The logical questions after my last blog post on PCOS symptoms, risks, and diagnosis are: What are the solutions for PCOS? Or what PCOS treatment options are available out there to help?
It is very common to see that the experience of many people with PCOS is to be offered hormonal birth control, metformin, or weight loss as treatment options. Usually very little to no guidance is provided. Many feel confused, lost, and stressed. Has that happened to you?
For PCOS, There are a few treatment options. Treatment options depend on the goals and the assessment of the individual with PCOS. For example, if you want to have a baby or not. If you have insulin resistance or if you have high androgen symptoms or other issues or risks.
There are treatment options beyond the hormonal birth control, metformin, and fertility meds.
Treatment options include nutrition and lifestyle, prescription medications, supplements, psychotherapy, complementary therapies, and aesthetic procedures. Based on your individual symptoms, testing, risks, and goals, one or more treatments can be considered.
Medical treatments are usually prescribed weighing the benefits and risks for the individual. They are chosen when benefits outweigh risks.
With any treatment, you are the one with the ultimate decision on what treatment option(s) you would like to have. Being informed is key to what each option entails.
In this blog, I will give a brief description of each treatment option for PCOS. So that you’ll be aware of what’s available for you and to make an informed decision.
The first line of treatment is education and lifestyle with or without the use of appropriate pharmacological therapies.
An important thing that there should be no judgement with any treatment decision you make for your PCOS as I see frequently some individuals get shamed for choosing or not choosing a certain treatment.
There is No Cure for PCOS – Yet
PCOS is considered a chronic condition. Unfortunately, so far, PCOS has no cure. You might see claims online that you can “cure” or “heal” your PCOS. However, PCOS treatments can help manage symptoms based on your goals. With the right treatment for you, you may feel that you have no symptoms.
Goals of PCOS Treatments
PCOS treatment goals are first determined if you want to conceive a baby or not. Based on that, your doctor may prescribe you medication. Some individuals can choose not to have any medications and go with other PCOS treatment options.
Goals of PCOS treatments include:
- Manage blood sugar or increase insulin sensitivity
- Reduce androgens and symproms that result from them (acne, extra hair growth, hair loss)
- Reduce body weight
- Induce ovulation for fertility purposes
- Reduce risks of cancers, diabetes and heart disease (Ajossa, Guerriero, Paoletti, Orrù, & Melis, 2004)
- Improve egg quality
- Improve quality of life
Let’s delve deeper into some of the common used treatments for PCOS. I’ll start with the medication options.
PCOS Treatment #1: Hormonal Birth Control (HBC)
For those who aren’t looking to get pregnant, HBC is the first line of treatment for PCOS (Williams, Mortada & Porter, 2016). HBC helps with menstrual irregularity, acne, and extra hair growth. It helps reduce the risk of endometrial (uterus) and ovarian cancers.
HBC is considered a band-aid treatment for PCOS, because it does not address the root cause of PCOS and the actual hormonal imbalances.
What is it?
HBC includes the pill, the patch, the ring, the shot, and IUD (intrauterine device). It has either a combination of two synthetic hormones: estrogen and progestin (synthetic from progesterone). It also comes in a form of progestin only.
The most commonly used one is the birth control pill or referred to as the pill.
Some combination pill examples that are used for PCOS:
- Cyclen
- Tri-cyclen
- Yaz and Yasmin
- Diane-35
Purpose of Use
The main purpose of using birth control is to prevent unwanted pregnancies.
Additionally for PCOS, It’s prescribed to induce a monthly bleeding or stop prolonged bleeding to prevent cancers. It also reduces androgens and their symptoms such as acne, and extra hair growth (hirsutism).
