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How Is Polycystic Ovary Syndrome (PCOS) Treated?

Natural treatments for PCOS can improve many PCOS symptoms for some; others may need PCOS medication to help manage certain related risks.

Healthy choices aren’t just common sense when you have PCOS. Eating wisely, being physically active, sleeping well, and managing your stress can help reverse the hormone imbalances at the center of polycystic ovary syndrome and the symptoms those hormone changes cause.

Research shows over and over again that managing your weight, even shedding a small percentage of your excess pounds (ie, abdominal fat) and exercising regularly can improve symptoms such as irregular periods and infertility, and improve the effectiveness of medications used to help manage your glucose and improve insulin resistance in polycystic ovary syndrome (PCOS).

And that’s not all. Nurturing your health with smart daily choices also helps protect against heart disease and diabetes, major health risks for women with PCOS. And while there’s little research specifically in PCOS, a healthy diet plus exercise and stress reduction are also proven to help lift anxiety and depression, improve sleep, reduce fatigue and boost energy – additional pluses that can help you feel great.

Wise food choices and more activity might reverse some symptoms of polycystic ovary syndrome.Healthy food choices and more activity might reverse some symptoms of polycystic ovary syndrome.

Begin a PCOS-Worthy Diet to Promote Gentle Weight Loss

Here’s How to Get Started: 

If you’re overweight, many of symptoms will improve if you can lose just a little. Dropping just 5 to 10% of your body weight (9 to 18 pounds if you now weigh 180) can make your body more sensitive to insulin (reducing the insulin resistance behind PCOS), lead to more regular menstrual cycles, and could even help control severe acne and excess hair growth,1 according to the American College of Obstetricians and Gynecologists (ACOG).

No wonder adjusting your eating plan and establishing a workout routine to help you safely and wisely lose even a little body fat is the top, “do this first” recommendation from ACOG and other major medical organizations including the Endocrine Society and the American Association of Clinical Endocrinologists.2  

Weight loss is also a key first step if you’re planning a pregnancy. It may improve your ability to get pregnant by restoring ovulation3 or make your body more responsive to fertility treatments if that is what is determined you need. In fact, up to 75 percent of women with PCOS who were able to reduce their body weight also had better glucose control and improved androgen hormone levels, helping to restore ovulation and fertility,2,3 experts say.  

In a study carried out at Penn State University,4 women with PCOS, ages 18-40, those who lost ~7% of their body weight before beginning fertility treatments were more than twice as likely to go on to have a baby compared to those who took birth-control pills to get ready for fertility treatment. (Oral contraceptives are often used this way.)

Results of a second study by the same research team offer doctors a clear strategy to help you lose weight.5 According to this study at Penn State Health in Philadelphia, patients who worked with their physician to follow a limited fat, low calorie diet (~1200 calories) by relying on low-calorie prepared meals (eg, SmartOnes, Lean Cuisine or Healthy Choice) and an appetite suppressant with meals and making lifestyle changes plus added fruits and vegetables.4

Revving Your Metabolism Will Help You Manage Your Weight 

The lifestyle adjustments focus on creating a personal physical activity plan that is moderately intense (ie, a brisk walk or similar type activity) for 30 minutes during five days of the week. You will be encouraged to keep a journal or chart showing the type of exercise and length of time you spend exercising.5

While very hard to do, the good news is even a little weight loss helps. Studies show women who lose just two to five percent of their weight (31/2 to 9 pounds if you weigh 180) saw benefits including drops in levels of testosterone and insulin, a rise in levels of the ovulation-promoting hormone SHBG, and more regular ovulation. 4-6

What matters most: Your goal when losing weight is to aim specifically to reduce the fat around your abdomen (belly fat). This requires boosting your metabolism like women who had PCOS did in an Italian weight loss study.7 Those who rode exercise bikes for 30 minutes, three times a week, lost more abdominal fat than those who shed pounds by just eating less.7 You won’t be successful if you only change your diet. More women in the exercise group than the diet group began ovulating even though both groups lost similar amounts of weight.7

What is the Best Diet? You Choose.  

