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Polycystic ovary syndrome: What is the treatment?

Mr Anil Gudi, Mr Amit Shah and Prof Roy homburg

Once the diagnosis of polycystic ovary syndrome (PCOS) has been established, the treatment depends on the complaint.

Adolescents with PCOS are particularly concerned about their appearance and excess facial or body hair or persistent acne may be a particular disaster from a psychological point of view. As for every aspect of treatment for PCOS, a change of life style for the overweight patient is the first line treatment. This treatment alone if resulting in a loss of even 5% of body weight or more, may well be enough to alleviate or eliminate symptoms. The oral contraceptive pill is an excellent method to regulate menstruation and pills with a similar make up but containing a hormone which specifically lowers male hormone levels are especially effective over time.

Women with PCOS who are having problems to conceive are basically suffering from a loss of ovulation and treatment to restore ovulation is extremely successful. The usual first line of treatment is clomiphene citrate, a short 5-day course of pills starting shortly after the beginning of menstruation. This will restore ovulation in about 85% of PCOS women although only about half of these will conceive. Failure to conceive with clomiphene usually leads to treatment with injections of follicle stimulating hormone (FSH) which is given daily in low doses until ovulation is achieved. Taking the results of clomiphene and FSH treatment together, about 75% will become pregnant on one or the other of these treatments. Metformin pills may help some but they are not as effective as clomiphene. For those who have not conceived by this stage, if they are of normal weight, a laparoscopy and ‘drilling’ of the ovaries is effective treatment to restore ovulation. The last resort method, usually only needed for those who have an additional fertility problem (sperm or mechanical), is in-vitro fertilization.

In summary, with so many successful treatments available, the vast majority of women suffering from infertility associated with PCOS will conceive.

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