Polycystic Ovary Syndrome Treatment Overview

When to see a healthcare provider

Polycystic ovary syndrome (PCOS) should be treated by a healthcare provider. Your doctor may refer you to an endocrinologist, who specializes in hormonal conditions. It's important to lower elevated male hormones like testosterone and DHEA-sulfate to help prevent complications and treat your symptoms. Your doctor may prescribe medications, most likely the birth control pill, to help with a range of symptoms.

A doctor will also monitor you for other disorders like diabetes, high cholesterol, fatty liver disease, sleep apnea and mood disorders. These are all chronic conditions that may require prescription medications.

How to test for PCOS

Your doctor may do the following tests to diagnose PCOS.

• FSH, LH, and estrogen levels
• Testosterone and DHEA-sulfate (male hormones typically elevated in PCOS)
• TSH (thyroid stimulating hormone) to check for hypothyroidism
• Prolactin—high levels can cause irregular periods.
• 17-hydroxyprogesterone, a marker of a rare congenital syndrome called adrenal hyperplasia
• Hemoglobin A1C, fasting glucose, or an oral glucose tolerance test to check for prediabetes or diabetes
• Comprehensive metabolic panel to test for liver function and signs of fatty liver disease
• Lipid panel to test for high cholesterol
• Serum cortisol levels or low dose dexamethasone suppression test to check for Cushing's syndrome, which can cause excess weight gain
• An ovarian ultrasound (less commonly performed but may help with the diagnosis)

What to expect from your doctor visit

Once you have been diagnosed with PCOS, your doctor will discuss both lifestyle approaches and medications.

• You will likely be prescribed a birth control pill, as long as you’re not trying to get pregnant or cannot take the pill for health reasons. The pill contains estrogen and progesterone and can help your period be more regular, reduce excess hair growth, and prevent uterine cancer by reducing abnormal uterine lining growth.
• Progesterone-only birth control, which is sometimes used to manage PCOS, can also prevent pregnancy and lower uterine cancer risks.
• For women who can’t tolerate or safely take a birth control pill, you may take other medications, like spironolactone,  to reduce male hormones.
• Excess hair growth can be treated with eflornithine cream (Vaniqa), laser treatment, or epilation (a device that removes hair at the roots).
• Some women who are obese may consider having bariatric surgery to help lose weight.
• For women with prediabetes or diabetes, medications that target blood sugars can also help with weight loss. These include metformin and GLP-1 (glucagon-like peptide) agonists.
• If you have high cholesterol, your doctor will discuss lifestyle changes to reduce your cholesterol levels and may prescribe a medication like a statin.
• If you are trying to get pregnant, you will be given medications that help induce ovulation (release of an egg every month).
• Sometimes women with PCOS who want to get pregnant will need to see a reproductive endocrinologist and have fertility treatments like in-vitro fertilization (IVF).
• You may be referred to a sleep specialist to see if you have sleep apnea.

Prescription medications

Birth control pills

• Ethinyl estradiol, norgestimate (ortho tri-cyclen Lo)
• Ethinyl estradiol, norethisterone acetate (Junel)

Anti-androgens (testosterone blockers)

• Spironolactone (aldactone)
• Cyproterone acetate (cyprostat)--not available in the US

Type 2 diabetes

• Metformin (Glucophage)
• Semaglutide (Ozempic)

Obesity

• Semaglutide (Wegovy)
• Liraglutide (Saxenda)

High cholesterol

• Atorvastatin (Lipitor)
• Rosuvastatin (Crestor)

Ovulation induction

• Clomiphene citrate (Clomid)
• Letrozole (Femara)

Types of providers

• An endocrinologist specializes in hormone disorders and can diagnose and treat PCOS and diabetes.
• A primary care physician can help treat diabetes or high cholesterol.
• A gynecologist, who specializes in women’s reproductive health, may help with diagnosis and with prescribing contraception.
• A bariatric surgeon is a specialized physician that provides treatments and surgery for obesity.
• A sleep medicine doctor can treat sleep apnea
• A gastroenterologist (who specializes in digestive disorders) or hepatologist (who specializes in the liver) may be needed if you have fatty liver.

How to manage PCOS at home

Though polycystic ovary syndrome (PCOS) should be managed by a doctor, there are steps you can take on your own to improve your symptoms. A common symptom of PCOS is being overweight or obese, so one of the most important things you can do is to lose weight.

This means trying to eat healthy, limiting your calories, and increasing your exercise. If you have prediabetes or diabetes—both are a complication of PCOS—it will be important to reduce the amount of sugar you eat and make a number of changes to your diet to control your blood sugar levels.

Tips for treating PCOS

• Start a diet that reduces your calorie intake if you’re overweight.
• Get at least 30 minutes of aerobic exercise 5 days a week to help with weight loss and managing blood sugar levels.
• If you have prediabetes or diabetes, eat a diet that is moderate in carbohydrates and low in concentrated sugar like juice and soda.
• Consider using a calorie-tracking app to help with developing and following a nutrition plan.
• Commercial diet programs that offer services like meal planning, prepackaged foods, tracking, and support, can help with losing weight.
• Stop smoking.