Mechanism of Action
HBC gives external hormones that shuts down the natural hormone release from the pituitary gland and the ovaries. Therefore, it shuts down ovulation. Each component of the hormonal contraceptive plays few roles:
Ethinyl Estrogen Component:
- Suppresses the follicle-stimulating hormone (FSH) from the pituitary gland
- Suppresses the formation of the dominant follicle
- Increase in sex hormone-binding globulin (SHBG), which binds to free testosterone and reduces androgenic effects
Progestin component (variable according to preparation)
- Suppresses the luteinizing hormone (LH) from the pituitary gland
- Creates hostile cervical mucus
- Decrease in ovarian androgen secretion (Nader & Diamanti-Kandarakis, 2007)
Side effects
HBC, depending on the type, has a range of side effects that include:
- Spotting between periods
- Breasts pain
- Mood changes
- Headaches
- Bloating
Other more serious side effects include increasing the risk of:
- High blood pressure
- Dyslipidemia
- Vein thrombosis and blood clots (de Melo, Dos Reis, Ferriani, & Vieira, 2017)
- Increase in insulin levels
- Weight gain (I’ve seen differences between resources reviewed when it comes to this effect)
- Inflammation (Manzoor et al., 2019)
The pill also depletes a lot of important nutrients such as riboflavin (vitamin B2), B6, B12, folate, vitamin C and E, and the minerals: magnesium, selenium and zinc (Palmery et al., 2013).
PCOS Treatment #2: Metformin
It is a drug that is mainly used in blood sugar management in type 2 diabetes. It is used off-label for PCOS.
What is it?
Metformin is known as a biguanide and comes with brand names as: Glucophage, Glucophage XR (extended release), Glumetza, Fortamet, and Riomet.
Purpose of use
To help with insulin sensitivity, which can help with ovulation induction. It also has other benefits of reducing bad cholesterol and preventing gestational diabetes in pregnancy.
Mechanism of Action
Metformin help lower glucose and insulin levels as it:
- Suppresses glucose release from the liver
- Increases the sensitivity of the muscle cells to insulin
- Decreases the absorption of carbohydrate eaten
Side effects
The side effects of Metformin are mainly gastrointestinal (digestive) ones. You may feel nausea, stomach pain, diarrhea, gas, and bloating. Usually those side effects fade away with time or with the choice of the extended release metformin, or with graduality in dosing the metformin.
Long term use of metformin affects the levels of vitamin B12 too. It’s a good idea to monitor vitamin B12 in the blood from time to time.
More serious side effect is lactic acidosis, which is the increase of lactic acid in the body. It happens especially if there are issues with the liver or the kidneys.
PCOS Treatment #3: GLP-1 Receptor Agonist (GLP-1 RA)
It includes a group of medications that are mainly prescribed for individuals with type 2 diabetes or individuals who are interested in taking prescribed medication to assist with weight loss.
What is it?
GLP-1 (Glucagon Like Peptide -1) is a hormone that is naturally produced by the intestines
GLP-1 RA includes injectables:
- Dulaglutide (Trulicity), weekly
- Exenatide extended release (Bydureon), weekly
- Exenatide (Byetta), twice daily
- Semaglutide (Ozempic), weekly
- Liraglutide (Victoza), daily
- Lixisenatide (Adlyxin), daily
- Liraglutide (Saxenda), daily
Oral GLP-1 RA medication:
- Semaglutide (Rybelsus), daily
Purpose of use
The main purpose of use is to reduce blood sugar and help with weight loss as it affects stomach emptying and appetite.
Mechanism of Action
GLP-1 RA activates GLP-1 receptors in the pancreas, which leads to enhanced insulin release and reduced glucagon release. It reduces appetite and delays glucose absorption due to slower gastric emptying.
Side effects
Side effects include: nausea, belching, vomiting, diarrhea, and constipation. It is contraindicated in a history of thyroid cancer.
PCOS Treatment #4: Spironolactone
It is a blood pressure lowering medication and used in PCOS due to its anti-androgenic effect.
What is it?
Spironolactone is the generic name for Aldacton. It is a potassium sparing diuretic drug.
Purpose of use
To manage the symptoms of high androgens (male hormones) such as acne, hair growth on the body, and hair loss.
Mechanism of Action
It is not completely understood. Spironolactone affects androgen receptors, so it reduces acne, hair growth (hirsutism), and hair loss.
Side effects
- vomiting
- diarrhea
- stomach pain or cramps
- enlarged or painful breasts
- irregular menstrual periods
- drowsiness
- tiredness
- Restlessness
There’re more serious side effects as well. There’re also considerations due to interactions with many meds and potassium salts or supplements.
PCOS Treatment #5: Letrozole
It is originally used to treat breast cancer.
What is it?
