How Is Polycystic Ovary Syndrome (PCOS) Treated? Everyday Health MenuNewslettersSearch PCOS How Is Polycystic Ovary Syndrome PCOS Treated Exactly By Jessica MigalaMedically Reviewed by Kacy Church, MDReviewed: June 4, 2018Medically ReviewedBirth control and weight loss are two treatment options for PCOS.iStock.com; Shutterstock Polycystic ovary syndrome (PCOS) can be a daunting diagnosis to receive. The National Polycystic Ovary Syndrome Association defines the condition as a “genetic, hormonal, metabolic, and reproductive disorder that affects women.” (1) One in 10 women have it (about half don’t know it), and the complications can include infertility, obesity, and mood disorders. Excess androgens (male hormones) and insulin resistance (leading to higher levels of insulin) in PCOS cause symptoms such as unwanted hair growth, acne, male-pattern hair loss, and irregular periods, while increasing the risk for insulin resistance and type 2 diabetes. (1,2) The unfortunate truth is that there is no cure for PCOS. But because the disorder can have a profound effect on your health and well-being, treatment is a must. There is one important thing to know about your options: Because the cause of PCOS is still unknown, appropriate therapies are based on a woman’s individual concerns. Is she bothered most about excess hair growth? Does she want to have a baby? Does she need to get her periods back on track? “There is no boilerplate treatment,” says Andrea E. Dunaif, MD, professor of medicine and chief of the Hilda and J. Lester Gabrilove Division of endocrinology, diabetes, and bone disease for the Mount Sinai Health System in New York City. Most Recent in Women s Health Home Remedies for Vaginal Yeast Infections Coping With Hot Flashes and Other Menopausal Symptoms What 15 Celebrities Said Preventing Vaginal Yeast Infections Women s Health Worsened in 2021 as Many Women Lack Access to Health Screenings and Preventive Care PCOS Medication Options to Discuss With Your DoctorOne option is taking a medication used to target specific symptoms. It’s important to know that there are no drugs that the Food and Drug Administration has approved specifically for PCOS, she adds, meaning these options are prescribed off-label. Here are the ones you might talk about with your healthcare team: Glucophage metformin Metformin is among one of the main treatments to target insulin resistance if you have prediabetes or diabetes, including because of PCOS. The advice is controversial, but some physicians believe that PCOS always requires metformin, notes Dr. Dunaif. “There’s no reason to give every woman with PCOS metformin. It’s a good and safe drug, but there’s no point in taking it if you don’t need it,” she says. (She notes that it has such a good safety profile that even when overprescribed, it doesn’t cause any harm.) But it’s not a good way to reduce the male hormone symptoms, like excess hair growth. Aldactone spironolactone This was originally developed as a blood pressure medication and diuretic for hormonal forms of high blood pressure (hypertension) and fluid retention. “Turns out, in high doses, it’s very good at blocking male hormones,” explains Dunaif. For that reason, it’s used to target excess hair growth, a symptom of PCOS that can be particularly embarrassing. The catch is that it’s not safe in pregnancy, as it can cross the placenta and harm a fetus. For that reason, doctors prescribe spironolactone along with combination estrogen-progesterone birth control pills. If a woman doesn’t want to take these, they have other options, like a progesterone-releasing intrauterine device (IUD). The benefit of using combination birth control pills and spironolactone is that they work even better together, she says.More on IUDs, a Possible PCOS Treatment What s New With IUDs for Birth ControlOne note: “It takes about six months before the effect of these medications are seen on hair growth,” says David A. Ehrmann, MD, director of the University of Chicago Center for PCOS in Illinois. (This is because one hair growth cycle takes two to three months.) “When patients don’t know that, they get frustrated when they don’t see results quickly,” he says. Talk to your doctor about what you can realistically expect and when. Hormonal Birth Control Pills Combination birth control pills — those with estrogen and Prometrium (progesterone) — are frequently prescribed to women with PCOS not looking to get pregnant. If the main concern is irregular periods and the resulting potential health risks, this is a great option. “Birth control pills are very good for protecting the lining of the uterus in women who are chronically anovulatory,” says Dunaif. When a woman isn’t ovulating regularly, the lining of her uterus (the endometrium) isn’t being exposed to the normal patterns of estrogen and