What is the best treatment for polycystic ovary syndrome (PCOS)? Exploring options

Posted On April 15, 2022January 29, 2023

Introduction

Do you want to know the best and most effective treatment for polycystic ovary syndrome (PCOS)?Then, keep reading this post. 

It was really hard to hear about PCOS in the past because there was no PCOS problem earlier. But now, it has become a common problem for females. 

The exact cause of PCOS is still unknown. But many studies suggest unhealthy lifestyle is the primary cause of PCOS. We have changed our lifestyle.

In today’s life, we are in the trap of unhealthy foods and inactive lifestyles like –

• Eating processed or packed foods (such as cake, biscuits, cheese, bread, pastries, ice creams, etc.)
• Eating fast foods (such as pizza, burgers, sandwiches, noodles, etc.)
• Having too many cold drinks instead of regular drinking water
• Drinking alcohol 
• Smoking cigarettes
• Lack of physical exercise 
• Wake up too late in the morning
• Spending too much time on smartphones and watching television 

This unhealthy lifestyle triggers your PCOS problem that aggravates the androgen level in your body.

PCOS can’t be adequately cured. You will be thinking about what I need to do?

Simple! You have to change your lifestyle. 

A review article published in gynecological endocrinology, 2018 concluded that lifestyle modification is the first line of treatment for polycystic ovary syndrome. 

Some medicines can treat symptoms of PCOS. But these medicines are depended on individual concerns of PCOS like infertility, irregular menstrual cycles, obesity, acne, hair loss, diabetes, etc.

In this post, I will review some natural remedies & effective medicines that help treat polycystic ovary syndrome (PCOS).

So, without further delay, let’s start the topic. 

How would I know if I have PCOS?

You can’t get PCOS diagnosed through a simple blood test. You need to meet specific clinical criteria for PCOS.

Firstly, your doctor (gynecologist or endocrinologist) may ask for medical history, including improper menstrual cycles and weight fluctuation. 

Physical examination 

Then your doctor may conduct physical tests or observe signs and symptoms of polycystic ovary syndrome, such as – 

• Menstrual irregularity
• Infertility 
• Pimples 
• Excess facial hair growth 
• Hair loss
• Acanthosis nigricans 
• Obesity
• Diabetes and cardiovascular problems 
• Obstructive sleep apnea

Ultrasound 

If your doctor suspects you have PCOS, they may go for a transvaginal ultrasound. 

In a transvaginal ultrasound, an instrument (transducer) is inserted into your vagina. Then, ultrasound waves go to your ovary and convert it into picture form. 

If you have PCOS, you may observe some tiny dark circles in the ultrasound image representing fluid-filled follicles (or multiple follicles). 

If these follicles are more than 20 in each ovary, that indicates polycystic ovary syndrome. 

Blood tests

Your doctor may suggest specific blood tests like –

• Serum androgen test – to evaluate the level of testosterone hormone
• Insulin blood test – to determine the insulin resistance 
• Oral glucose tolerance test (OGTT) – to determine the blood glucose level
• Liver function test – to evaluate the cholesterol and triglyceride level

How can I change my lifestyle with PCOS? 

Since PCOS is a lifestyle disorder. So, lifestyle modification is considered the first-line treatment for polycystic ovary syndrome. 

Here, you need to do 8 steps to reverse your PCOS symptoms –

1. Weight reduction 

Yes, losing weight is an essential step in managing your signs and symptoms of PCOS. You need to monitor your BMI (Body Mass Index). It should be within the normal range of 18.5 to 24.9 kg/m2.

2. Low-calorie intake 

According to a study, healthy women require 1868 calories per day. While PCOS condition, you need to reduce your calories, and you should take around 1445 calories per day. In case of insulin resistance, you have to take less than 1400 calories per day.

3. Avoid processed or junk foods

You should avoid high glycemic foods while you have PCOS. These foods are cake, cookies, pastries, white rice, white bread, potatoes, burger, pizza, etc. 

