Polycystic ovary syndrome treatment generally focuses on management of your individual main concerns, such as infertility, hirsutism, acne or obesity.
Your doctor might recommend that you:
• Schedule regular checkups. Long term, managing cardiovascular risks, such as obesity, high blood cholesterol, type 2 diabetes and high blood pressure, is important. To help guide ongoing treatment decisions, your doctor will likely want to see you for regular visits to perform a physical examination, measure your blood pressure, and obtain glucose and lipid levels.
• Adjust your lifestyle habits. Making healthy-eating choices and getting regular exercise is the first treatment approach your doctor might recommend, particularly if you're overweight. Obesity makes insulin resistance worse. Weight loss can reduce both insulin and androgen levels, and may restore ovulation. Ask your doctor to recommend a weight-control program, and meet regularly with a dietitian.
• Regulate your menstrual cycle. If you're not trying to become pregnant, your doctor may prescribe low-dose birth control pills that contain a combination of synthetic estrogen and progesterone. They decrease androgen production and give your body a break from the effects of continuous estrogen. This decreases your risk of endometrial cancer and corrects abnormal bleeding.
An alternative approach is taking progesterone for 10 to 14 days each month. This regulates your periods and offers protection against endometrial cancer, but it doesn't improve androgen levels.
Your doctor also may prescribe metformin (Glucophage, Glucophage XR), an oral medication for type 2 diabetes that lowers insulin levels. This drug improves ovulation and leads to regular menstrual cycles. Metformin also slows the progression to type 2 diabetes if you already have prediabetes and aids in weight loss if you follow a diet and exercise program.
• Reduce excessive hair growth. Your doctor may recommend birth control pills to decrease androgen production, or another medication called spironolactone (Aldactone) that blocks the effects of androgens on the skin. Because spironolactone can cause birth defects, effective contraception is required when using the drug, and it's not recommended if you're pregnant or planning to become pregnant. Eflornithine (Vaniqa) is another medication possibility; the cream slows facial hair growth in women.
Shaving, waxing and depilatory creams are nonprescription hair removal options. Results may last several weeks, and then you need to repeat treatment.
For longer lasting hair removal, your doctor might recommend a procedure that uses electric current (electrolysis) or laser energy to destroy hair follicles and control unwanted new hair growth.
• Use medication to induce ovulation. If you're trying to become pregnant, you may need a medication to induce ovulation. Clomiphene citrate (Clomid, Serophene) is an oral anti-estrogen medication that you take in the first part of your menstrual cycle. If clomiphene citrate alone isn't effective, your doctor may add metformin to help induce ovulation.
If you don't become pregnant using clomiphene and metformin, your doctor may recommend using gonadotropins — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications that are administered by injection.
• Have surgery. If medications don't help you become pregnant, an outpatient surgery called laparoscopic ovarian drilling is an option for some women with PCOS. Your doctor can help you determine if you're a candidate for this type of surgery.
In this procedure, a surgeon makes a small incision in your abdomen and inserts a tube attached to a tiny camera (laparoscope). The camera provides the surgeon with detailed images of your ovaries and neighboring pelvic organs. The surgeon then inserts surgical instruments through other small incisions and uses electrical or laser energy to burn holes in follicles on the surface of the ovaries. The goal is to induce ovulation by reducing androgen levels.