Treatment - Polycystic ovary syndrome (PCOS)

There is no cure for polycystic ovary syndrome (PCOS). But you can manage the symptoms.

If you want to get pregnant, you you might need to make some significant changes in your lifestyle and maintain or reach a normal weight.

You may experience a range of symptoms or only one. So treatment options can vary.

Read about symptoms of PCOS

Lifestyle changes

You can improve symptoms and long-term health problems by losing excess weight. Weight loss of 5% to 10% can make a big improvement. Being overweight reduces significantly your chances of conceiving.

BMI is a measurement of your weight in relation to your height. A normal BMI is between 18.5 and 24.9.

You can use a BMI calculator to check your BMI.

Diet

You can lose weight by eating a healthy, balanced diet and exercising regularly.

Your diet should include:

• plenty of fruit and vegetables
• whole foods such as wholemeal bread, wholegrain cereals and brown rice
• lean meats, fish and chicken

Some research shows that low GI (low glycaemic index) foods may be helpful for PCOS.

Low GI foods are absorbed more slowly. This means your blood sugar stays stable.

Examples of low GI foods include:

• wholemeal bread
• pasta
• rice
• most fruits, vegetables and pulses

Joining a structured weight loss programme or getting advice from a dietitian can also be helpful in losing weight.

Exercise

You should try and do 30 minutes of moderate intensity exercise five times per week. But do what you can. Even 10-15 minutes of exercise is better than nothing.

Moderate intensity means that you are breathing faster, feel warmer and may even be sweating. Brisk walking is an example of moderate intensity exercise.

Fertility and weight loss

If you are overweight and are not ovulating, losing weight can mean that you begin ovulating again. It improves your fertility.

Being overweight increases you risks of miscarriage, diabetes, clots, high blood pressure, fits and death during pregnancy. This is why loosing weight before attempting to conceive offers a better chance to get pregnant but also a safer pregnancy.

Some women with PCOS find it hard to lose weight. Speak to your GP or your practice nurse who can support you with this.

Your GP may be able to refer you to a dietitian if you need specific dietary advice.

Medication for irregular or absent periods

You may need a contraceptive pill to induce regular periods. You can also use progestogen tablets.

Medication will also reduce the risk of developing endometrial cancer (cancer of the womb). This is linked with not having regular periods.

Other hormonal contraception may reduce this risk, by keeping the womb lining thin. For example, an intrauterine system (IUS). But they may not cause periods.

Medication for fertility problems

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

Treatment can be a short course of tablets. You take these at the beginning of each menstrual cycle for a few months.

If these are not successful, you may need injections or IVF treatment. There's an increased risk of a multiple pregnancy with these treatments.

Clomiphene

Clomiphene is a treatment prescribed to most women with PCOS who are hoping to become pregnant. It encourages ovulation.

Metformin

Another tablet that you may be prescribed is metformin. This can help to lower your insulin levels and stimulate fertility.

Letrozole

Letrozole is sometimes used to stimulate ovulation instead of clomifene.

Gonadotrophins

You may not get pregnant after taking oral medications. If so, you may need gonadotrophins. You will get these through an injection.

There's a higher risk that they may overstimulate your ovaries. This can lead to multiple pregnancies.

Medication for unwanted hair growth and hair loss

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

• a combination of oral contraceptive tablets
• cyproterone acetate
• spironolactone
• finasteride

These medications work by blocking the effects of male hormones, such as testosterone. Some also suppress the production of these hormones by the ovaries.

Eflornithine is a cream that can slow down the growth of unwanted facial hair. This cream does not remove hair or cure unwanted facial hair. You may wish to use it alongside a hair removal product. You may see improvements between 4 to 8 weeks after treatment with this medication.

If you have unwanted hair growth, you may also want to remove the excess hair. You can do this by using methods such as plucking, shaving, threading, creams or laser removal.

Medication for other symptoms

Medications can also treat some of the other problems associated with PCOS.

These include:

• weight-loss medication, such as orlistat, if you're overweight
• cholesterol-lowering medication (such as statins) if you have high levels of cholesterol in your blood
• acne treatments

Surgery

A surgical procedure called laparoscopic ovarian drilling (LOD) may be a treatment option. This is for fertility problems with PCOS that do not respond to medication.

Under general anaesthetic, your doctor will make a small cut in your tummy. They will pass a laparoscope (thin microscope) into your tummy.

The ovaries will then be surgically treated using heat or a laser by placing 4 to 5 small openings into the surface of one of your ovaries. This will destroy the tissue that's producing androgens (male hormones).

LOD can lower levels of testosterone and luteinising hormone (LH). It can raise levels of follicle-stimulating hormone (FSH).

This corrects your hormone imbalance. It can restore the normal function of your ovaries.

Pregnancy risks

If you have PCOS, you have a higher risk of pregnancy complications.

For example:

• high blood pressure (hypertension)
• pre-eclampsia
• gestational diabetes
• 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.

Read more about PCOS