progesterone. With no progesterone exposure, the lining won’t shed completely (when it sheds, that’s what women see as their period). “If this goes on, a woman can develop endometrial hyperplasia and even endometrial cancer,” she adds. (Endometrial hyperplasia is when the lining of the uterus is abnormally thick, most likely due to estrogen without progesterone exposure, and it can lead to uterine cancer.) (3)More on Menstruation Trouble and Pain 7 Reasons You Have Period PainA woman should shed this lining at least four times a year, says Dunaif. One option: taking progesterone (often called a “progesterone challenge”). But the resulting bleed can be heavy for some women. Another: Take birth control pills to get the regular cycle back online. These have the added benefit of lowering male hormones, too. What’s more, there are noted benefits of taking hormonal birth control that are true across the board, like getting regular, predictable periods and having up to a 20 and 50 percent lower risk of colon (colorectal) cancer and ovarian cancer, respectively. (4) A final word on birth control pills, as they can make insulin resistance worse, something that would appear to be particularly harmful for women with PCOS, as insulin resistance is the hallmark of type 2 diabetes — and women with PCOS are already believed to be at a higher risk of this form of diabetes. But these worries are largely unfounded, notes Dunaif. “There’s no data to support that taking them increases the risk of diabetes. This is a good therapeutic option for young women,” she says. Editor s Picks on PCOS and Related Conditions How PCOS and Type 2 Diabetes May Be Linked and Why It Matters PCOS Affects Women s Mental Health and Baby s Risk for ADHD and Autism Heat Therapy May Help Lower Type 2 Diabetes Risk in Some Women With PCOS PCOS Plus 7 Other Health Conditions Linked to Psoriasis Clomid clomiphene or Femara letrozole “There are very good fertility options for PCOS women that have been well studied with randomized clinical trials,” says Dunaif. If a woman wants to become pregnant, her doctor may prescribe oral medication that work very well to induce ovulation, like clomid or letrozole (traditionally a breast cancer treatment but is now also used off-label to stimulate ovulation). Injectable gonadotrophins may also be used, as well as in vitro fertilization (IVF). With all of these options, it can’t be stressed enough that a woman will be making a choice about what’s most important to her in the moment. If a woman wants to get pregnant, she can’t also treat male hormone problems (excess hair growth, male-pattern hair loss, acne) simultaneously — those are two conflicting goals. But there’s a bright spot: Once she does get pregnant, the high levels of estrogen in her system help suppress hair growth, notes Dunaif. Nonmedication Options for Treating PCOS to Ask Your Doctor About There are also experts who suggest taking more of a lifestyle treatment approach rather than medication, which some call a “Band-Aid” to symptoms. One such expert is Amy Medling, a certified health coach who is founder of PCOS Diva and author of Healing PCOS: A 21-Day Plan for Reclaiming Your Health and Life with Polycystic Ovary Syndrome. She stresses that some women don’t feel well on some of these drugs (she was one of them), so looking at other ways to manage PCOS will get them to a more balanced place. “I hear from many women who are frustrated and hopeless and feel underserved by the mainstream way of managing PCOS,” says Medling. There are real side effects to any medication. Talking to your healthcare team about your concerns and options is the best way to get to a treatment plan that is tailored to your needs. If you’re looking to help treat PCOS symptoms without taking a prescription medication, consider looking into these holistic and practical steps with your doctor’s help: Lose Weight Aim for shedding seven percent of body weight, says Dr. Ehrmann. “This can help enormously with regulating the menstrual cycle. It will put a woman closer to the point where she will ovulate on her own,” he says. As for how to do it, long-term weight loss can be difficult. One thing is for sure, though: A restricted diet won’t cut it. Changing your eating habits means making tweaks and adopting a balanced diet that you can stick with long-term. Key to making lasting changes is “shifting your mindset on the way you view food,” says Medling. Do this by packing your diet with nourishing foods, which will naturally crowd out the unhealthy stuff without making you feel deprived. The Weight Loss Plans to Try and the Fad Diets to Skip if You Want to See Results There are numerous diet programs out there. How do you know which is best for you? This detailed guide is a great place to start your research.Article Try an Anti-Inflammatory