Polycystic Ovary Syndrome (PCOS)

Treatment Overview

Polycystic ovary syndrome (PCOS) is a group of health problems caused by out-of-balance hormones. It often involves irregular menstrual periods beginning in puberty, or difficulty getting pregnant.

Regular exercise, a healthy diet, not smoking, and weight control are the cornerstone of treatment for PCOS. Sometimes, also using a medicine to balance hormones is helpful.

There is no cure for PCOS, but controlling it lowers your PCOS risks of infertility, miscarriages, diabetes, heart disease, and uterine cancer.

Initial treatment

The first step in managing polycystic ovary syndrome (PCOS) is getting regular exercise, eating a healthy diet, and not smoking. This is a medical treatment for PCOS, not just a lifestyle choice. Additional treatments depend on your symptoms and whether you are planning a pregnancy.

• If you are overweight, a small amount of weight loss is likely to help balance your hormones and start up your menstrual cycle and ovulation. Use regular exercise and a healthy weight-loss diet as your first big treatment step. This is especially important if you're planning a pregnancy.
• If you smoke, consider quitting. Women who smoke have higher levels of androgens than women who don't smoke.¹ Smoking also increases your risk of heart disease.
• If you are planning a pregnancy and weight loss doesn't improve your fertility, your doctor may suggest a medicine that helps lower insulin. With weight loss, this can improve your chances of ovulation and pregnancy. Fertility drug treatment may also help start ovulation.²
• If you are not planning a pregnancy, you can also use hormone therapy to help control your ovary hormones. To correct menstrual cycle problems, birth control hormones keep your endometrial lining from building up for too long. This is what prevents uterine cancer. Hormone therapy can also help with male-type hair growth and acne.³ Birth control pills, patches, or vaginal rings are prescribed for hormone therapy. Androgen-lowering spironolactone (Aldactone) is often used with estrogen-progestin birth control pills. This helps with hair loss, acne, and male-pattern hair growth on the face and body (hirsutism).³

Taking hormones does not help with heart, blood pressure, cholesterol, and diabetes risks. This is why exercise and a healthy diet are a key part of your treatment.

For helpful information, see:

• A registered dietitian who has special knowledge about diabetes.
• The topic Healthy Eating.
• The topic Fitness.
• Physical activity for weight loss.
• The topic Quitting Tobacco Use.

Fitness: Walking for wellness

Additional treatments for menstrual cycle and hair and skin problems

Other treatments for PCOS problems include:

• Hair removal with laser, electrolysis, waxing, tweezing, or chemicals.
• Skin treatments. Acne medicines can be nonprescription or prescription. Some are taken by mouth and some are applied to the skin. (For more information, see the topic Acne Vulgaris.) Skin tag removal is not needed unless the tags are irritating, such as a tag on an eyelid. Generally they can be removed easily by your doctor.

Teenage girls. Early diagnosis and treatment of PCOS may help prevent long-term complications, such as obesity, diabetes, and infertility.

Ongoing treatment

To control polycystic ovary syndrome (PCOS) for the long term, keep up with regular exercise and eat a healthy diet to control body weight and your metabolism. This approach helps you fight the risks of diabetes and heart disease, as well as hair and skin problems caused by the hormones.

To correct menstrual cycle problems, hormone therapy keeps your endometrial lining from building up for too long. This is what prevents uterine cancer. Birth control pills, patches, or vaginal rings are prescribed for hormone therapy.

For help with male-type hair growth, male-pattern hair loss, and acne, hormone therapy and spironolactone (Aldactone) are often used together to lower androgen levels.

Regular checkups are important for catching any PCOS complications, such as high blood pressure, high cholesterol, uterine cancer, heart disease, and diabetes. All women with PCOS are advised to be checked for diabetes by age 30.⁹

Treatment for infertility from PCOS focuses on starting ovulation:

• If you have PCOS and are overweight, weight loss may be all the treatment you need. Even a small weight loss can trigger ovulation. Weight loss of as little as 5% to 7% over 6 months can lower your insulin and androgen levels. This restores ovulation and fertility in more than 75% of women with PCOS.⁵
• If weight loss alone does not start ovulation (or if you don't need to lose weight), your doctor may have you try a medicine such as metformin or clomiphene to help you start to ovulate. Several months of treatment may be needed. Sometimes combining these two treatments can trigger ovulation in women with PCOS.^{10, 11}
• If metformin and clomiphene do not work, gonadotropins are sometimes used. These are similar to the hormones the body makes to start ovulation. But they also increase the chances of having a high-risk pregnancy with two or more embryos. During gonadotropin treatment, you must have daily checks of egg follicle development, using blood tests and ultrasound, to prevent ovarian hyperstimulation syndrome.

If weight loss and medicine do not work, treatment options include:

• In vitro fertilization. Eggs are fertilized with sperm in a lab, grown for a few days, then put in the uterus to start a pregnancy. This treatment is complex, difficult, and expensive, but it may improve your chances of pregnancy.
• Ovarian drilling, or partial destruction of an ovary. This is a surgical treatment that can trigger ovulation. It is sometimes used for women with PCOS who have tried weight loss and fertility medicine but still are not ovulating.¹¹

For more information, see the topic Fertility Problems.

Women with PCOS who become pregnant have increased risks during pregnancy. Using metformin when trying to get pregnant may lower your risks of miscarriage and gestational diabetes.³ But the risks of using metformin throughout pregnancy are not known. For more information, see the topic Gestational Diabetes.

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Author:	Bets Davis, MFA Kathe Gallagher, MSW	Last Updated: January 23, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Samuel S. Thatcher, MD, PhD - Obstetrics and Gynecology, Reproductive Endocrinology
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