The principle of the treatment of PCOS is to manage the current symptoms being experienced by the patient. The main symptoms that need treating are:
Systemic Treatment options for hirsutism and acne
The aim of systemic therapy is to suppress the ovarian testosterone production using oestrogens or anti-androgen drugs. The treatment options include:
Local Treatment options for hirsutism
The problem with the majority of these techniques is that they require repeated use. Electrolysis can give some permanent hair reduction but is not available on the NHS.
The principle of the use of this drug in PCOS is that it reduces insulin resistance and so may break the chain of events resulting the syndrome. There is evidence that metformin reduces insulin and testosterone levels and hence may improve menstrual irregularity, reduce hirsutism and weight.
The most important first step in the treatment of an overweight woman with PCOS is weight loss. There is now evidence that a combination of dietary advice and weight loss can improve ovulation and pregnancy rates in anovulatory obese woman.
Clomiphene is the first line drug in anovulatory infertility. Clomiphene is a potent anti-oestrogen which blocks the oestrogen feedback to the pituitary. This inhibition results in an increase in LH and FSH, which in turn stimulates ovulation.
Up to 12 cycles of clomiphene may be offered to patients before other medical treatments may be tried. Other medical treatments include the administration of exogenous gonadotrophins.
CAUTION: It is important to remember that all these medical therapies can result in multiple pregnancies and ovarian hyperstimulation (a potentially life threatening complication characterised by cystic ovarian enlargement). For these reasons it is important that care is monitored by experienced fertility specialists.
This is a controversial technique which uses laparoscopic (key-hole) surgery to cut a wedge in or burn small holes in the ovary. The principle of this technique is to reduce the androgen production by the ovary. At the moment there is insufficient evidence in clinical trials to show that this technique is effective.