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 treatment options may include:
- losing weight and adopting a healthy lifestyle
- hormone treatment, such as specific types of contraceptive pill or anti-androgen drugs which block the effects of male hormones on the body
- a medication called metformin to improve the body's sensitivity to insulin
- a fertility medication called clomifene, sometimes leading to more complex treatment such as IVF.
- a cream called eflornithine to stop excess hair growth (hirsutism)
- surgery to treat the ovaries known as laparoscopic ovarian drilling (LOD)
These 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.
Losing weight will reduce the amount of insulin that your body needs to produce. This reduces testosterone levels and improves the chances of ovulation.
Menstrual and fertility problems will improve, along with a decrease in excessive hair growth and acne.
You can lose weight by following a suitable diet and doing 45-60 minutes of aerobic exercise every day. Your GP can refer you to a dietician, who will offer you advice. Weight loss of just 5% can lead to a significant improvement in PCOS.
Find out if you are a healthy weight.
A normal body mass index (BMI) is 19-25. If you have PCOS and your BMI is:
- more than 30, you will be especially difficult to treat; in many areas of the UK a BMI above 30 will exclude you from receiving complex fertility treatments
- more than 35, you're seriously at risk of medical problems
- more than 40, the risk of medical problems is so high that pregnancy is inadvisable
Read more information and advice on how to lose weight.
Hormone treatment
Some anti-male hormone medication can be used to block the 'masculine effects' of hormones, such as testosterone, which can cause some of the symptoms of PCOS (particularly excess facial hair and loss of hair from the head). These medications include:
Hormone treatment can also control irregular or absent periods. The contraceptive pill may be recommended to induce regular periods. This will also reduce your long-term risk of cancer of the womb lining (endometrial cancer) if you don't have periods.
Gonadotrophins (hormones produced by the body that stimulate the ovaries) may be recommended for some women with PCOS who haven't responded to clomifene (see below). However, there's a risk that gonadotrophins may overstimulate the ovary and lead to multiple pregnancies. An alternative to this treatment is surgery (see below).
Clomifene
If you're trying to conceive but not ovulating, your ovaries can be stimulated with a fertility drug called clomifene.
Clomifene corrects your hormone imbalance and makes you more likely to ovulate, therefore improving your fertility.
Diabetes medications
A diabetes medication called metformin can increase ovulation in women with PCOS, along with other treatments. It may also reduce health risks from insulin resistance and the effect of abnormal levels of male hormones. It can be taken with clomifene.
However, metformin is not a weight loss drug.
Eflornithine
Eflornithine is a cream that blocks the action of an enzyme found in hair follicles that is needed for hair growth. The cream slows down the growth of unwanted facial hair, which may be a symptom of PCOS.
However, it 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 as early as four to eight weeks after treatment.
Surgery
A minor surgical procedure called laparoscopic ovarian drilling (LOD) may be a treatment option.
Under general anaesthetic, your doctor will make a small cut in your lower abdomen and pass a long telescope called a laparoscope through into your abdomen. The ovaries are then surgically treated using heat or a laser.
The aim is 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 therefore restores the normal function of your ovaries.
The National Institute for Clinical Excellence (NICE) guidance recommends that women with PCOS who haven't responded to clomifene should be offered LOD because it is as effective as gonadotrophin treatment (see above) and is not associated with multiple pregnancy.
Other medications
- If you're overweight you may be prescribed a weight-loss medication, such as orlistat.
- If you have high levels of cholesterol in your blood, you may be prescribed a cholesterol-lowering medication (statin) such as simvastatin. This is unlikely to be prescribed if you're still planning on having a baby.
- You may also be offered treatment for acne.
