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.

Edmonton, Canada

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