effective as oral contraceptives for treating hirsutism in women with PCOS, 33 but in contrast, a recent systematic review suggested that metformin is not effective.
Sibutramine Meridia , which is approved for obesity management, can also improve hirsutism. Hormonal aberrations in women with PCOS e. Clomiphene is an ovulation induction agent that has been used and studied in patients with and without PCOS. It is embryotoxic and fetotoxic in animal studies, and there are no studies in pregnant women. Insulin-sensitizing agents, including metformin, 11 , 32 rosiglitazone, 19 , 20 , 32 and pioglitazone Actos , 17 have been effective in improving fertility and ovulation in women with PCOS.
There are contradictions in the literature regarding whether metformin, clomiphene, or a combination of the two agents is superior for improving pregnancy rates in women with PCOS.
A Cochrane review suggested that metformin should be a first-line treatment for infertility in women with PCOS. The prevalence of insulin resistance in women with PCOS, as measured by impaired glucose tolerance, is substantially higher than expected compared with age-and weight-matched populations of women without PCOS.
Women with PCOS who are not obese may benefit more from metformin than women who are obese. Other insulin-sensitizing agents are also effective for improving insulin resistance in women with PCOS, including rosiglitazone 19 — 21 and pioglitazone.
If a woman's weight is excessive, the physician should be aggressive in championing a weight-loss program. Medications effective for weight loss in addition to lifestyle modifications that have been specifically studied in women with PCOS include metformin, acarbose, sibutramine, and orlistat Xenical.
Metformin is probably the first-line medication for obesity or weight reduction in patients with PCOS. Metformin results in a decrease in body mass index BMI of 1 to 2 kg per m 2 or weight loss up to 6 lb, 10 oz to 8 lb, 13 oz 3 to 4 kg 10 , 46 , 49 ; acarbose results in an approximate 3 kg per m 2 decrease in BMI 24 ; sibutramine results in a decrease in BMI of 5.
Anecdotally, oral contraceptives are among the most common agents used to treat menstrual irregularities in women with PCOS. However, there are few studies examining their effect on menstrual cycles in women with PCOS. Cyproterone acetate plus ethinyl estradiol has been extensively studied, but it is not available in the United States. Studies suggest that the following agents may improve menstrual irregularities e.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Reprints are not available from the author. Metformin and glitazones: do they really help PCOS patients? J Fam Pract. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. Zawadski JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. Polycystic Ovary Syndrome current issues in endocrinology and metabolism.
Boston, Mass: : Blackwell Scientific Publications Revised consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome Fertil Steril. Clinical Management Guidelines for Obstetrician—Gynecologists. Number 41, December polycystic ovary syndrome.
Obstet Gynecol. Comparison of letrozole and clomiphene citrate in women with polycystic ovaries undergoing ovarian stimulation. J Int Med Res. Time of initiation of clomiphene citrate and pregnancy rate in polycystic ovarian syndrome. Int J Gynaecol Obstet. The active ingredient in turmeric is called curcumin. Turmeric may be promising for decreasing insulin resistance and as an anti-inflammatory agent. Zinc is a trace element that can boost fertility and your immune system.
Excessive or unwanted hair growth and alopecia may be improved with zinc supplements. Evening primrose oil has been used to help with period pain and irregular menstruation. It may also improve cholesterol levels and oxidative stress, both of which are linked to PCOS. Buy evening primrose oil now. Vitamin D and calcium may improve irregular periods and help you ovulate. Cod liver oil contains vitamins D and A, as well as high amounts of omega-3 fatty acids. These acids can help improve menstrual regularity and help get rid of fat around your waist.
Buy cod liver oil now. Berberine is an herb used in Chinese medicine to help with insulin resistance. Adaptogen herbs claim to aid your body in balancing these hormones.
Some adaptogen herbs also claim to ease other symptoms of PCOS, like irregular periods. The root of the maca plant is a traditional herb used to boost fertility and libido. Maca root may help balance hormones and lower cortisol levels. It may also help treat depression, which can be a symptom of PCOS. Buy ashwagandha now. Holy basil , also called tulsi, addresses chemical and metabolic stress.