High glycemic foods may cause a sudden spike in your blood glucose level. Due to this increased blood glucose, too much insulin secretes, which may develop insulin resistance. 

4. Eat low glycemic foods 

You have to shift your diet towards low glycemic foods instead of high glycemic. Low glycemic foods have a lot of benefits for PCOS conditions. It reduces obesity, cholesterol level, acne problem, risk of the development of diabetes, and cardiovascular disease.

Low glycemic foods gradually increase your blood sugar level and provide sustained energy for a long time. So, you must add low glycemic foods to your diet.

It includes –

a) Legumes like kidney beans, soybeans, chickpeas, pulses, etc. 

b) Heavy mixed-grain bread, barley, quinoa 

c) Vegetables like broccoli, pumpkin, sweet potatoes, cauliflower, cucumber, spinach, tomatoes, tomato, mushrooms, onions, spinach, etc.

d) Fruits – apple, apricot (fresh, dried), banana, berries, honeydew melon, mango, orange, peach, pear, plum, pomegranate

e) Nuts- almonds, peanuts, cashew, almonds 

5. Eat high protein diet 

Protein is also an essential nutrient for your PCOS diet because it requires for every cell, tissue, and organ. You need to take at least 0.8 gm protein per kg of your body weight. 

Suppose your body weight is 60 kg, then you will have to take (60×0.8) 48 gm of protein every day. You must include high protein foods such as tofu, chicken, beans, peas, and fish.

6. Stop drinking alcohol

In a study, researchers have found that excess intake of alcohol impairs ovulation in females. Due to this, it decreases the chance of fertility. So, you have to limit the use of alcohol. 

7. Start exercise 

According to a review article, at least 150 minutes of physical activity in a week improves the PCOS condition. This means you need to do 20 mins exercise per day. 

8. Low AGEs (Advanced glycation end-products)

When a glucose molecule binds with protein or fat and makes, a nonenzymatically glycated product is called AGEs (Advanced glycation end-products).

This composition increases the reactive oxidative stress (ROS) and generates free radicles in your body cells. As a result, it causes inflammation that worsens the condition of diabetes, atherosclerosis, chronic kidney disease, and Alzheimer’s disease. 

AGEs are also exaggerating the PCOS condition. The animal-derived foods, overcooked foods, processed foods, or prepacked foods are major sources of AGEs.

You should avoid certain foods from your diet. For example – Meat (mostly red meat), chicken, cheeses, fried eggs, butter, cream, french fries, etc. 

What are natural remedies for polycystic ovary syndrome (PCOS)?

Some best natural remedies help to manage your PCOS symptoms – 

1. Cinnamon 

A study published in the Journal of ethnopharmacology 2020 assessed the effect of cinnamon in PCOS patients. It was observed that cinnamon supplement improves the metabolic parameters of PCOS women. 

It reduces insulin resistance and menstrual problem. 

2. Turmeric 

A study has shown the excellent effect of turmeric extract in the treatment for polycystic ovary syndrome patients.

Turmeric helps in –

• reduce inflammation
• reduce cholesterol 
• reduce high blood glucose level
• prevents the oxidation of cells 
• improves ovarian morphology.

3. Vitamin D and calcium supplement 

As per a study, the deficiency of vitamin D may worsen the condition of PCOS that affect insulin resistance, lipid metabolism, menstrual cycle, and androgen level. So, you need to take proper vitamin D and calcium in your diet.

• Daily recommended dose of Vit. D – 50,000 IU every week. 

4. Magnesium supplement 

Many studies suggest that magnesium deficiency may cause insulin resistance and increase androgen levels in PCOS women. 