Brand name is Femera. is an aromatase inhibitor (inhibts aromatase enzyme that changes hormones to estrogen) which is used in the treatment of hormonally-responsive breast cancer.
Purpose of use
For PCOS, it is used to induce ovulation to treat infertility.
Mechanism of Action
Aromatase inhibitors are a class of drugs that block estrogen production and tells the pituatry gland to produce FSH and induce ovulation.
Side effects
Hot flashes, hair loss, joint/bone/muscle pain, tiredness, unusual sweating, nausea, diarrhea, dizziness, and trouble sleeping may occur.
Other serious side effects, includs:
- bone fractures
- mental/mood changes (such as depression, anxiety)
- swelling of arms/legs
- blurred vision
- persistent nausea/vomiting
- unusual tiredness
- dark urine
- yellowing eyes/skin.
PCOS Treatment #6: Clomiphene
It is another fertility drug.
What is it?
Brand names include Clopmid, Milophene, Serophene
Purpose of use
For PCOS, it is used to induce ovulation to treat infertility.
Mechanism of Action
Clomiphene triggers the brain’s pituitary gland to secrete an increased amount of follicle stimulating hormone (FSH) and LH (luteinizing hormone). This action stimulates the growth of the ovarian follicle and initiates ovulation
Side effects
- flushing (feeling of warmth)
- upset stomach
- vomiting
- breast discomfort
- headache
- abnormal vaginal bleeding
More Serious side effects:
- blurred vision
- visual spots or flashes
- double vision
- stomach or lower stomach pain
- stomach swelling
- weight gain
- shortness of breath
Long-term use of clomiphene may increase the risk of ovarian cancer. Clomiphene should not be used for more than about six cycles
PCOS Treatment #7: The Essential PCOS Treatment: Food, Nutrition and Lifestyle
Nutrition and lifestyle is the number one treatment for PCOS. Not just for weight loss, but for many other goals. You may find generalized diet or nutrition advice, however, It is important to be personalized based on the individual needs.
Weight should Not Be the Only Target of Lifestyle Changes
Many times people with PCOS and even their health care providers focus on weight as the target or outcome of nutrition and lifestyle. I don’t think that is the right focus.
Weight is not a behaviour. When weight loss is the goal, people may use tools that can create harm such as restrictions and diets. It also affects your relationship with food and body.
Also, weight loss isn’t required for everyone with PCOS. People with PCOS are at higher risk of developing disordered eating and eating disorders.
You may still want to lose weight or have a target weight, and that is totally valid. I will not dismiss this desire. See, weight loss is complicated especially with PCOS, but it is possible. However, the focus needs to be shifted.
Focus on self-care, satisfaction, improving quality of life, and understanding your condition and your body needs and cues.
Food and Nutrition
Getting the right nourishment from food is key for PCOS management. The goals of nutrition management for PCOS are:
- Ensure adequate nutrition through eating enough energy and macro and micro nutrients
- Manage blood sugar/insulin levels
- Reduce inflammation
- Reduce androgens
- Restore gut health
- Manage symptoms such as acne, cravings, fatigue.
- Prevent health complications
Many times I get asked what foods should I avoid for PCOS? All food fits with of course considering your individual needs, tolerances, and preferences.
I always like to focus on what can be added to your eating versus what needs to be taken away. By the way, there is no diet that has been approved to be the “one” for PCOS. For the next blog post, I outlined almost all diets that are commonly suggested for PCOS and what you can do for you.
Your diet needs to have the right balance of nutrients such as carbohydrates, protein, and fats. You don’t need to avoid carbs or cut out major food groups (except for an indication for that).
Overall, What helps is consuming a diet that is rich in vegetables, fruit, whole grains, nuts, seeds, legumes, and healthy oils. It is also colourful and delicious.
Food and nutrition need to be enjoyed and sustainable for you.
Lifestyle
Lifestyle includes a few items underneath, while mostly we think about movement as the lifestyle management piece, but It also includes stress, sleep, and environment as they all have an impact on health, hormones, and PCOS.
Movement
You may have noticed that I like to call it movement versus exercise or workout because movement is less connected to diets and diet culture. Movement can be fun and joyful, which is key for consistency and sustainability.
