Treatment of PCOS
There are several treatment options for polycystic ovarian syndrome available:
1) Combination oral contraceptives OCP's: (first line) estrogen and progestin are useful for menstrual irregularity and cutaneous manifestations of androgen excess. Progestin inhibits endometrial proliferation, preventing hyperplasia. Estrogen inhibits the activity of the hypothalamic-pituitary- gonadal axis, reducing ovarian androgen production as well as increasing serum sex hormone binding globulin levels. This results in decreased concentrations of unbound testosterone. OCP therapy will normalize androgen levels in most cases within 18 to 21 days. Preparations available include:
Ethynodiol diacetate (1 mg), a progestin of low androgenic potential, is combined with ethinyl estradiol: 35 or 50 mcg (in Demulen1/35 or 1/50, respectively). The 1/50 preparation is useful for patients who require a large dose of estrogen, such as those with obesity or dysfunctional uterine bleeding.
Norgestimate is a potent progestin with low androgenic effect and is combined with ethinyl estradiol: 35 mcg (in Ortho-Tri- Cyclen). It is especially useful for patients with associated acne vulgaris.
Drospirenone, a spironolactone analogue with weakly anti-androgenic and anti-mineralocorticoid properties, is combined with ethinyl estradiol: 30 mcg (in Yasmin), it addresses both menstrual irregularity and hirsutism.
2) Metformin in adolescent PCOS is used as an adjunct to management of obesity and the related insulin-resistant metabolic abnormalities. Metformin tends to suppress appetite and enhance weight loss. It also reduces insulin levels primarily by directly inhibiting hepatic glucose output. This medication also promotes ovulation and will increase fertility and thus the risk of pregnancy if patient is sexually active.
3) Other treatment options that need to be individualized depending on the results and response to therapy include weight loss of the patient is overweight, progestin alone, anti-androgens, glucocorticoid, etc.