You heard that right. But first, don’t believe what you may have heard about special diets for polycystic ovary syndrome. Some women lose more weight and feel better on a higher-protein, lower-carbohydrate plan, but the research isn’t conclusive. Remember, the Penn State researchers found a low-calorie, low-fat meal replacement diet proved successful for some women but there is no one perfect diet that will be right for everyone.8 In fact, when researchers from Australia’s University of Adelaide and Monash University reviewed five PCOS diet studies involving 137 women, they concluded that PCOS symptoms improved on any diet the women followed.9

Certainly, an eating plan that packs in plenty of plant foods (vegetables, fruit, nuts, legumes) along with good fats, healthy lean proteins, and low-fat dairy or calcium-rich dairy alternatives is a good start. What matters is picking a plan you can stick with— not just to lose weight— but to become how you eat long into the future.

In several diet studies, 10-12 researchers have found high drop-out rates among women with PCOS -- so find an eating plan you like—and make sure you have plenty of support to help you stay with it, as that is the key to success.

One strategy that may help some of you: Have a big breakfast. When a group of normal weight women with PCOS got a whopping half of their daily calories first thing in the morning, insulin levels dropped 8% and testosterone levels fell 50% in three months.13 And that’s not all. These women ovulated more frequently and had improved insulin sensitivity in comparison to another group of women in the study who more of their calories at dinner.13

Fit in Physical Activity, Your Way.

A stroll around the block with your dog (spouse/significant other, neighbor, or exercise buddy), your favorite exercise class at the gym, following a video at home, or peddling on an exercise bike while you watch TV…whatever you choose to get you moving will be good.14 Aim to fit in at least 30 minutes, five times a week – the basic recommendations from the US Centers for Disease Control and Prevention.15

Getting three hours of exercise a week is enough to improve insulin sensitivity in women with PCOS, especially if you have been inactive up until now. Exercise can help you lose more weight, but more importantly, it can also help you lose the fat around your abdomen – that’s what contributes directly to insulin resistance, which fuels PCOS symptoms – even if you don’t lose any weight. That’s what happened in a 2017 small Monash University study.16  Women in this study added interval training (ie, short bursts of high-intensity exercise followed by regular or moderate intensity intervals) for part of their workout.16

Relieve stress. Depression and anxiety are more common in women with PCOS than in women without this condition. Hormone imbalances may affect your moods – and the struggles of learning to cope with the challenges of PCOS can certainly play a role in mood swings. Relaxation to the rescue!

Here are two strategies to consider but the best technique is the one that appeals most to you.

  • Simple yoga poses ease tension, based a study of 90 teens with PCOS from SVYASA University in India that was published in the International Journal of Yoga.17
  • Mindfulness-based stress reduction brings calm, lessening the sense of stress, and improves blood-sugar levels, according to a Penn State University study of 86 overweight and obese women. Although these women did not have PCOS, this simple technique – sit in a quiet, comfortable spot and follow your breath – could help you, too.18

What Are the Currently Recommended Medications? 

For some, lifestyle changes may be all you need to control the symptoms of your PCOS. But for many other women, medications may be necessary to help control harder to manage symptoms, such as fertility, and major risk factors that arise with polycystic ovary syndrome, specifically insulin resistance that leads to diabetes and high blood cholesterol that may end up developing into heart disease.

The best strategies for these PCOS-related symptoms will be considered after assessing your symptoms, your level of risk for these other conditions, and what you want to address most urgently.

