How Polycystic Ovary Syndrome (PCOS) Is Treated

Polycystic ovary syndrome (PCOS) does not have a cure, but there are treatments that can address its symptoms and complications. For example, medications can be used to help regulate menstruation, while lifestyle approaches (like exercise) can help reduce related risks like metabolic syndrome.

Work with your healthcare team to find which PCOS treatment options are advised in your case, and know that it may take some time to find the optimal approach. Finding the right treatment plan also involves you proactively communicating how you are feeling so that plan can be adjusted, if needed, along the way.

Home Remedies and Lifestyle

Lifestyle modifications are the first line of treatment for PCOS. Not only do they address the reproductive problems in PCOS, but they also reduce the risks of common complications such as metabolic syndrome, type 2 diabetes, heart disease, and stroke.

Healthy Weight

The single most important PCOS treatment is to lose weight if you are overweight.1 By reducing calories and simple sugars, increasing lean protein and fiber, and beginning a regular exercise routine, you can help your body increase its response to insulin, and possibly decrease androgen production. This may help reduce symptoms, restore normal menses, and make it easier to conceive.

While there are medications that can help manage the symptoms you are experiencing, losing weight is the best thing you can do to help treat the disease.

Weight loss is challenging when you have PCOS, which can be quite frustrating. It may help to focus on the fact that losing as little as 5% of your body weight can improve your condition. A 10% loss can help improve your chances of becoming pregnant.

Healthy Diet

A healthy diet is important in PCOS, even if you are at a normal weight. Enjoy limited fruits (too many may negatively affect insulin resistance due to high fructose levels) and plenty of vegetables, moderate amounts of high-fiber, unprocessed, low-glycemic index grains (such as oats and quinoa), and foods rich in omega-3 fats such as fish (salmon, mackerel, sardines), nuts, seeds, and avocados.2

Keep the number of carbohydrate foods per meal moderate and in balance with protein, so your blood sugar levels are stabilized, and you feel more energized.

Click Play to Learn About the Symptoms of Polycystic Ovary Syndrome

This video has been medically reviewed by Peter Weiss, MD

Exercise

No matter your weight, being sedentary can further raise your risk of metabolic syndrome and type 2 diabetes.3

Reduce the time you spend sitting. Find ways to break up long times at your desk or watching television in the evening. Many fitness trackers now alert you when you have been sitting for an hour without activity.

More specifically, aim to get 30 minutes per day of cardiovascular exercise most days of the week, and work in two days of weight training weekly to build muscle mass that can help your body use insulin more effectively. This is where the extra testosterone seen in PCOS can work to your advantage: It helps your body build muscle more easily.

Over-the-Counter (OTC) Therapies

Excessive facial and body hairOTC facial hair removal

Laser hair removal and electrolysis, offered at clinics and spas, can give you longer-lasting results. These treatments are usually performed by technicians under the supervision of a healthcare provider, but without a prescription.

OTC acne and skincare products may also be useful. But depending on your amount of acne, it may be best to consult a dermatologist instead of self-treating.

Prescriptions

A variety of prescription medications can treat the symptoms of PCOS.

Options for Regulating the Menstrual Cycle

For people who are currently not interested in having a baby, oral contraceptives ("the pill") are usually a practitioner’s first choice. The pill contains a combination of estrogen and progesterone which aids in regulating a woman’s hormones. This will help normalize your cycle, thereby making your periods more regular.

Even though the lack of periods may seem convenient, sustained lengths of time without a period may increase your risk of endometrial cancer.4

Your healthcare provider may feel it necessary to give you a medication called Provera (medroxyprogesterone) which will induce bleeding if you have not had a period in a while. Provera is an oral medication taken for five to 10 days that will bring on a period. You may need a blood test prior to beginning this medication to confirm that you are not pregnant.

Androgen Suppressors

Medicationsan antiandrogenic medication

Spironolactone inhibits the testosterone secreted by the body and competes for hormone receptors in the hair follicles. Receptors are sites on cells that allow hormones or chemicals to bind to them, creating a reaction. If another chemical is in the receptor site, androgens cannot bind to them and stimulate the reaction that causes excessive hair growth.

Flutamide works in the same fashion, but is not typically used due to the effect that the medication has on the liver. If you are taking Flutamide, it is important to follow up with your healthcare provider, who can order blood tests to help early detection of liver problems.

While anti-androgen medication is approved by the U.S. Food and Drug Administration (FDA) for hirsutism—a symptom of PCOS—it is not specifically approved for PCOS itself, so its use for the condition is off-label. These medications are not safe to use during pregnancy.1

Metformin

Because of the connection between PCOS and insulin resistance, medications that are normally used to treat diabetes, namely metformin, may be used to increase insulin sensitivity. While many healthcare providers prescribe it for patients with PCOS, the FDA has not approved metformin for this use.

