In many cases, the first action that health care providers recommend for women with polycystic ovary syndrome (PCOS) is that they make specific lifestyle changes.
In many cases, the first action that health care providers recommend for women with PCOS is that they make specific lifestyle changes, such as following a lower-calorie diet, losing weight, and getting more physical activity.1,2
Losing weight and being more physically active can minimize many PCOS symptoms and related conditions. Even a 5% weight loss can improve many symptoms of PCOS.3
A recent NICHD-funded study found that a diet low in dairy and carbohydrates helped women with PCOS lose weight, reduce excess testosterone, and improve insulin sensitivity.8 Talk to your health care provider about designing a plan that's best for you.
- Weight loss can restore ovulation and make your menstrual cycles more normal, which can improve your chances of pregnancy.1,4
- Losing weight reduces the risk of diabetes and lowers cholesterol levels.1,5
- For many women, weight loss reduces such symptoms as excessive hair growth and acne.1,6
- Physical activity can reduce depression associated with PCOS.7
Also called birth control pills or "the Pill," hormonal contraceptives can be used for the long-term treatment of women with PCOS who do not wish to become pregnant,1 and in fact they are the primary treatment for these women. Oral contraceptive pills contain a combination of the hormones estrogen and progestin. In women with PCOS, these hormones:1
- Make menstrual periods more regular
- Reduce the level of androgens produced by the ovaries, leading to reduction in androgen activity
- Help clear acne and reduce excess hair growth
Oral contraceptives can help lower the risk of certain types of cancers, but they may also raise the risk of other types of cancers.9 There is no one oral contraceptive that works best for women with PCOS, but those that are less androgenic are more effective at treating the symptoms of PCOS.10 Please note that oral contraceptives, like all medications, are associated with some level of risk for side effects, some of them serious. Discuss all possible risks and side effects with your health care provider before making a final decision on a treatment.
- Clear acne and reduce hair growth
- Improve weight loss
- Lower cholesterol levels
- Make periods more regular
- Slightly reduce infertility associated with PCOS12
After 4 to 6 months of using these medications, women with PCOS may start ovulating naturally.13
The U.S. Food and Drug Administration (FDA) has not approved insulin-sensitizing medications, such as metformin (pronounced met-FAWR-min), specifically for treating PCOS. Even so, your health care provider may use these medications to treat your symptoms. Talk to your health care provider about any concerns you may have about these medications.14
These medications either prevent the body from making androgens or limit the activities or effects of those hormones. In women with PCOS, anti-androgens can:
- Lower androgen levels
- Reduce excess hair growth
- Help clear acne
Because anti-androgens can cause birth defects, they are often taken with oral contraceptives to prevent pregnancy.15 Be sure to talk with your health care provider about the risks of these treatments, especially if you want to become pregnant.
As with insulin-sensitizing medications, anti-androgens are not approved by the FDA for the treatment of PCOS. At this time the best type of anti-androgen for treating PCOS symptoms is not known.
There are many ways to remove excess or unwanted hair or to hide this hair without actually removing it. Women with PCOS can use the methods below instead of or in combination with other approaches:14
- Daily application of an eflornithine (pronounced ee-FLOOR-nih-theen) cream slows hair growth, especially on the face. This drug works by blocking an enzyme that is needed by hair to grow. If you stop using the cream, the hair will grow back, and so you should talk to your health care provider about a long-term management plan.
- Eflornithine is FDA-approved for the treatment of unwanted facial hair, but no studies have been published about its use specifically in women with PCOS.14
- This cream should not be used in pregnant women, and thus you should talk to your health care provider about its risks and benefits before using it, especially if you want to get pregnant.16
- Shaving, bleaching, plucking, waxing, and using depilatories (creams that dissolve hair, pronounced dih-PIL-uh-tawr-ees) are some of the more common ways of removing or hiding unwanted hair. Some of these methods, such as shaving and plucking, are associated with skin irritation and the development of ingrown hairs.
