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Treatment Options For Polycystic Ovary Syndrome



Polycystic Ovary Syndrome (PCOS) is by far the most common endocrine problem in women and may be present in about one in five women who fail to get pregnant.

Although the exact etiology of PCOS remains unclear, it is commonly associated with overweight and obesity, with patients often (but not always!) presenting with signs of increased androgen production (or action) and (often quite severe) insulin resistance.

Clinically the signs and symptoms of PCOS can range from mild menstrual disorders to severe disturbance of reproductive and metabolic functions.

Because of its variability, the definition of PCOS has changed over the years – current diagnoses requires the demonstration of hyperandrogenism and ovarian dysfunction (including infrequent or irregular ovulation or anovulation) and/or polycystic ovaries as demonstrated by imaging (e.g. ultrasound).

A paper by Ahmed Badawy and Abubaker Elnashar from the Universities of Mansoura and Benha, Egypt, just published in the International Journal of Women’s Health, presents a comprehensive overview of the current treatment options for PCOS.

With regard to excess weight, the authors note:

Obesity is observed in 35%–60% of women with PCOS and is related to lack of or delayed response to different treatments…Weight loss improves the endocrine profile and increases the likelihood of ovulation and pregnancy. Normalization of the menstrual cycles and ovulation could occur with modest weight loss as little as 5% of the initial weight. Weight loss can improve not only circulating androgen and glucose levels but also ovulation and pregnancy rates in obese women with PCOS.

The authors also report that a few recent studies describe high success rates in restoring regular cycles and pregnancies in severely obese women with PCOS, who underwent bariatric surgery.

The paper describes in great detail other treatment options that can often complement weight loss, including the use of medications such as clomiphene citrate, tamoxifen, aromatase inhibitors, metformin, glucocorticoids, or gonadotropins or even surgically by laparoscopic ovarian drilling.

Treatment options of course also include in vitro fertilization as a last resort to achieve pregnancy when all other treatments fail.

The paper also touches on the treatment of androgenic symptoms, such as excessive hair growth on the body and face, balding, or acne.

Given that PCOS is such a common problem, I wonder if my readers wish to share their experience with managing this syndrome.

As always, comments are greatly appreciated.

AMS
Edmonton, Canada

Badawy A, & Elnashar A (2011). Treatment options for polycystic ovary syndrome. International journal of women’s health, 3, 25-35 PMID: 21339935

15 Comments

  1. I know of one doctor who has claimed success in curing it by putting his patients on a diabetic diet (no added sugars, all grains whole, etc.). Here is his write-up with citations from the literature.

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  2. After having a child losing over 60lbs (40 pregnancy and 20 post pregnancy) my pcos symptoms have actually gotten worse! My cycle and period have not returned but each month I have horrific cramping and pms. This is frustrating as I’ve gone from a bmi of 32 to 28 with no improvements. I am a bit concerned for my ability to conceive another child.

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  3. I was told at around age 20 that I likely had PCOS, and I’m 42 now. I did have difficulty conceiving, but ultimately was able to give birth a healthy baby when I was 36.
    For me, it has been difficult to tease out the relationship between PCOS, type 2 diabetes, and weight. I think that the metabolic “irregularities” that led me to develop type 2 diabetes when I was 25 were there prior to weight gain, but it was starting on Metformin about 8 years after I was diagnosed with type 2 diabetes that led to an improvement in PCOS symptoms as well. I responded really well to Metformin.
    For me, there’s this cluster of “stuff” — PCOS, type 2 diabetes, hypothryroid, “calorie sensitivity” — that doesn’t respond to the “eat less” advice in a predictable way. I do find that physical activity is very helpful, and finding physical activity that I love is a big help.
    I do wish someone had told me when I was first diagnosed with PCOS that it will be easier for me to gain weight and harder for me to lose it than it is for most people, and that for me, getting rather large amounts of moderate to intense physical activity is something I need more than most people. I don’t know if I would have taken it to heart at that age. These days, it is nice to hear, when I tell a health professional that I have PCOS, that they understand it’s harder for me to lose weigh or maintain weight loss than it would likely be for someone without PCOS. That understanding goes a long way.

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  4. Please excuse bringing up another question . Dr Sharma, do you have any comments on the book The End Of Overeating. Taking Control Of The Insatiable North American Diet, by David A. Kessler, MD. He was commissioner of U.S. Food and Drug Administration, Dean of Medical Schools at Yale and U. of California, and is a pediatrician, so he is in scientific community, reputable.

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  5. “Taking Control Of The Insatiable North American Diet”

    Sorry, don’t know the book.

