Treatment

Polycystic ovary syndrome (PCOS) can't be cured, but the symptoms can be managed.

Treatment options can vary because someone with PCOS may experience a range of symptoms, or just one.

The main treatment options are discussed in more detail below.

Lifestyle changes

In overweight women, the symptoms and overall risk of developing long-term health problemsfrom PCOS can be greatly improved by losing excess weight. Weight loss of just 5% can lead to a significant improvement in PCOS.

You can find out whether you're a healthy weight by calculating your body mass index (BMI) , which is a measurement of your weight in relation to your height. Anormal BMIis 18.5-24.9. Usethe BMI healthy weight calculator to work out whether your BMI is in the healthy range.

You can lose weight by exercising regularly and having a healthy, balanced diet . Your diet should include plenty of fruit and vegetables, (at least five portions a day ),whole foods (such as wholemeal bread, wholegrain cereals and brown rice), lean meats, fish and chicken. Your GP may be able to refer you to a dietitian if you need specific dietary advice.

These are described below.

Irregular or absent periods

The contraceptive pill may be recommended to induce regular periods, or periods may be induced using anintermittent course of progestogen tablets (which are usually given every three to four months, but can be given monthly).

This will also reduce the long-term risk of developing cancer of the womb lining (endometrial cancer) associated with not having regular periods. Other hormonal methods of contraception, such as an intrauterine (IUS) system , will also reduce this riskby keeping the womb lining thin, but they may not cause periods.

Fertility problems

With treatment, most women with PCOSare able toget pregnant.

The majority of women can be successfully treated with a short course of tablets taken at the beginning of each cycle for several cycles. If these aren't successful, you may be offered injections or IVF treatment. There's an increased risk of multiple pregnancy (rarely more than twins) with these treatments.

A medication calledclomifeneis usually the first treatment recommended for women with PCOS who are trying to get pregnant. Clomifene encourages the monthly release of an egg from the ovaries (ovulation).

If clomifene is unsuccessful in encouraging ovulation, another medication called metformin may be recommended.Metformin is often used to treat type 2 diabetes , butit can also lower insulin and blood sugar levels in women with PCOS.

As well as stimulating ovulation, encouraging regular monthly periods and lowering the risk of miscarriage , metformin canalso have other, long-termhealth benefits, such as lowering high cholesterol levels and reducing the risk of heart disease .

Metformin isn't licensed for treating PCOS in the UK, but because many women with PCOS have insulin resistance, it can be used" off-label " to encourage fertility and control the symptoms of PCOS . Possible side effects of metformin include nausea, vomiting, stomach pain, diarrhoea and loss of appetite.

As metformin can stimulate fertility, if you're considering using itfor PCOS and aren't trying to get pregnant, make sure you use suitable contraception if you're sexually active.

TheNational Institute for Health and Care and Excellence (NICE) has more information about the use of metformin for treating PCOS in women who aren'ttrying to get pregnant , including a summary of the possible benefits and harms .

Letrozole and tamoxifen are sometimes used to stimulate ovulation instead of clomifene. These medications can also be used for treating breast cancer . Use of letrozole for fertility treatment is off-label. This means that the medication's manufacturer hasn't applied for a licence for it to be used to treat PCOS.

In other words, althoughletrozole is licensed for treating breast cancer, it doesn't have a licensefor treating PCOS. Doctors sometimes use an unlicensed medication if they think it's likely to be effective and the benefits of treatment outweigh any associated risks.

These are given by injection and there's a higher risk that they may overstimulateyour ovaries and lead to multiple pregnancies.

An alternative to gonadotrophins is a surgical procedure called laparoscopic ovarian drilling(see below). This treatment can be as effective as using gonadotrophins, but it doesn't increase your risk of multiple pregnancies.

It's likely that a fertility specialist will check that your fallopian tubes aren't blocked before most of these treatments areused.

This cream 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 four to eight weeks after treatment with this medication.

However, eflornithine cream isn't always available on the NHS, because some local NHS authorities have decided it's not effective enough to justify NHS prescription.

If you have unwanted hair growth, you'll probably also want to use a method of physically removing the excess hair (such as plucking, shaving, threading, creams or laser removal).Laser removal of facial hair maybe available on the NHS in some parts of the UK.

Other symptoms

Medications can also be used to treat some of the other problems associated with PCOS, including:

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

Surgery

A minor surgical procedure called laparoscopic ovarian drilling (LOD) may be a treatment option for fertility problems associated with PCOS.

Under general anaesthetic , your doctor will make a small cut in your lower abdomen (tummy) and pass a long, thinmicroscope called a laparoscope through into your abdomen. The ovaries will then be surgically treated using heat or a laser 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 andcan restore the normal function of your ovaries.