Metformin for PCOS, Plus 7 More Treatment Options to Know About

Polycystic ovary syndrome (PCOS) is a health condition that affects up to 13% of women. It can cause acne, irregular periods, and extra hair growth on the face and body. Many people with PCOS also have trouble with weight management and insulin resistance. This can increase the risk of developing Type 2 diabetes.

There is no single medication designed specifically for PCOS. But medications are often prescribed off-label to help manage your symptoms. Some, such as metformin for PCOS, help with blood sugar and weight control. Others, such as combination birth control pills, help balance hormone levels. In this article, we’ll go over eight medications used to treat PCOS symptoms and how they might help you.

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1. Metformin

As mentioned, metformin (Glucophage) is a Type 2 diabetes medication. But it’s often prescribed off-label for PCOS.

Experts estimate that more than 75% of people living with PCOS have insulin resistance. This can lead to weight gain and Type 2 diabetes. It can also raise the risk of heart-related conditions over time. Metformin helps improve insulin sensitivity, which can reduce the risk of these problems.

Metformin may also help lower high androgen levels, another common PCOS symptom. Androgens are sex hormones, such as testosterone. High androgen levels in women can cause acne, irregular periods, and excess hair growth (hirsutism). Metformin helps lower androgen levels and, in turn, reduce these symptoms.

These effects make metformin one of the most common treatment options for PCOS.

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2. Combination birth control pills

Combination birth control pills (also referred to as combination oral contraceptives, or COCs) are another first-choice medication for PCOS.

COCs contain both estrogen and progestin. PCOS is associated with hormone changes, which can lead to irregular menstrual cycles. COCs help regulate hormone levels throughout the menstrual cycle. This, in turn, can improve hormone-related PCOS symptoms.

Progestin-only or hormone-free birth control options may help regulate your menstrual cycle. But they aren’t as effective at reducing other PCOS symptoms.

Keep in mind that the progestins in some COCs can have androgenic effects. Since PCOS is already associated with high androgen levels, it’s best to avoid these COCs. There’s a chance they may worsen androgen-related symptoms, such as acne and facial hair growth. Other COCs have antiandrogen effects, which may be beneficial for these symptoms. Your prescriber can help you find the right COC for your needs.

3. Spironolactone, flutamide, and finasteride (antiandrogens)

As mentioned, PCOS is often associated with high androgen levels. Antiandrogen medications block the formation or activity of androgens in the body. Examples include:

• Spironolactone (Aldactone)

• Flutamide (Eulexin)

• Finasteride (Propecia, Proscar)

Antiandrogen medications aren’t considered first-choice PCOS medications. They’re typically prescribed only if COCs aren’t an appropriate or effective option. Of the antiandrogen medications, spironolactone seems to have the most evidence behind it. Flutamide can further increase heart-related issues that are common with PCOS, such as high cholesterol. So it isn’t a preferred option.

Good to know: Antiandrogen medications can harm a growing fetus. So you shouldn’t take them if you’re pregnant or trying to become pregnant.

4. GLP-1-related medications

GLP-1-related medications are prescribed for Type 2 diabetes and weight loss. But they may also be helpful for PCOS symptoms. Examples include:

• Ozempic (semaglutide)

• Wegovy (semaglutide)

• Mounjaro (tirzepatide)

• Zepbound (tirzepatide)

GLP-1-related medications may help several PCOS symptoms. These include weight management, insulin sensitivity, and infertility. But GLP-1-related medications are recommended only for weight management in those living with PCOS. Studies are ongoing to learn more about their role in treating other PCOS symptoms.

5. Oral weight-loss medications

Overweight and obesity affect up to 88% of people living with PCOS. Studies show that even a modest 2% to 5% reduction in body weight can help improve PCOS symptoms. But weight loss can be harder when living with PCOS. This is where oral weight-loss medications may help.

Common examples include:

• Contrave (naltrexone / bupropion)

• Qsymia (phentermine / topiramate ER)

• Phentermine (Adipex-P)

• Orlistat (Xenical, Alli)

These medications are more effective when combined with a balanced diet and regular exercise. And they may not be appropriate for everyone. Your prescriber can help you find the best option for your needs.

6. Eflornithine (Vaniqa)

Eflornithine (Vaniqa) is a topical cream that’s FDA approved to treat unwanted facial hair. It works by blocking an enzyme (protein) that hair needs to grow.

Eflornithine hasn’t been studied specifically for PCOS. But in general, it can be safely used to reduce excess facial hair caused by this condition.

Keep in mind that hair growth will return once you stop using eflornithine. You can combine eflornithine with laser hair removal for a more permanent solution.

7. Medroxyprogesterone

Medroxyprogesterone (Provera) is a progestin that can help regulate the menstrual cycle. It may also improve insulin sensitivity and lipid levels in people living with PCOS.

In most cases, you won’t take medroxyprogesterone every day. Instead, you’ll take it for 10 to 14 days each month. Keep in mind that you shouldn’t take medroxyprogesterone if you’re pregnant, breastfeeding, or trying to become pregnant.

8. Statins

Statins are medications commonly used to treat high cholesterol levels. Examples include:

• Simvastatin (Zocor)

• Atorvastatin (Lipitor)

• Pravastatin (Pravachol)

About 70% of people living with PCOS have increased cholesterol levels.

Statins can help reduce cholesterol levels. But they may have an antiandrogen effect as well. This is because cholesterol is used to make hormones in the body. In most cases, your prescriber will recommend a statin only if your cholesterol levels are high.

Can medications help with infertility related to PCOS?

Yes, some medications can help improve fertility issues associated with PCOS. About 8 in 10 women with PCOS experience infertility (trouble getting pregnant). But this doesn’t mean pregnancy is impossible.

Fertility medications can help improve ovulation and increase the chances of a successful pregnancy. Common examples include:

• Letrozole (Femara)

• Clomiphene (Clomid)

• Gonadotropin injections (Follistim AQ, Gonal-f RFF)

Weight-loss medications can also help improve fertility issues related to excess body weight. But many of these medications aren’t safe to take while pregnant.

Your prescriber can help you find the best treatment for PCOS-related fertility issues based on your personal needs.

Can OTC supplements help treat PCOS?

Some over-the-counter (OTC) supplements may help manage PCOS symptoms. But there’s limited evidence about their effectiveness compared with prescription options.

Examples include:

• Inositol

• Berberine

• Chromium

• Vitamin D

• Vitamin E

• Omega-3 fatty acids

• Selenium

• Curcumin (turmeric)

• Probiotics and prebiotics

• Zinc

• Cinnamon

Supplements aren’t regulated the same way as OTC and prescription medications. And they have side effects and drug interactions to be aware of. So be sure to talk to your healthcare team before adding a supplement to your routine.

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Written by:

Jill Barat, PharmD

Jill Barat, PharmD has nearly 10 years of experience as a pharmacist, including serving as the pharmacist in charge at an independent sterile and non-sterile compounding pharmacy. She also worked as the head of medical content for a telemedicine company.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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