The daily recommended magnesium for PCOS women is 310 to 320 mg per day. You may take magnesium from a natural diet or supplements. There are some natural sources of magnesium – 

• Nuts – Almonds, cashews, and peanuts
• Seed – Flaxseed, pumpkin seeds
• Fruits – Guavas, bananas, kiwi fruit, papayas, blackberries, raspberries, and grapefruit.
• Dark chocolate
• Vegetables – Spinach 
• Low-fat dairy products – milk and yogurt

5. Cod liver oil

Cod liver oil is prepared from fish which contains an essential element, omega 3 fatty acid. A study has shown the numerous benefits of omega 3 supplements in PCOS women. 

You must include omega-3 supplements in your diet. It helps to decrease lipid profiles, reduce obesity, and improves menstrual cycles. 

6. Chromium supplement 

The deficiency of chromium has been reported in diabetes and PCOS women. You need to have sufficient chromium in your diet. Chromium supplements may improve BMI, insulin level, and testosterone level in PCOS patients. 

You should consume 35 mcg chromium daily.

Can I get pregnant with PCOS?

Yes. If you want to be pregnant, ovulation induction therapy is an effective fertility treatment for polycystic ovary syndrome. 

There are two main drugs (letrozole and clomiphene) that induce ovulation. These medicines help to make eggs in your ovary. 

Based on a clinical trial study published in Advanced Biomedical Research, 2016 observed that letrozole and clomiphene citrate have the same effect on inducing ovulation and achieving pregnancy in patients with PCOS.

Let’s discuss each drug separately – 

Clomiphene citrate

Mechanism of action – 

• Clomiphene is a pure estrogen antagonist which directly inhibits the estrogen receptors. When your hormones get imbalanced, your body sends a signal as negative feedback to maintain estrogen balance. 
• This estrogen deficiency stimulates the hypothalamus and secretes follicle-stimulating hormone (FSH). This FSH helps the development and maturation of follicles in the ovary. Eventually, eggs start to prepare monthly from your ovary. 

Dosing – 

• The usual starting dose of clomiphene citrate is 50 mg once daily. You can start this medicine from the 5^th day of the menstrual cycle for five days. 
• You may get ovulation usually in 5–10 days after the treatment ends.
• The dose of clomiphene may be doubled for 2-3 cycles if you don’t get conception in 1-2 months. 
• If ovulation still does not occur, even gradually increasing to 250 mg/day, the patient is considered clomiphene resistant.
• Clomiphene is usually present in the body for five to seven days because the half-life of clomiphene is 6 days and affects the entire menstrual cycle.

Side effects –

• Since clomiphene directly inhibits the estrogen receptors. So, it has high antiestrogenic side effects like hot flashes (intense feeling of heat over the face, neck, and chest), the chance of multiple pregnancies, and an increased risk of venous thrombosis.

Letrozole 

Although, letrozole is primarily used in postmenopausal breast cancer. But now, it is officially used off-label to treat infertility in polycystic ovary syndrome.

Mechanism of action –

• In the normal menstrual cycle, androgen (male sex hormone) converts into estrogen (female sex hormone) under the influence of FSH by the aromatase enzyme. 
• But in PCOS, follicles do not mature due to a lack of FSH. 
• Here, letrozole inhibits the aromatase enzyme and inhibits the production of estrogen. Due to this, a negative feedback signal goes to the hypothalamus that secretes FSH.
• This FSH helps in the development and maturation of follicles. Eventually, ovulation gets started. 

Dosing – 

• The usual starting dose of letrozole is 2.5 and 5 mg once daily for five days. You can start this medicine from the 3^rd to the 7^th day of the menstrual cycle.

Advantage – 

• Promoting ovulation in obese patients with PCOS.
• Rapidly absorbed with 100% bioavailability.
• Reduced multiple pregnancies.
• Does not directly block the estrogen receptors. So, it has fewer antiestrogenic side effects.
• Letrozole is a non-steroidal drug, so it does not give any steroidal side effects.
• According to a study, letrozole is a more effective drug than clomiphene. It is becoming the first-line drug in treatment for polycystic ovary syndrome patients with fertility requirements.