Commonly prescribed medications include:

  • Combination birth control pills: Oral contraceptives (OCs) containing estrogen plus progestin help you manage PCOS symptoms by normalizing your menstrual cycle. By reducing levels of male hormones, OCs can help control excess hair growth and acne, too. You’ll usually shed the lining of your uterus every 28 days while taking an oral contraceptive, which also reduces your risk for endometrial cancer. Oral contraceptive pills are sometimes prescribed for women before they begin fertility treatment because these female hormones reduce the “male” androgen levels. But it’s important to know that they won’t help restore ovulation.19
  • Insulin-sensitizing drugs. A particular medication, called metformin, is usually prescribed.20 Another medication, pioglitazone (Actos) may also be suggested for women with PCOS. These two medications are FDA-approved for diabetes treatment, but plenty of research shows they can be equally effective for women with PCOS, too. These insulin-sensitizing medications can help your body respond more readily to insulin, and better control your glucose levels. Both metformin and pioglitazone can reduce the insulin resistance and high insulin levels that commonly occur with PCOS, and in turn, can reduce high androgen levels.

As a result, these anti-diabetes medications may improve ovulation and help make menstrual periods more regular, but this process can take four to six months. Also, while these medications can work well for some women, these medications don’t help every woman.

While taking metformin or pioglitazone, the American College of Obstetricians and Gynecologists warns doctors that women who start insulin-sensitizing agents should consider using birth control pills if they are sexually active but don’t want to become pregnant.19 The reason: Women who take these medications may start ovulating again.

The bonus: By reducing the high levels of androgens, these medications can also help take care of acne, excess hair growth, hair loss at the scalp, may promote easier weight loss, reduce high cholesterol levels, and may even reduce the risk for heart disease, too.

Fertility Treatments: Once other possible reasons for infertility in you and your partner have been ruled out, your gynecologist or fertility specialist may recommend the drug clomiphene (Clomid) to induce ovulation. Six months of treatment has been known to achieve successful pregnancies for about 20-40% of women with PCOS,19 according to ACOG. If clomiphene is tried and isn’t effective, you may be given gonadotrophins to try and jumpstart your ovaries.

If these standard treatments don’t work, your doctor may recommend in vitro fertilization (IVF). Your egg is fertilized by your partner’s sperm in a lab, then transferred to your uterus to implant and grow. Your doctor may also recommend a surgical procedure called ovarian “drilling”. Lasers, or a very thin, heated needle, are used to pierce several holes in the surface of your ovary, which improves the chances of successful ovulation for about six to eight months. This is specifically effective for women with PCOS since the outer surface of the ovaries can become extra thick, interfering with the natural process of ovulation.

Removing or slowing the growth of excess hair.  Shaving, bleaching, plucking, waxing, and applying over-the-counter hair-removal creams are effective, albeit temporarily methods to get rid of unwanted excess hair. For more permanent results, you might try laser hair removal or electrolysis but these are expensive, require repeated treatments, and are not guaranteed to be successful.

The prescription cream eflornithine HCl can slow the growth of new hair when applied as directed on the face and other areas – but it won’t remove existing hair. 20,21 Your doctor may also prescribe a medication called an anti-androgen. In the United States, a medication called spironolactone is used to slow new hair growth. In other countries, cyproterone acetate is widely used but it is not available in the United States.  

Since many anti-androgens appear to cause birth defects, your doctor will likely recommend taking birth-control pills at the same time. It can take six months to see if these drugs are helpful in reducing hair growth.21

Acne: Birth-control pills, anti-androgen drugs and insulin-sensitizing drugs, all mentioned above, can bring the severe acne of PCOS under control by reducing the high levels of male hormones that trigger bad break-outs in PCOS. In addition, your family doctor or dermatologist may recommend additional acne medications to unclog pores, control skin bacteria and soothe inflammation. These may include retinoids, antibiotics, and products to help unclog pores. One warning: Retinoids can cause birth defects and cannot be used if you are already pregnant or are planning to become pregnant.

 In the final section, you will learn about resources to help you find the right doctor to address your PCOS symptoms and reduce your risks for chronic diseases, and how to stay positive during this journey. 

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If I Have PCOS, How Do I Find the Right Doctor?