By increasing the body’s response to insulin, it is thought that the ovary may not make as many androgens, which increases the likelihood that ovulation will occur. Metformin may also reduce the levels of circulating androgens. This will help regulate your menstrual cycle and may help you lose weight.1

Vaniqa

Vaniqa (eflornithine hydrochloride) is a prescription facial cream that can slow the growth of facial hair in women after four to eight weeks of use. It doesn't permanently remove hair, so you need to apply it daily and continue to do so indefinitely to maintain results.

Vaniqa should not be used while you are pregnant.

Acne Treatment

Prescription acne treatmenttame acne

Surgeries and Specialist-Driven Procedures

While rarely performed, ovarian drilling is a surgical option that can help treat PCOS. A healthcare provider makes tiny incisions into your abdomen and, using a very small camera to assist in visualizing your internal organs, makes small burns on the enlarged ovarian follicles. The hope is to reduce androgen and LH secretion, thereby inducing ovulatory cycles.

Even less common is ovarian wedge resection. Due to the increased risk of scarring and permanent ovarian damage, if your healthcare provider suggests this procedure, it's best to get a second opinion.6 It is no longer recommended in the treatment of PCOS.

Fertility Treatment

If you want to try to have a baby but you have PCOS-related fertility issues, there are many options.

The medications that your healthcare provider will probably prescribe first are Clomid (clomiphene) or Femara (letrozole). These are given to stimulate ovulation in people who do not regularly ovulate. Some research has shown higher efficacy of letrozole compared to clomiphene.7

Towards the middle of your cycle, you may be able to use an ovulation predictor kit which can help you time the best days to begin trying. Keep in mind that some people with PCOS have persistently high LH levels (the hormone detected in ovulation kits), making this method of timing inappropriate.

Some people may need to take both Clomid and metformin in order to ovulate. Losing weight can also help accomplish this. In some people, moderate weight loss can help restore ovulation and greatly increase your odds of pregnancy.1

If these options do not work, the next step will most likely be injectable medications known as gonadotropins. Each month, follicle stimulating hormone (FSH) is secreted by the pituitary gland to make an egg follicle grow. Gonadotropins directly increase the amount of FSH circulating in the body, promoting the growth and development of a mature egg.

Your healthcare provider will most likely monitor your progress through ultrasound and blood tests. Once the healthcare provider feels that you are close to ovulating, they may have you take an injection of human chorionic gonadotropin (HCG) to trigger your ovulation within 36 hours. This will allow you to more precisely time when to have intercourse or have intrauterine insemination (IUI). Your healthcare provider can help you identify which choice is better for you.

Finally, your last choice is in vitro fertilization (IVF), a complex process where you will undergo controlled hyperstimulation of your ovaries through injectable medications. This produces many eggs which the healthcare provider will then remove through a surgical procedure.

Fertilization takes place outside of the body and in the more controlled environment of the lab. Growing embryos are then transferred back into the body, where they will hopefully implant in the uterus and form a viable pregnancy.

There are many treatment protocols within the IVF process and your healthcare provider will choose the best one, based on your medical history, age, and diagnosis. If standard IVF does not work for you, it can be done with donor eggs, donor sperm, or with a surrogate.

Complementary Alternative Medicine (CAM)

Some studies have shown a slight correlation between acupuncture and the success of fertility therapy. It is thought that it may help regulate the menstrual cycle and even induce ovulation in some people.

Studies of nutritional supplements and herbal remedies such as calcium plus vitamin D, Camellia sinensis (tea plant), and cinnamon have not been found to be effective for PCOS.

Before beginning any therapy, make sure to speak with your healthcare provider and find a qualified practitioner with experience in women’s health issues. Some herbal supplements may interact with prescription medications and some may be harmful during pregnancy. They may also have effects on the production or regulation of hormones, which is already a concern in PCOS.

A Word From Verywell

Each person with PCOS will have different symptoms, so the course of treatment will be unique. Talk to your healthcare provider about what will work best for you. Be sure to ask for any needed help with lifestyle modifications. You may need support from a registered dietitian, nutritionist, physical trainer, or therapist.

Frequently Asked Questions

• How is PCOS diagnosed?

  PCOS diagnosis begins with a physical exam. Your healthcare provider will also run lab tests to check various hormone levels (testosterone, FSH, LH, prolactin), perform a transvaginal ultrasound, and possibly an endometrial biopsy.

• How common is PCOS?

  PCOS is very common. It affects between 6% and 12% of women of reproductive age in the U.S.8

8 Sources

Nicole Galan, RN, is a registered nurse and the author of "The Everything Fertility Book."