Side effects – 

• Decrease bone mineral density (BMD). You may have an increased risk of fractures and osteoporosis. 
• Increase cholesterol level
• Increase hepatic impairment. You need to require dose adjustment like 2.5 mg letrozole on alternate days.
• It does hot flashes. 

How does metformin help with polycystic ovarian syndrome?

Metformin is well known as an antidiabetic drug used in Type-2 diabetes mellitus. Since the majority of PCOS people have insulin resistance. So, metformin is also used as a off-label to treat PCOS insulin resistance. 

Metformin was the first insulin-sensitizing drug (ISD) in PCOS women. Based on a study in 2010, metformin has a significant role in PCOS. 

• Reduction of the circulating insulin level
• Decrease in circulating androgen levels
• Reduce bodyweight 
• Reducing the risk of gestational diabetes mellitus (GDM)
• Improves menstrual irregularities 

Metformin also works as an ovulation induction agent for non-obese PCOS women. It helps in restoring ovulation and stimulates your fertility. 

You can take metformin 500 mg thrice a day under proper medical supervision. 

So, metformin should be considered the most suitable first-line treatment for anovulatory infertility in non-obese PCOS women.

If you get resistant to clomiphene alone, then a combination of metformin and clomiphene is an effective option.

Even in a study, the pregnancy rate was much higher in PCOS women who took a combination of metformin and clomiphene citrate. 

How do oral contraceptives help with PCOS? 

If you don’t want to be pregnant yet or wish to remain childless, oral contraceptives therapy is the first-line treatment. 

Oral contraceptive therapy (or birth control pill) is the most popular and most effective treatment option to prevent fertility. 

Oral contraceptives (OC) pills are generally hormonal preparation made of estrogen and progesterone hormones. It is available in the market in fixed-dose combinations. For examples, 

• Mala D (Norgestrel 0.3 mg + Ethinylestradiol 30 mg)
• Unwanted 21 days (Ethinyl Estradiol 0.03mg + Levonorgestrel 0.15mg)
• Duoluton L 21 (Levonorgestrel 0.25 mg + Ethinylestradiol 50 μg)
• Femilon 21 tab (Desogestrel 0.15 mg + Ethinylestradiol 20 μg)

You can start this therapy on the 5^th day of the menstrual cycle with one tablet daily for 21 days. Then, you have to start the next course after a gap of 7 days in which bleeding occurs, so that cycle of 28 days is maintained. These pills are also available in calendar packs. 

These pills are anti-ovulatory drugs used for the reversible suppression of fertility. This means when you discontinue all OC pills, you can get a complete return of fertility within 1-2 months. 

Oral contraceptive pills help – 

• to inhibit ovulation (stop preparation of follicles and maturation of ovum)
• to encourage menstrual bleeding at the end of a cycle
• to prevent the risk of developing endometrial cancer due to the estrogen

Moreover, Birth control pills also decrease unwanted hair growth (hirsutism) and acne problem. But it takes at least 6 months of continuous treatment. 

As far as the concern of its mechanism, OC pills prevent your fertility when estrogen reduces the FSH secretion while progesterone decreases the LH (Luteinizing hormone). Due to this, follicles fail to develop and rupture. As a result, ovulation does not occur. 

The long-term use of oral contraceptive pills may cause venous thrombosis.

How does spironolactone affect PCOS?

If you struggle with excessive facial hair growth in unusual places, acne problems, and hair loss during PCOS. And, if you haven’t seen good results from the oral contraceptive pill, your doctor may prescribe spironolactone in your treatment plan. 

Spironolactone is one of the medicines which can treat these PCOS symptoms.  

This drug is available in the brand name Aldactone, and it is often prescribed with a hormonal birth control pill.

Spironolactone is an antihypertensive drug that controls high blood pressure. It prevents potassium loss because it acts as a potassium-sparing thiazide diuretic.