- Electrolysis (pronounced ih-lek-TROL-uh-sis), laser hair removal, and intense pulsed light (IPL) therapy are other options, but they are often expensive and may require multiple treatments.1 Electrolysis uses an electric current applied to each hair follicle to destroy its root. Laser hair removal involves shooting a laser beam at each hair follicle to destroy its root. IPL therapy uses an intense flash of light in a specific wavelength that targets the melanin, or color, in hair to effectively kill the hair follicle.
Retinoids (pronounced RET-n-oids), antibacterial agents, and antibiotics may be used to treat acne. These products may be available in pills, creams, or gels. The specific treatment depends on the severity of the acne and how long it has been visible. Because retinoids can cause birth defects, you should not use them if you want to become pregnant.1
- American College of Obstetricians and Gynecologists(ACOG). (2015). Polycystic ovary syndrome. Retrieved May 20, 2016, from http://www.acog.org/Patients/FAQs/Polycystic-Ovary-Syndrome-PCOS
- Moran, L. J., Pasquali, R., Teede, H. J., Hoeger, K. M., & Norman, R. J. (2009). Treatment of obesity in polycystic ovary syndrome: A position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertility and Sterility, 92(6), 1966–1982.
- ACOG. (2009; reaffirmed 2015). Polycystic ovary syndrome. Practice Bulletin 108. Washington, DC: ACOG.
- Badawy, A., & Elnashar, A. (2011). Treatment options for polycystic ovary syndrome. International Journal of Women's Health, 3, 25–35.
- National Heart, Lung, and Blood Institute. (n.d.). Aim for a healthy weight. Retrieved May 23, 2016, from https://www.nhlbi.nih.gov/health-topics/publications-and-resources
- Moran, L. J., Hutchison, S. K., Norman, R. J., & Teede, H. J. (2011). Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews, 2, CD007506.
- Lamb, J. D., Johnstone, E. B., Rousseau, J. A., Jones, C.L., Pasch, L. A., Cedars, M. I., et al. (2011). Physical activity in women with polycystic ovary syndrome: Prevalence, predictors, and positive health associations. American Journal of Obstetrics and Gynecology, 204(4), 352.e1–352.e6.
- Phy, J. L., Pohlmeier, A. M., Cooper, J. A., Watkins, P., Spallholz, J., Harris, K. S., et al. (2015). Low starch/low dairy diet results in successful treatment of obesity and co-morbidities linked to polycystic ovary syndrome (PCOS). Journal of Obesity and Weight Loss Therapy, 5(2), 259.
- National Cancer Institute. (2012). Oral contraceptives and cancer risk: Questions and answers. Retrieved May 23, 2016, from http://www.cancer.gov/cancertopics/factsheet/Risk/oral-contraceptives
- Mathur, R., Levin, O., & Azziz, R. (2008). Use of ethinylestradiol/drospirenone combination in patients with the polycystic ovary syndrome. Journal of Therapeutics and Clinical Risk Management, 4(2), 487–492.
- National Center for Biotechnology Information, National Library of Medicine, PubMed Health. (n.d.). Polycystic ovary syndrome. Retrieved May 23, 2016, from https://www.ncbi.nlm.nih.gov/pubmed/24582095
- Legro, R. S., Barnhart, H. X., Schlaff, W. D., Carr, B. R., Diamond, M. P., Carson, S. A., et al. (2007). Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. New England Journal of Medicine, 356(6), 551–566.
- Barbieri, R. L. (2003). Metformin for the treatment of polycystic ovary syndrome. Obstetrics and Gynecology, 101(4), 785–793.
- Radosh, L. (2009). Drug treatments for polycystic ovary syndrome. American Family Physician, 79(8), 671–676.
- Martin, K. A., Chang, R. J., Ehrmann, D. A., Ibanez, L., Lobo, R. A., Rosenfield, R. L., et al. (2008). Evaluation and treatment of hirsutism in premenopausal women: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 93(4), 1105–1120.
- U.S. Food and Drug Administration. (2000). VANIQA™ (eflornithine hydrochloride) cream, 13.9%. Retrieved May 23, 2016, from http://www.accessdata.fda.gov/drugsatfda_docs/label/2000/21145lbl.pdf (PDF - 133 KB)