PCOS - Treating polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) can't be cured, but the symptoms can be managed.

Treatment options can vary as someone with polycystic ovary syndrome (PCOS) may experience a range of symptoms, or just one.

The main treatment options are discussed in more detail below.

Lifestyle changes

In overweight women, the symptoms and overall risk of developing long-term health problems due to polycystic ovary syndrome (PCOS) can be greatly improved by losing excess weight. Weight loss of just 5% can lead to a significant improvement in PCOS.

You can find out if you are a healthy weight by calculating your body mass index (BMI), which is a measurement of your weight in relation to your height. A normal BMI is 19-25. Use the BMI calculator to work out if your BMI is in the healthy range.

You can lose weight by exercising regularly and having a healthy balanced diet. Your diet should include lots of fruit and vegetables, whole foods (such as wholemeal bread, wholegrain cereals and brown rice), lean meats, fish and chicken. Your GP can usually refer you to a dietician who can offer specific diet advice.

Read more about losing weight, healthy eating and exercise.

Medications

A number of medications are available to treat different symptoms associated with PCOS. These are described below.

Irregular or absent periods

The contraceptive pill may be recommended to induce regular periods or periods may be induced by progesterone tablets (which can be given regularly or intermittently). This will also reduce the long-term risk of developing cancer of the womb lining (endometrial cancer) associated with not having regular periods. An IUS (intrauterine system) will also reduce this risk but will not cause periods.

Fertility problems

With treatment, most women with PCOS are able to get pregnant.

Medications called clomifene and metformin are usually the first treatments used for women with PCOS who are trying to get pregnant. These medications encourage the monthly release of an egg from the ovaries (ovulation). You may be offered one of the medications or both together.

If you are unable to get pregnant despite taking clomifene and/or metformin, a different type of medication called gonadotrophins may be recommended. However, there's a risk this medication may overstimulate your ovaries and lead to multiple pregnancies.

An alternative to gonadotrophins is a surgical procedure called laparoscopic ovarian drilling (see below). This treatment can be as effective as using gonadotrophins, but it does not increase your risk of multiple pregnancies.

It is likely that a fertility specialist will check that your fallopian tubes are not blocked before most of these treatments are used because this will prevent them from working.

Unwanted hair growth and hair loss

Medications to control excessive hair growth (hirsutism) and hair loss (alopecia) include:

• particular types of combined oral contraceptive tablets (such as co-cyprindiol, Dianette. Marvelon and Yasmin)
• cyproterone acetate
• spironolactone
• flutamide
• finasteride

These medications work by blocking the effects of "male hormones", such as testosterone and some also suppress production of these hormones by the ovaries.

A cream called eflornithine can also be used to slow down the growth of unwanted facial hair. This cream doesn't remove hair or cure unwanted facial hair, so you may wish to use it alongside a hair-removal product. Improvement may be seen four to eight weeks after treatment with this medication.

However, eflornithine cream is not always available on the NHS because some local NHS authorities have decided it is not effective enough to justify NHS prescription.

If you have unwanted hair growth, you will probably also wish to use a method of physically removing the excess hair (such as plucking, shaving, threading, creams or laser removal), although it is unlikely these will be provided on the NHS.

Other symptoms

Medications can also be used to treat some of the other problems associated with PCOS, including:

• weight-loss medication, such as orlistat, if you're overweight
• cholesterol-lowering medication (statin), if you have high levels of cholesterol in your blood,
• acne treatments

Surgery

A minor surgical procedure called laparoscopic ovarian drilling (LOD) may be a treatment option for fertility problems associated with PCOS.

Under general anaesthetic, your doctor will make a small cut in your lower abdomen (tummy) and pass a long, thin microscope called a laparoscope through into your abdomen. The ovaries are then surgically treated using heat or a laser to destroy the tissue that's producing androgens (male hormones).

Laparoscopic ovarian drilling has been found to lower levels of testosterone and luteinising hormone (LH) and raise levels of follicle-stimulating hormone (FSH). This corrects your hormone imbalance and can restore the normal function of your ovaries.