Treating polycystic ovary syndrome 

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

Treatment options can vary because someone with 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 from 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 whether you're 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 18.5-24.9. Use the BMI healthy weight calculator to work out whether your BMI is in the healthy range.

You can lose weight by exercising regularly and having a healthy, balanced diet. Your diet should include plenty of fruit and vegetables, (at least five portions a day), whole foods (such as wholemeal bread, wholegrain cereals and brown rice), lean meats, fish and chicken. Your GP may be able to refer you to a dietitian if you need specific dietary advice.

Read more about losing weighthealthy 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 intrauterine (IUS) system) will also reduce this risk, but won't cause periods.

Fertility problems

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

A medication called clomifene is usually the first treatment recommended for women with PCOS who are trying to get pregnant. Clomifene encourages the monthly release of an egg from the ovaries (ovulation).

If clomifene is unsuccessful in encouraging ovulation, another medication called metformin may be recommended. Metformin is often used to treat type 2 diabetes, but it can also lower insulin and blood sugar levels in women with PCOS.

As well as stimulating ovulation, encouraging regular monthly periods and lowering the risk of miscarriage, metformin can also have other, long-term health benefits, such as lowering high cholesterol levels and reducing the risk of heart disease.

Metformin isn't licensed for treating PCOS in the UK, but because many women with PCOS have insulin resistance, it can be used "off-label" to encourage fertility and control the symptoms of PCOS. Possible side effects of metformin include nausea, vomiting, stomach pain, diarrhoea and loss of appetite.

As metformin can stimulate fertility, if you're considering using it for PCOS and aren't trying to get pregnant, make sure you use suitable contraception if you're sexually active.

The National Institute for Health and Care and Excellence (NICE) has more information about the use of metformin for treating PCOS in women who are not trying to get pregnant, including a summary of the possible benefits and harms.

If you're 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 that 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 doesn't increase your risk of multiple pregnancies.

It's likely that a fertility specialist will check that your fallopian tubes aren't blocked before most of these treatments are used.

Unwanted hair growth and hair loss

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

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 isn't always available on the NHS, because some local NHS authorities have decided it's not effective enough to justify NHS prescription.

If you have unwanted hair growth, you'll probably also want to use a method of physically removing the excess hair (such as plucking, shaving, threading, creams or laser removal), although it's unlikely that 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 (statins), 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 will then be surgically treated using heat or a laser to destroy the tissue that's producing androgens (male hormones).

LOD 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.

Pregnancy risks

If you have PCOS, you have a higher risk of pregnancy complications, such as high blood pressure (hypertension), pre-eclampsiagestational diabetes and miscarriage. These risks are particularly high if you're obese.

If you're overweight or obese, you can lower your risk by losing weight before trying for a baby.

Page last reviewed: 13/05/2015

Next review due: 13/05/2017