The root of the licorice plant contains a compound called glycyrrhizin, which has several unique properties. Licorice root has been suggested as an anti-inflammatory agent. It works to help metabolize sugar and balance hormones. Tribulus terrestris has been shown to help stimulate ovulation and support healthy menstruation. It may also decrease the number of ovarian cysts.
Buy tribulus terrestris now. Chasteberry has been used for centuries to help with reproductive conditions. It may improve some symptoms of PMS, though its effect on fertility requires more research. They can play an important role in treating PCOS. They can also reduce inflammation and regulate sex hormones like androgen and estrogen.
Consider taking probiotic supplements and eating probiotic foods , like kimchi and kombucha. Maintaining a healthy weight can help decrease insulin resistance, regulate your period , and reduce your risk of conditions associated with PCOS. Exercise is important for maintaining a healthy weight. But too much exercise can disrupt your hormones, so talk with your doctor about a healthy balance. If clomifene is unsuccessful in encouraging ovulation, another medicine called metformin may be recommended.
Metformin is often used to treat type 2 diabetes , but it can also lower insulin and blood sugar levels in women with PCOS.
As well as stimulating ovulation, encouraging regular monthly periods and lowering the risk of miscarriage , metformin can also have other long-term health benefits, such as lowering high cholesterol levels and reducing the risk of heart disease. Possible side effects of metformin include nausea, vomiting, stomach pain, diarrhoea and loss of appetite. As metformin can stimulate fertility, if you're considering using it for PCOS and not trying to get pregnant, make sure you use suitable contraception if you're sexually active.
Letrozole is sometimes used to stimulate ovulation instead of clomifene. This medicine can also be used for treating breast cancer. Use of letrozole for fertility treatment is "off-label". This means that the medicine's manufacturer has not applied for a licence for it to be used to treat PCOS. In other words, although letrozole is licensed for treating breast cancer, it does not have a license for treating PCOS. Doctors sometimes use an unlicensed medicine if they think it's likely to be effective and the benefits of treatment outweigh any associated risks.
Find out more about unlicensed and off-label use of medicines. If you're unable to get pregnant despite taking oral medicines, a different type of medicine called gonadotrophins may be recommended. Extra male hormones disrupt the menstrual cycle, so women with PCOS get fewer periods than usual.
Italian physician Antonio Vallisneri first described its symptoms in 3. Polycystic ovary syndrome PCOS affects up to almost 27 percent of women during their childbearing years 4. It involves cysts in the ovaries, high levels of male hormones, and irregular periods. They believe that high levels of male hormones prevent the ovaries from producing hormones and making eggs normally. Studies show that PCOS runs in families 5.
The pancreas makes more insulin to compensate. Extra insulin triggers the ovaries to produce more male hormones. Obesity is a major cause of insulin resistance. Both obesity and insulin resistance can increase your risk for type 2 diabetes 8. Women with PCOS often have increased levels of inflammation in their body. Being overweight can also contribute to inflammation. Studies have linked excess inflammation to higher androgen levels 9.
They believe it stems from factors such as genes, insulin resistance, and higher levels of inflammation in the body. Some women start seeing symptoms around the time of their first period. PCOS can disrupt the menstrual cycle, leading to fewer periods.
Acne, hair growth, weight gain, and dark skin patches are other symptoms of the condition. Having higher-than-normal androgen levels can affect your fertility and other aspects of your health. To get pregnant, you have to ovulate. PCOS is one of the leading causes of infertility in women Up to 80 percent of women with PCOS are overweight or have obesity Both obesity and PCOS increase your risk for:.
Together, these factors are called metabolic syndrome , and they increase the risk for:. Sleep apnea is more common in women who are overweight — especially if they also have PCOS. During ovulation, the uterine lining sheds. A thickened uterine lining can increase your risk for endometrial cancer Both hormonal changes and symptoms like unwanted hair growth can negatively affect your emotions.
Many with PCOS eventually experience depression and anxiety PCOS can increase the risk of infertility, metabolic syndrome, sleep apnea, endometrial cancer, and depression. Doctors typically diagnose PCOS in women who have at least two of these three symptoms 17 :.
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