Management of PCOS

Management of PCOS is tailored towards the individual goals and needs of the patient. Therapy is focused on alleviating symptoms of hyperandrogenism and/or improvement of fertility.  Long-term measures should also be taken to restore regular menstruation to prevent endometrial hyperplasia (4).

Pharmacotherapy 

  • The oral contraceptive pill (OTC) or the levonorgestrel-releasing intrauterine device can help to induce or regulate menstruation (4,7).
  • If fertility is desired, medications including letrozole or clomifene (Clomid) are used for ovulation induction (4).
  • Metformin is used to improve insulin resistance, decrease testosterone levels, promote weight loss and induce ovulation (4,7).
  • Topical therapies for hirsutism include eflornithine and minoxidil (4). 

Surgical Intervention

Laparoscopic ovarian drilling (LOD) uses lasers to reduce the amount of functional ovarian tissue present which in turn reduces androgen production. This has been proven to restore ovulation and result in pregnancy rates of 25% to 65% (4). It is offered when there has been a poor response to medication.

Nutrition & Lifestyle Changes 

People who are overweight or obese should be offered weight loss advice and referral to a dietitian should be considered. Healthy lifestyle changes should be encouraged, focusing on improving diet and activity levels. The health benefits of achieving a 5% weight loss via a healthy energy-restricted diet and regular exercise should be discussed (e.g., reduces hyperinsulinism, can improve menstrual regularity and efficacy of pregnancy, if desired) (7,11). Evidence has shown that low glycemic index (GI) and low carbohydrate dietary interventions have demonstrated improved insulin sensitivity and weight loss, in people with PCOS (12,13).

It should be noted that not all people with PCOS are overweight. Dietary changes, however, can still be beneficial. For example, a Mediterranean diet has been shown to reduce insulin resistance and improve ovarian function and should be encouraged in place of a ’western style’ diet (14). A Mediterranean diet is characterised by one that is high in vegetables, legumes, fruits, nuts, olive oil and fish, with moderate amounts of dairy products and wholegrains, and low in red meat, processed foods and saturated fats.

Mental Health Support

A systematic review found that PCOS is associated with an increased risk of depression or anxiety (15). PCOS affects a person’s life in various ways, such as impacting self-esteem, appearance and/or the ability to start a family. It is inevitable that this will impact mental health. Early screening by healthcare professionals (HCPs) can help people with PCOS to access early and effective interventions.

HCPs can signpost people with PCOS to Verity, the national PCOS charity. The charity hosts an online community to enable people with PCOS to give and receive peer support, which can help break the isolation that often accompanies the diagnosis.

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