Polycystic Ovary Syndrome (PCOS)

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Treatment

There is no cure for polycystic ovary syndrome and the goals of treatment are to manage symptoms, achieve pregnancy (if desired), and reduce the risk for complications, such as heart disease and diabetes. Medical treatment (i.e., medications) for the condition must be continued indefinitely to control symptoms.

Women with PCOS who are overweight or obese should attempt to lose weight through a healthy diet, increased exercise, and lifestyle changes. Doctors, nutritionists, and fitness experts can help women work out a program that best suits their needs. It is important to consult with a doctor before beginning a weight loss program.

In women who do not wish to become pregnant, hormonal contraceptives (e.g., birth control pills) can be used to help regulate the menstrual cycle, balance hormone levels, and reduce acne. Hormonal contraceptives can cause a number of side effects, some of which may be severe. Smoking increases the risk for severe side effects and women who use hormonal contraceptives should not smoke.

Spironolactone (Aldactone®), which also is used to treat high blood pressure, counteracts male hormones and can reduce abnormal hair growth in women with polycystic ovary syndrome. Side effects of this medication include headaches, fever, and ulcers.

In women with PCOS who wish to become pregnant, fertility medications, such as clomiphene citrate (Clomid®, Serophene®) and human chorionic gonadotropin (HCG) may be helpful. In some cases, in vitro fertilization (IVF) also may be used. Fertility treatments may increase the risk for multiple pregnancy (e.g., twins, triplets, quadruplets).

IVF involves surgically removing a number of eggs (ova) and mixing them with sperm (male reproductive cells) in a laboratory. After a couple of days, the fertilized eggs are placed in the woman's uterus, where they continue to develop.

Metformin (Glucophage®) is a medication used to treat type 2 diabetes that also can reduce symptoms in women who have PCOS, although it is not approved by the U.S. Food and Drug Administration (FDA) for this use. Recent studies show that metformin can help regulate ovulation, improve cholesterol levels, reduce abnormal hair growth, and decrease body mass index (BMI) in women with PCOS. Side effects include diarrhea, nausea, and vomiting.

Severe cases of polycystic ovary syndrome that do not respond to other therapies may be treated using a surgical procedure called laparoscopic ovarian drilling. In this procedure, which is performed through a small incision using an instrument called a laparoscope, the ovarian tissue that produces male hormones is destroyed with a laser or electrical current.

Ovarian drilling has a lower rate of success in women who are obese. Risks associated with the procedure include damage to the ovaries or fallopian tubes and the formation of scar tissue. Benefits of this procedure are not long lasting in all cases.

Prognosis

Women who have polycystic ovary syndrome are at increased risk for serious complications, some of which can be life threatening. PCOS increases a woman's risk for the following conditions:

• Cardiovascular disease
• Diabetes and pre-diabetes
• Endometrial cancer
• Heart attack
• High blood pressure (hypertension)
• High levels of "bad" cholesterol (LDL) and low levels of "good" cholesterol (HDL)

Early diagnosis and treatment can help reduce the risk for many of the complications. Women who have PCOS should receive regular medical care (including screening for diabetes, high blood pressure, and high cholesterol) and should maintain a healthy lifestyle by eating right and exercising regularly. Women who have polycystic ovary syndrome should not smoke.

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