MedifocusHealth

Acne is often treated with medications either following or concurrently with weight loss and exercise.

Drugs commonly used for acne treatment in women with PCOS include:

• Oral contraceptive pills - Ortho Tri-Cyclen (norgestimate and ethinyl estradiol) and Estrostep (ethinyl estradiol and norethindrone acetate) have been approved by the FDA for treatment of acne.
• Spironolactone
• Retinoids (topical or systemic) - These drugs are teratogenic (can cause birth defects in a fetus) and should not be taken if trying to conceive or if pregnant.
• Antibiotics (topical or systemic)
• Topical benzoyl peroxide

If left untreated, acne can lead to scarring and/or abnormal pigmentation.

Hyperinsulinemia

One of the most effective ways to treat hyperinsulinemia is through calorie reduction, weight loss, and exercise. Research shows that a combination of intensive weight loss and exercise significantly reduces or delays the risk of developing Type II diabetes. For some women with PCOS, metformin treatment appears to have a beneficial effect on weight loss but the evidence is inconsistent.

Insulin sensitizing agents are very effective and are prescribed to treat hyperinsulinemia and to improve all of the other aspects of PCOS that are related to the underlying hyperinsulinemia.

Insulin sensitizing agents include:

• Metformin (most commonly used)
• Pioglizatone
• Rosiglitazone

Dyslipidemia

Diet, weight loss, and exercise also significantly influence dyslipidemia. These lifestyle modifications can result in lowering LDL, increasing HDL, lowering triglycerides and lowering total cholesterol. If these steps are not sufficient, there are also cholesterol reducing drugs that are available (statins).

Menstrual Irregularity

Menstrual regularity is crucial for fertility as well as for the overall health of the endometrium. Amenorrhea or oligomenorrhea must be treated to reduce long term risks of endometrial hyperplasia, endometrial cancer, and breast cancer.

As with most other symptoms of PCOS, the first line of treatment is weight loss and exercise. If further treatment is necessary, medications can be used.

Progesterone is the hormone secreted by the ovary during ovulation and it promotes the increase of blood vessels in the uterine lining. If conception does not take place, the uterine sloughs off the excess blood and tissue and a menstrual flow commences. Progesterone levels are often low in women PCOS and increasing their levels usually induces menstruation. One strategy to raise progesterone levels is to regulate the menstrual cycle either by promoting ovulation, which leads to an increased in the production of progesterone, or through the use of progestogen supplementation.

Drugs used to promote menstrual regularity in women with PCOS include:

• Oral contraceptive pills
• Medroxyprogesterone (Provera)
• Micronized progesterone (Prometrium)
• Insulin-sensitizing agents

Women with PCOS and menstrual irregularity experience a significant increase in regulated menstrual cycles and ovulation with metformin treatment. Some women benefit from the addition of clomiphene citrate to metformin treatment.

Anovulatory Infertility

In many cases, it is possible to restore fertility to women with PCOS. Weight loss and exercise are considered the first-line therapy for overweight women with infertility. Exercise and weight loss also improved the fertility of non-obese women, whether insulin resistant or not. If fertility is not achieved, there are several medications that are used to help increase ovulation and chances for conception. Women who are trying to conceive must stop taking oral contraceptives as well as antiandrogens.