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Treatments and drugs
By Mayo Clinic staffPolycystic ovary syndrome treatment generally focuses on management of your individual main concerns, such as infertility, hirsutism, acne or obesity.
Medications
Your doctor may prescribe a medication to:
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Regulate your menstrual cycle. If you're not trying to become pregnant, your doctor may recommend 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 also follow a diet and an exercise program.
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Help you ovulate. If you're trying to become pregnant, you may need a medication to help you ovulate. 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.
- 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.
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.
- Wilson EE. Polycystic ovarian syndrome and hyperandrogenism. In: Schorge JO, et al. Williams Gynecology. New York, N.Y.: The McGraw-Hill Companies; 2008. http://www.accessmedicine.com/content.aspx?aid=3157034. Accessed June 28, 2011.
- Barbieri RL, et al. Clinical manifestations of polycystic ovary syndrome in adults. http://www.uptodate.com/home/index.html. Accessed June 28, 2011.
- Ehrmann DA. Polycystic ovary syndrome. New England Journal of Medicine. 2005;352:1223.
- Azziz RA, et al. The androgen excess and PCOS society criteria for the polycystic ovary syndrome: The complete task force report. Fertility and Sterility. 2009;91:456.
- Polycystic ovary syndrome (PCOS): Frequently asked questions. The National Women's Health Information Center. http://www.womenshealth.gov/faq/polycystic-ovary-syndrome.cfm. Accessed June 28, 2011.
- Guzick DS. Polycystic ovary syndrome. Obstetrics & Gynecology. 2004;103:181.
- Radosh L. Drug treatments for polycystic ovary syndrome. American Family Physician. 2009;79:671.
- Barbieri RL, et al. Treatment of polycystic ovary syndrome in adults. http://www.uptodate.com/home/index.html. Accessed June 28, 2011.
- Tapanainen JS, et al. Effective regimens for ovulation induction in polycystic ovary syndrome. In: Dunaif A, et al. Polycystic Ovary Syndrome: Current Controversies, From the Ovary to the Pancreas. Totowa, N.J.: Humana; 2008:307.
- Gonzalez F, et al. Increased activation of nuclear factor kappaB triggers inflammation and insulin resistance in polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism. 2006;91:1508.
- Diamanti-Kandarakis E, et al. Insulin resistance in PCOS. In: Farid ND, et al. Diagnosis and Management of Polycystic Ovary Syndrome. New York, N.Y.: Springer Verlag; 2009:35.
- Abbott DA, et al. Fetal origins of polycystic ovary syndrome. In: Dunaif A, et al. Polycystic Ovary Syndrome: Current Controversies, From the Ovary to the Pancreas. Totowa, N.J.: Humana; 2008:87.
- Berrino F, et al. Reducing bioavailable sex hormones through a comprehensive change in diet: The diet and androgens (DIANA) randomized trial. Cancer Epidemiology, Biomarkers & Prevention. 2001;10:25.
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