Lifestyle Changes and Managing Symptoms
One of the first lines of treatment for PCOS involves making lifestyle changes to manage symptoms and reduce risk of developing other health issues. Losing just 5-10% of your body weight through diet and exercise can help regulate menstrual cycles and increase fertility. Eating a balanced diet low in refined carbs and sugar but high in fiber, lean proteins, and healthy fats can help control insulin levels and reduce androgens. Regular exercise for at least 30 minutes per day also improves insulin sensitivity.

For menstrual irregularities, birth control pills are often prescribed to induce periodic bleeding and reduce androgen levels. They may also help reduce excess hair growth, acne, and risk of endometrial cancer. If oral contraceptives are not suitable, other options include progestin-only pills or an intrauterine device (IUD) with progestin.

Metformin Prescription to Lower Insulin Levels

For women who are overweight or insulin resistant, metformin may be prescribed. Metformin is a medication primarily used to treat type 2 diabetes as it helps control blood sugar levels. However, studies show it can also help regulate periods and ovulation in women with PCOS by lowering high insulin levels. Common side effects are diarrhea, nausea, and abdominal discomfort which usually subside over time. It may also aid in weight loss when combined with lifestyle interventions.

Spironolactone for Excess Hair and Acne

The anti-androgen medication spironolactone can help reduce unwanted hair growth and acne breakouts related to high androgen levels in PCOS patients. It works by blocking the effects of androgens at receptors in hair follicles and sebaceous glands. Improvement is often seen within 3-6 months of continuous use. Potential side effects may include fatigue, headaches, menstrual changes, and mild dehydration. Blood tests are required to monitor potassium levels for safety.

Fertility Drugs for Conception

For women with PCOS trying to conceive, fertility medications like clomiphene citrate (Clomid) can stimulate ovulation. It works by targeting the hypothalamus and pituitary gland to increase FSH and LH production, initiating follicle development and ovulation. Success rates are around 65-75% over 3-6 treatment cycles. If Clomid fails, gonadotropins like follicle-stimulating hormone (FSH) injections may be prescribed to directly stimulate follicle growth and maturation. These come with a higher risk of multiple births but have an 80% likelihood of resulting in pregnancy within 3 treatment cycles.

Insulin-Sensitizing Agents for Improving Fertility

For those with severe insulin resistance, insulin-sensitizing drugs like metformin may help improve fertility outcomes compared to just lifestyle changes alone. By lowering high insulin levels, they allow hormone levels to normalize and promote regular ovulation. Studies show metformin use increased pregnancy rates by 70-80% versus placebo within 6 months in women with PCOS trying to get pregnant. It is usually combined with fertility medications like Clomid.

Other Options like Acupuncture and Supplements

While not mainstream treatments, some research shows adjunct therapies may provide additional support for PCOS management when combined with medications and lifestyle changes. Acupuncture aimed at increasing blood flow and balancing hormones had positive effects on period regulation and fertility in some clinical trials. Herbal supplements such as inositol, magnesium, omega-3s, cinnamon, and N-acetylcysteine may also help reduce insulin resistance and androgen levels, but more robust studies are still needed. Consults with registered dietitians, herbalists, and acupuncturists are recommended for safety oversight.

Surgical Options for Severe, Treatment-Resistant Cases

In cases where PCOS symptoms are severe and do not respond to other therapies, surgical options may be explored. Laparoscopic ovarian drilling uses diathermy or laser to destroy small portions of ovarian cortex, which reduces androgen secretion and restores ovulation in around 70-80% of women treated. Another option is ovarian wedge resection to physically remove a small piece of ovaries responsible for excess androgen production. Both come with risks like reaction to anesthesia, infection, injury to surrounding tissues. Hence, they are only considered for refractory cases when childbearing is no longer desired.

Life-long Management Even After Treatment

While different combinations of diet, lifestyle changes, medications, and procedures can help manage PCOS symptoms effectively for many women, it remains a chronic condition requiring long-term oversight. Symptom control may fluctuate at various life stages like premenopause or after discontinuing birth control pills. Regular monitoring with endocrinologists and OBGYNs helps adjust treatment strategies accordingly to prevent complications. With adequate treatment tailored to the individual, it is possible for most women to lead healthy, active, and fulfilling lives despite having PCOS.