How to treat pcos
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Treatment Options for Polycystic Ovary Syndrome (PCOS)
Diagnosis and Initial Assessment of PCOS
Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting women of reproductive age. The diagnosis of PCOS typically follows the Rotterdam criteria, which require the presence of two out of three features: androgen excess, ovulatory dysfunction, or polycystic ovaries. It is crucial to exclude other androgen-excess disorders and assess risk factors for conditions such as endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease .
Lifestyle Modifications and Weight Management
Lifestyle intervention, including diet and exercise, is the first-line treatment for PCOS, particularly in overweight or obese patients. Weight loss can improve the endocrine profile, increase the likelihood of ovulation, and enhance fertility outcomes . Even modest weight loss, as little as 5% of initial body weight, can normalize menstrual cycles and ovulation.
Pharmacological Treatments
Hormonal Contraceptives
Combined oral contraceptive pills (COCs) are the first-line pharmacological treatment for menstrual irregularity and hyperandrogenism in PCOS. They help regulate menstrual cycles and reduce symptoms such as hirsutism and acne . There is no specific recommended preparation, but lower doses with fewer side effects are preferred.
Metformin
Metformin is primarily recommended for its metabolic benefits, including improving insulin sensitivity and regulating menstrual cycles. It is particularly effective in overweight adolescents and women with PCOS who cannot tolerate COCs . However, metformin has limited benefits for treating hirsutism, acne, or infertility.
Ovulation Induction
For women with PCOS experiencing infertility, clomiphene citrate is the first-line therapy for ovulation induction. Alternatives include low-dose gonadotropins, aromatase inhibitors, and laparoscopic ovarian drilling . In vitro fertilization (IVF) remains an option when other treatments fail.
Anti-Androgens and Other Medications
Anti-androgens, such as spironolactone, can be added to estrogen-progestin therapy to improve severe hirsutism. Other medications, including thiazolidinediones and glucagon-like peptide-1 (GLP-1) receptor agonists, have shown some benefits in regulating menstrual cycles and improving insulin sensitivity.
Non-Hormonal and Alternative Treatments
Phytochemicals and Herbal Medicine
Phytochemicals from traditional Chinese medicine and medicinal plants, such as flavonoids, polyphenols, and alkaloids, have shown potential in treating PCOS by reducing inflammation, oxidative stress, and insulin resistance. Herbal medicines like Vitex agnus-castus, Cimicifuga racemosa, and Tribulus terrestris have demonstrated beneficial effects on ovulation and metabolic profiles in PCOS.
Non-Hormonal Pharmacological Options
Non-hormonal treatments, including metformin, GLP-1 analogues, and supplements like myo-inositol, have been effective in regulating menstrual cycles in adolescents with PCOS, especially when COCs are contraindicated or poorly tolerated.
Conclusion
The treatment of PCOS requires a multifaceted approach tailored to the individual's symptoms and health profile. Lifestyle modifications, particularly weight management, are foundational. Pharmacological treatments, including hormonal contraceptives, metformin, and ovulation induction agents, play significant roles. Emerging evidence supports the use of phytochemicals and herbal medicines as complementary treatments. Ongoing research and individualized care are essential to optimize outcomes for women with PCOS.
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