How Do You Treat Polycystic Ovary Syndrome (PCOS)?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Polycystic ovary syndrome (PCOS) is a common cause of acne, irregular periods, and infertility in women. And don’t forget about excess hair growth, which also comes along with PCOS.

Diagnosing PCOS is tricky and not clear cut. Many people believe you must have the presence of polycystic ovaries (on ultrasound) to make the diagnosis, but this is not true for postmenopausal women. Also, skipping periods and having polycystic ovaries (multiple cysts) isn’t enough, as you must also have signs of hyperandrogenism (excess hair growth and/or acne).

If you do have those symptoms (irregular periods, acne, or excess hair growth and polycystic ovaries) you should see your doctor to rule out other things. Know this:

  •  Women suspected of having PCOS should have blood tests for thyroid disease, prolactin, and 17 hydroxyprogesterone to rule out other causes of their irregular periods, acne, and excess hair growth.

  •  Women diagnosed with PCOS should undergo screening tests for diabetes and should be screened for depression. Diabetes screening should occur every 3 to 5 years after a normal result.

Ok you have PCOS, now what? Here is how we treat PCOS:

1.  Hormonal contraceptives are the first-line treatment of anovulatory symptoms (skipped and irregular periods) and hirsutism (excess hair) in PCOS. There is no recommendation for one type of pill vs another.

2.  Metformin should be used in cases of PCOS featuring diabetes or glucose intolerance (an elevated fasting blood sugar). It is a second-line drug for women with menstrual irregularities who cannot tolerate hormonal contraceptives.

3.  Weight loss will improve reproductive outcomes in PCOS, so weight loss may improve your fertility if you have PCOS.

4.  If you have PCOS and you want to get pregnant, Clomid is the first-line treatment of anovulatory (irregular periods from not ovulating) infertility among women with PCOS.

5.  Actos (a thiazolidinedione) is not recommended for the treatment of PCOS because of safety concerns. Years ago this was widely used; that is no longer the case.

With good treatment periods can be regulated, sugars and skin improved, and chances of conceiving increased. So ask about it.

Dr O.

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