Movement implies less sedentary lifestyle and more joy in doing it. The recommendation according to the International Evidence-based Guidelines for PCOS (2018) (Teede et al, 2018) that It includes a minimum of 150 min/week of moderate intensity physical activity or 75 min/week of vigorous intensities or an equivalent combination of both including muscle strengthening activities on 2 non-consecutive days/week.
Stress Management
Stress management should not be ignored in the lifestyle aspect of managing PCOS. Stress does affect hormones. I can explain that in another blog post.
Stress management starts with understanding yourself and source of stress. There are multiple ways to deal with different stressors. Mindfulness, meditation, movement, eating well, setting healthy boundaries, taking breaks, doing things you love, self-compassion, and gratitide are a few ways to manage stress.
Some times, you may need a help of a professional to talk to to help with managing stress and mental health issues such as anxiety and depression.
Sleep Improvement
Getting enough high quality sleep can help tremendously as well. Sleep has an effect on insulin levels, hunger, fatigue, and stress.
PCOS affects sleep. Trying to improve sleep is necessary as well.
Sleeping at least 7 hours following the circadian rhythm. There are few practices that help or hinder that.
Reducing Endocrine Disrupting Chemicals (Environment)
Endocrine Disrupting Chemicals (EDC) are compounds that could mimic, suppress or affect teh action of hormones in the body. They include:
- BPA (Bisphenol-A) found in food packages
- Phthalates found in personal care products
- Perfluorinated chemicals (PFCs) found in non-stick pots and pans
- Triclosan found in cleaning products
- And more!
It was found that some of these EDCs are high in the blood of people with PCOS. It has an effect on metabolism and fertility (in both women and men).
When you reduce EDC in your daily life by avoiding or reducing the exposure of them as much as possible, you reduce the negative effects that EDC could have on your body.
Supplements
Supplements are usually considered after ensuring adequate food intake. In PCOS, there are some nutrients that people with PCOS may lack or have depleted.
Individualized supplementation can be helpful in covering deficiencies or as a therapeutic route to achieve goals such as reduce androgens, reduce insulin resistance, improve egg quality, and more.
There are a lot of nutritional and herbal supplements that can be beneficial for people with PCOS such as inositols, Berberine, NAC (N-acetyl cysteine), ALA (alpha lipoic acid), Vitamin D, Omega 3, Melatonin, CoQ10, magnesium, and more. You may have heard about some of them.
I will talk in more detail about supplements for PCOS in a future post. Stay tuned!
Other Treatments
Those include:
- Complementary treatments such as acupuncture
- Aesthetic skin or hair procedures such as hair removal, acne care, topical skin treatments
- Psychotherapy to address stress, anxiety, depression, or any other mental health issues
Conclusion
Knowing your treatment options well can help you make an informed decision based on your goals. You can ask questions, find more information, work with a dietitian who specializes in PCOS to help you make the most informed choice that is best for you and your health.
As a dietitian specializing in PCOS, I can help you with food, lifestyle, and supplements. Supplements need to be individualized too based on your assessment and goals. If you have more questions, book a free discovery call now.
References
Ajossa, S., Guerriero, S., Paoletti, A. M., Orrù, M., & Melis, G. B. (2004). The treatment of polycystic ovary syndrome. Minerva ginecologica, 56(1), 15-26.
de Melo, A. S., Dos Reis, R. M., Ferriani, R. A., & Vieira, C. S. (2017). Hormonal contraception in women with polycystic ovary syndrome: choices, challenges, and noncontraceptive benefits. Open access journal of contraception, 8, 13.
Manzoor, S., Ganie, M. A., Amin, S., Shah, Z. A., Bhat, I. A., Yousuf, S. D., … & Rashid, F. (2019). Oral contraceptive use increases risk of inflammatory and coagulatory disorders in women with Polycystic Ovarian Syndrome: an observational study. Scientific reports, 9(1), 1-8
Nader, S., & Diamanti-Kandarakis, E. (2007). Polycystic ovary syndrome, oral contraceptives and metabolic issues: new perspectives and a unifying hypothesis. Human Reproduction, 22(2), 317-322.
Palmery, M., Saraceno, A., Vaiarelli, A., & Carlomagno, G. (2013). Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci, 17(13), 1804-13.Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., … & Norman, R. J. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human reproduction, 33(9), 1602-1618.
