PCOS treatment depends on the specific goals and characteristics of the patient
The way your doctor will prescribe PCOS treatment depends on your goals, specifically are you seeking pregnancy or just to alleviate symptoms. Additionally, your weight has a large impact on the treatment prescribed.
Patient Desires Fertility and is Normal Weight
Ovulation induction using fertility drugs are indicated if you are infertile due to polycystic ovary syndrome and are of normal weight. These medications are used to regulate or induce ovulation. In general, they are designed to work like your own hormones. Fertility drugs are either used alone or in combinations depending on the reason for your ovulatory problem. Currently used fertility medications may include clomiphene citrate (Clomid®, Serophene®), gonadotropins, letrozole (Femara®, Amiridex®), bromocriptine (Parlodel®) or cabergoline (Dostinex®).
Patient Desires Fertility and is Overweight
As in the patients who do not desire fertility, the first step of PCOS treatment for overweight patients is addressing any metabolic issues. The same recommendations hold true and the same approach is used. The main difference is with the time frame with which the treatment is completed. If the patient is young (<33 years old), then it makes logical sense to proceed with aggressive weight loss and achieve a more healthy body mass index, a measure of weight in relation to height. With higher BMIs, consideration should be given to aggressive weight loss and then proceeding with ovulation induction and pregnancy. This timeline is very patient dependent and will involve close conversations with your provider to balance your goals for a healthy lifestyle and healthy pregnancy.
There is not an “ideal weight.” Complications from PCOS can affect the ensuing pregnancy regardless of the weight. However, miscarriage, gestational diabetes, hypertension are all significantly increased in patients with a BMI of >40. It is strongly recommended that no attempts with ovulation induction occur when the BMI is >40 (even with patients older than 35). And we have seen improved results with patients who undergo weight loss surgery. However, the best strategy should be determined after a honest dialogue where the patient is open about her dietary and lifestyle habits.
After weight loss, it is recommended to proceed directly with ovulation induction. Some patients may start to ovulate on their own and provided there are no other fertility factors (low sperm count, blocked tubes, advanced reproductive age), it is reasonable to consider waiting for spontaneous conception with timed intercourse.
Patient Does Not Desire Pregnancy and is Normal Weight
If the patient does not desire pregnancy and is not overweight or insulin resistant, a very common approach is to begin treatment with oral contraceptive pills (OCP’s) and specific treatments for any excess hair growth. Birth control pills can help your periods be regular and can reduce symptoms such as excess facial hair and acne. An androgen-lowering medicine, spironolactone, may be used with birth control pills to help reduce symptoms even more. These medicines are not used if you are trying to get pregnant.
It is important to see your doctor for follow-up to make sure treatment is working and to adjust it if needed. You may also need regular tests to check for diabetes, high blood pressure, and other possible problems. In addition, it may take a while for treatments to help with symptoms such as facial hair or acne. In the meantime, over-the-counter or prescription acne medicines may help with skin problems and waxing, tweezing, and shaving are easy ways to get rid of unwanted hair. Electrolysis or laser treatments can permanently remove the hair but are more expensive. Your doctor can also prescribe a skin cream that slows hair growth for as long as you use it regularly.
Patient Does Not Desire Pregnancy and is Overweight
The first step in managing PCOS when you are overweight is to get regular exercise and eat heart-healthy foods. This can help lower blood pressure and cholesterol and reduce the risk of diabetes and heart disease. Try to fit in moderate activity and/or vigorous activity on a regular basis, with a goal of up to 150 minutes per week. Walking is a great exercise that most people can do. Eat a heart-healthy diet. In general, this diet has lots of vegetables, fruits, nuts, beans, and whole grains. It also limits foods that are high in saturated fat, such as meats, cheeses, and fried foods. If you have blood sugar problems, try to eat about the same amount of carbohydrate at each meal. A registered dietitian can help you make a meal plan, but a good rule of thumb is a diet focused in higher protein and fiber, and less in carbohydrates and sugars.
Most women who have PCOS can benefit from losing weight. Even losing 10 lb (4.5 kg) may help get your hormones in balance and regulate your menstrual cycle. PCOS can make it hard to lose weight, so work with your doctor to make a plan that can help you succeed. Additionally, if you smoke, consider quitting. Women who smoke have higher androgen levels that may contribute to PCOS symptoms. Smoking also increases the risk for heart disease.
Though there are many options to choose in losing weight, our physicians have had many patients have success with programs that limit your carbohydrate intake and increase your exercise levels. These weight loss programs encourage healthy living that begins with changes in your eating and ends with habits of health—healthy eating, healthy activity, and healthy sleep. If you have concerns regarding weight or metabolism, talk with one of our physicians or staff members to help get you started.