Lifestyle changes

Loss of weight, even a 5% loss of weight will reduce insulin resistance and result in symptom improvement.

• It will restore ovulation
• reduce symptoms
• reduce risk of diabetes & insulin resistance and cardiovascular disease (CVD)
• dietary plan similar for diabetics with low GI (Glycaemic Index) foods
• high protein/ low carbohydrate diets good in initial weight loss phase

Exercise (physical activity), even without weight loss, this effectively reduces insulin resistance, 10,000 steps per day with a simple pedometer is very effective cheap and achievable for most women.

• regular low fat burning
• improves self esteem
• reduces CVD risk
• reduces weight

Se also Role of lifestyle modification in PCOS

Support Groups

• information
• support and sharing among fellow sufferers.

Polycystic Ovarian Syndrome Association of Australia  (www.posaa.asn.au)
Dietitians Association of Australia (www.daa.asn.au)
PCOS Support  (www.pcosupport.org (USA))

Medications

Period Problems:

Oral contraceptives (Diane/Brenda/Juliet or low dose pills) “the pill” will regulate the period, eliminate a troublesome period or and may reduce risks of endometrial cancer. Because of the lack of ovulation oestrogen levels may be normal or high and therefore increase the risk of abnormal cell changes in the lining of the uterus (endometrium).

Hirsuitism – Anti-androgen therapies:

Oral contraceptives (Diane/Brenda/Juliet) contain small amount of anti-androgen, cyproterone acetate, but concerns of possible side effects of weight gain, ovarian cysts and change in glucose tolerance.

Cyproterone acetate is an effective anti-androgen often used with “the pill”. Side effects may include weight gain, depression, reduced libido and tiredness.

Spironolactone is a diuretic (fluid tablet) which also is an effective anti-androgen and should be used only in women who are not trying to conceive because of the possibility of foetal abnormalities (birth defects)

Metformin, a drug for diabetes, reduces the insulin level and insulin resistance leading to a reduction in testosterone and therefore an effect on hair growth.

Acne:

• the pill effectively reduces acne
• the anti-androgens, cyproterone acetate; “the pill” or spironolactone reduce acne by reducing testosterone.
• Roacutane for acne.
• Metformin by reducing testosterone.

Alopecia:

• can occur due to an increase in androgens so it is appropriate to use the same therapies as for hirsuitism.

Reduced fertility

Ovulation needs to be monitored and sexual intercourse timed to coincide with ovulation. There are over-the-counter kits available to measure LH, which goes up at ovulation. Temperature charting can show ovulation change but is not a reliable indicator. A progesterone level taken about seven days after expected ovulation will determine if ovulation has occurred (day 21 progesterone in a 28 day cycle). If ovulation is not regular, even modest lifestyle change and weight loss can effectively improve ovulation. Also medications to induce ovulation maybe required.

Referral to a fertility specialist is necessary for further treatment. Ovulation may be induced by oral Clomiphene,. Metformin (based on recent Cochrane review) or FSH injections. It may be necessary to proceed to assisted reproduction techniques including IVF although these are more effective in those women who have instituted lifestyle change effectively first.

Alternative therapies

Natural remedies should only be prescribed by an experienced qualified practitioner with an interest in women’s health including fertility. There are no clinical trials at present that have been completed on alternative therapies in this area.

Content updated December 11, 2005