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  6. Being one of the “rare” PCOS patients with a normal BMI (22.6) and normal insulin I a different experience with managing my PCOS. I have a hard time because 99% of the information that I can find about PCOS talks about weight loss for overweight/obese patients to help with symptom management. I find it is quite frustrating to be told the only thing that I can do for now is go on oral contraception to try to regulate hormones and go for waxing/laser for the hair growth. Basically because I am normal weight and not currently trying to get pregnant I have been told there is nothing else that can be done for me.

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  7. sir,
    ima student who is very much interested in doing my research in pms and pco.i am monitoring some subjects in my place who have pco and would very much like to work onthis topic.can you help me sir?

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  8. I was diagnosed at 27 with PCOS, though I knew that I probably had the syndrome much earlier. I never had a regular period – more often yearly than monthly from the age of 12. I am completely anovulatory despite having lost near 100 pounds (half or so since weight loss surgery a couple of months ago). I too found it frustrating to be told that BCP was really the only choice of treatment that I could pursue if I was not looking for fertility treatments. I was told that pregnancy was unlikely to ever happen, even if I lost weight. I did not want to pusue IV or fertility drugs.

    Eventually I was put on spironolactone (aldosterone), an androgen inhibitor that helps control hirsuitism (which helped a lot when combined with laser hair removal), and metformin, which seemed to do very little to help me lose, or even contain my out of control weight gain.

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  9. We started trying to conceive when I was 25 and overweight. We had years of trying, and miscarriages, my doctor blaming my difficulties on being overweight and PCOS, even though I had none of the the usual symptoms – irregular cycles, excess hair and so on. Cue years later, during my second c-section, my OB noticed that I have an abnormally shaped uterus, which he feels likely caused my problems. I feel so angry that I spent years waiting, grieving, feeling at fault because my OB/GYN took one look at me, decided I was too fat and gave me a diagnosis based on that.

    Between my second and third (successful) pregnany, I lost nearly 100 lbs with laproscopic band surgery. The difference in my health care was astonishing. Nurses were more attentive, I was asked more frequently if I needed pain medication, my OB/GYN came and checked on me. A VERY different experience that my first two births.

    For all of my sisters struggling with infertility and weight issues, be strong and demand better health care. Find an OB who is not weight biased. You are deserving of the same level of health care as everyone else.

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  10. I was diagnosed with pco just a few months after my marriage but I had the symptoms when I was 20 or so…even though my gyne didn’t bother to tell me abt the whole thing of PCO and put me on a complicated medication of some 5-7 types of different medicines taken as per the days of my cycle, I usually missed a medicine or two because the schedule was very difficult to follow on counted days. As usual I was having regular cycles but then I wanted I child that brought on more medicines (she never asked me to loose weight, never talked about insulin etc.). I got frustrated that once out of my city I missed the medicines and didn’t had my periods at all. Then I started to look out for another Gyne/ OB and mean while searched a lot on Net about this PCO and landed to a much womanized Gyne/OB. She has indeed asked me to loose weight,putme on Metformin.. I have regular cycles with any withdrawal medicines, no increase in weight, but I know I have a long way to go to reach my ideal weight. I am trying and I am sure I will soon come down to the fitter me and then would try to have a healthy baby…………… my LH levels are back to normal.
    Best of luck ladies , just love your self and do not cut urself emotionally from the world. PCOD is best treated when you try to rediscover your own self.

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  11. I recokn you are quite dead on with that.

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  12. I lost well over a hundred pounds, but i couldn’t afford doctor appts. for awhile, ran out of my metformin, and gained 80 of it back within 5 months. Trying again to lose but i’m soooo tired of fighting my body! Even with my meds again it’s very slow going this , and my friends think i’m crazy because i can fluctuate 7-9 pounds every other day because of water weight… I’m tired of being fat when i try so hard, tired of hurting all the time because of ovaries that i have no need for anyway…. I’m 37, have been married for 10 yrs, and we do NOT want children. I just want to not feel broken for 1 day out of my life.

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  13. I was suffering from Polycystic Ovary Syndrome (PCOS) since my 19 years of age. Ever since i got married i have not been able to get pregnant, so i was completely barren due to this genetic disorder. I was prescribed several Clomid Meds but couldn’t see any improvement. I would basically go from one outbreak to the next. Finally, on my best friend’s recommendation, i decided to try the rescue herbal remedy which are made in liquid form with natural root and herbs from Dr Molemen.Within a few weeks, I could see improvements in the symptoms.
    My Menstrual Period has been maintained to normal,I used this medicine for two weeks and after some months later i began to have some early symptoms of pregnancy, its been over a year and some months now since i used that medicine and i have successfully given birth to a child,after been childless for many years due to this PCOS Syndrome. I would recommend this medicine to my other friends out there who are suffering from PCOS to give this medicine a try.
    contact : drmolemenspiritualtemple@gmail.com) or (dr.molemenspiritualtemple@yahoo.com) or call him +2347036013351.

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