Management Medical treatment of PCOS is tailored to the patient’s goals in four main categories:
- lowering of insulin levels,
- restoration of fertility,
- treatment of hirsutism or acne,
- restoration of regular menstruation with prevention of endometrial hyperplasia and cancer.
There is considerable debate as to the optimal treatment. • General interventions that help to reduce weight or insulin resistance can be beneficial for all these aims and interrupt the self-perpetuating cycle of hyperandrogenic chronic anovulation.
1 Oral contraceptives have been the mainstay of long-term management of PCOS by decreasing LH and FSH secretion and ovarian production of androgens, increasing hepatic production of SHBG, decreasing levels of DHEA (dehydroepiandrosterone) and preventing endometrial neoplasia. Cyproteroneacetate(Dianette/Diane), spironolactone, or topical eflornithine may be especially helpful in patientswith excessive hirsutism.
2 Progestins have been shown to suppress pituitary LH and FSH and circulating androgens, but breakthrough bleeding is common.
3 Insulin-sensitizing agents (metformin) decrease circulating androgen levels, improve the ovulation rate, and improve glucose tolerance.
4 Clomiphene citrate has traditionally been the firstline treatment for women desiring pregnancy.
1 Ovarian drilling with laser or diathermy has few advantages over medical therapy for infertility and does not appear to have significant long-term benefits in improving metabolic abnormalities.
2 Mechanical hair removal (laser vaporization, electrolysis, depilatory creams) is often the front line of treatment for hirsutism.