DietAlong with the hormonal imbalance and insulin resistance, Medling says that chronic, low-grade inflammation is the third player in the syndrome. (5) Follow an anti-inflammatory diet, which includes nutrient and fiber-rich produce that are low on the glycemic index (like apples and berries), grass-fed meats, organic poultry, as well as sources of omega-3s (like chia seeds and fatty fish) and avoids inflammatory, heavily processed foods, like french fries, potato chips, cake, and cookies. You’ll also want to keep track of foods that bother you (like if dairy gives you gas) and avoid those to help you feel better, she says. (6) Lower Stress br class lsbr Stress exacerbates inflammation. (7) “Put yourself first and make sure your needs are met,” says Medling. You can do this by practicing self-care, which means carrying out small acts that make you feel less stressed and more balanced. This may be via mediation, exercise, or getting in tune with hobbies you love. “Anxiety is one of the key symptoms of PCOS. By reducing stress, you can reduce inflammation and better your hormonal balance,” she says. (8,9) Most Popular in Women s Health 10 Ways to Help Relieve Period Cramps 8 Rules for a Healthy Vagina Home Remedies for Vaginal Yeast Infections 4 Hidden Causes of Bladder Pain and When to See a Doctor Take Vitamin DIf you are looking to become pregnant, a vitamin D deficiency can decrease your chances of success by 40 percent, according to preliminary research. Taking vitamin D supplements and eating more food sources of vitamin D (fortified milk and yogurt, sardines, and salmon) can get your stores up. (10) Resources We LoveMayo ClinicMedline PlusNational Library of MedicineOffice on Women’s HealthPCOS Awareness AssociationPlanned ParenthoodNEWSLETTERS Sign up for our Women' s Health Newsletter SubscribeBy subscribing you agree to the Terms of Use and Privacy Policy. Editorial Sources and Fact-Checking ReferencesWhat is PCOS? The National Polycystic Ovary Syndrome Association.PCOS Symptoms. PCOS Awareness Association.Endometrial Hyperplasia. The American College of Obstetricians and Gynecologists. May 2011.Oral Contraceptives and Cancer Risk. National Cancer Institute. February 2018.Duleba AJ, Dokras A. Is PCOS an Inflammatory Process? Fertility and Sterility. January 2013.Tremellen K, Pearce K. Dysbiosis of Gut Microbiota (DOGMA) — A Novel Theory for the Development of Polycystic Ovarian Syndrome. Medical Hypothesis. July 2012.Cohen S, Janicki-Deverts D, Doyle WJ, et al. Chronic Stress, Glucocorticoid Receptor Resistance, Inflammation, and Disease Risk. PNAS. April 2012.McCook JG, Bailey BA, Williams SL, et al. Differential Contributions of Polycystic Ovary Syndrome (PCOS) Manifestations to Psychological Symptoms. The Journal of Behavioral Health Services & Research. July 2015.Zangeneh FZ, Jafarabadi M, Naghizadeh MM, et al. Psychological Distress in Women With Polycystic Ovary Syndrome from Imam Khomeini Hospital, Tehran. Journal of Reproduction & Infertility. April-June 2012.Vitamin D May Be Key for Pregnant Women With Polycystic Ovary Syndrome. Penn Medicine News Release. November 2017.Show Less The Latest in PCOS What Is PCOS Symptoms Causes Diagnosis Treatment and PreventionBy Jessica MigalaSeptember 10, 2020 Genetic Differences Suggest There May Be 2 Types of PCOSGenetic differences in women with polycystic ovary syndrome (PCOS) could affect their risk for infertility and type 2 diabetes. Experts say that the insights...By Sheryl Huggins SalomonJune 29, 2020 What Causes PCOS 7 Factors That May Affect Your RiskBy Jessica MigalaJune 1, 2018 12 Common Myths About PCOS — and the Facts Every Woman Should KnowBy Jessica MigalaJune 1, 2018 What Are the Symptoms of PCOS and How Is the Health Condition Diagnosed By Jessica MigalaMay 31, 2018 7 Simple Steps for Building a PCOS Meal PlanBy Jessica MigalaMay 31, 2018 How PCOS Leads to Infertility and the Treatment Options That Can Increase Your Chances of Getting PregnantBy Jessica MigalaMay 30, 2018 Hot Tub Soaks Improve Type 2 Diabetes Risk and Health Markers in Some Women Study SaysNew research explores specific health benefits from hot water immersion therapy.By Beth LevineApril 24, 2018 PCOS Affects Women s Mental Health and Baby s Risk for ADHD and AutismA new study reveals this condition impacts more than a woman’s fertility.By Julie Lynn MarksApril 10, 2018 Women s Health Worsened in 2021 as Many Women Lack Access to Health Screenings and Preventive CareNew global report shows that despite heavy spending, the United States lags behind other wealthy countries.By Becky UphamSeptember 27, 2022 MORE IN 9 Things Your Teen Should Know Before They Leave for College A Post-Roe Checklist Everything You Need to Know About Emergency Contraception First FDA-Approved Birth Control Wearable Tech Hits the Market