This drug removes excess fluid from your body. Spironolactone also acts as an antiandrogen drug, which means it blocks the conversion of testosterone to dihydrotestosterone and reduces androgen levels. 

A study published in the Journal of endocrinological investigations, 2005 assessed that spironolactone has highly effective in the treatment of hyperandrogenism (excess androgen level) associated with PCOS symptoms like alopecia, acne, and hirsutism. 

The usual starting dose of spironolactone is 50 mg twice for polycystic ovarian syndrome hirsutism treatment.

The spironolactone may cause unwanted side effects like excess thirst, frequent urination, increased appetite, breast enlargement, and hyperkalemia (excess potassium may cause heart rhythm problems).

When is surgery recommended for PCOS?

Suppose you are not getting any response from medicines (like clomiphene and letrozole), or you get resistant to these medications. In that case, surgery is the only and last option.

Laparoscopic ovary drilling (LOD) is the safe and effective surgical option for polycystic ovary syndrome. The procedure is done by laser therapy, which removes the ovarian stroma (unwanted connective tissue).

This LOD technique decreases androgen level production, increases the secretion of FSH, and lowers multiple pregnancy rates.

Are there any new treatments options for polycystic ovary syndrome (PCOS)?

The current treatment for polycystic ovary syndrome is very limited. There are some new approaches for the treatment of polycystic ovary syndrome – 

1. SGLT2 inhibitors therapy 

Although, SGLT2 inhibitor drugs are not officially approved for PCOS. But as per study 2021, SGLT2 inhibitors may be beneficial for improving glycemic and cardiovascular effects. It may be a potential new treatment option for PCOS. 

2. GLP-1 receptor agonist therapy

• Glucagon-like peptide-1 (GLP-1) receptor agonists like exenatide and liraglutide are effective treatment options for PCOS.
• Strong consideration for those PCOS patients who have obesity, high blood glucose level, non-alcoholic fatty liver disease (NAFLD), and cardiovascular diseases. 

3. Gonadotropins therapy

If you don’t get a response from clomiphene, then Gonadotrophins are a second-linetreatment option for anovulatory women with PCOS.

4. Leptin therapy

• Leptin is also called the “fat controller.”
• Leptin is a hormone secreted from fat cells that helps to regulate your body weight
• Leptin contributes to the development of follicles and improves insulin resistance 
• New research therapy in direction for treatment of PCOS.

5. Inositol therapy

• Inositol is a type of sugar or carbohydrate that is made naturally in the human body from glucose.
• Inositol is abundantly found in the human brain, where it plays a vital role in making neurotransmitters and steroid hormones. 
• Nowadays, inositol is encouraged as a dietary supplement to treat polycystic ovary syndrome. 
• There is a synthetic form of inositol used as a supplement like Myo-inositol (MI) and D-chiro-inositol (DCI) 
• It increases the number of mature follicles and decreases the number of unmatured follicles. 
• Therefore, inositol treatment can improve the quality of the ovarian follicles and reduce insulin resistance in women with PCOS.

Conclusion 

A treatment plan should be chosen according to the patient’s needs and the underlying cause of the disease.

Although, Lifestyle adjustment (LSM) should be considered a primary treatment for polycystic ovary syndrome. But suppose you don’t get an appropriate effect. In that case, you should proceed with medicines or a new treatment approach under proper medical supervision. 

Here, you need to manage the symptoms of PCOS. Your doctor may prescribe medicines as per your symptoms – 

• For insulin resistance – Metformin
• For pregnancy – clomiphene, and letrozole
• For regular menstrual periods – birth control or oral contraceptive pills
• For acne, hirsutism, and hair loss – Spironolactone 

I think I have covered every treatment approach for polycystic ovary syndrome. This post is only for information regarding treatment for polycystic ovary syndrome. 

You should not take any medicine without consulting your doctor except for lifestyle modifications. 

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Have questions? Let me know in the comments below. I will try my best to answer all of them.