What are the treatments for PCOS?

Treatments for PCOS, its specific symptoms, and its associated health problems vary, but they may include medications, lifestyle changes, and ways to address increased hair growth and acne.

Because PCOS has a broad range of symptoms, health care providers may use a variety of treatments for this condition and its symptoms.1

The treatment(s) your health care provider suggests will depend on your symptoms, overall health, and plans for pregnancy.

Because some of the common treatments for PCOS symptoms can prevent pregnancy or may harm the fetus during pregnancy, it's important to discuss your fertility goals with your health care provider when discussing treatment options. Be sure you fully understand your treatment options and their effects on pregnancy before deciding on a course of treatment.

Please note that treatments have risks and side effects, some of them serious. You should discuss the risks and possible side effects of treatments with your health care provider. Because some lifestyle choices, such as smoking cigarettes, can increase these risks, you should discuss all these factors with your health care provider before making decisions about treatments.

Many of the treatments discussed are not approved by the U.S. Food and Drug Administration (FDA) specifically for treating PCOS, meaning they cannot cure or prevent the condition. However, your health care provider may recommend them to treat symptoms of PCOS, such as acne and irregular periods.

The following information describes available treatments for different symptoms of PCOS. You can also review the treatment options for infertility related to PCOS.

Research shows that, if a person with PCOS has overweight or obesity, losing a small amount of weight and being more physically active can minimize many PCOS symptoms and related health issues, especially cardiovascular risks.2

  • Weight loss can restore ovulation and help make menstrual cycles more regular, which can improve chances of pregnancy and overall health.2,3
  • Losing weight can improve both insulin and cholesterol levels.2,4
  • For many people with PCOS, weight loss also reduces symptoms such as increased hair growth and acne.2,5
  • Physical activity can help reduce depression associated with PCOS.6

Adjusting your diet to reduce foods that can cause or increase inflammation could also be beneficial.7 Talk to your health care provider about designing a diet and physical activity plan just for you.

Also called birth control pills or “the pill,” oral contraceptives containing the hormones estrogen and progestin are the primary long-term treatment option for people with intact ovaries who have PCOS but do not wish to become pregnant.2 In people with PCOS, these hormones:2

  • Make menstrual periods more regular
  • Reduce the level of androgens, leading to lower androgen activity
  • Help clear acne and reduce increased 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.8 There is no one oral contraceptive that works best for people with PCOS. However, some pills contain progestin, and some types of progestin have “androgenic” side effects, such as oily skin, acne, and increased hair growth. For this reason, birth control pills that contain a low-androgenic progestin that does not activate these side effects are more effective at treating the symptoms of PCOS.9

These types of medications make the body more responsive to insulin and keep glucose levels more stable.2,10 In people with PCOS, these medications can help:

  • Clear acne and reduce hair growth
  • Improve weight loss
  • Lower cholesterol levels
  • Make periods more regular
  • Slightly reduce infertility associated with PCOS11

After 4 to 6 months of using these medications, people with PCOS who have ovaries may start ovulating naturally.12

Insulin-sensitizing medications, such as metformin, are not FDA approved to treat PCOS, but may help reduce symptoms. Talk to your health care provider about any concerns you may have about these medications.13

These medications either prevent the body from making androgens or limit the activities or effects of those hormones. In people with PCOS, anti-androgens can:

  • Lower androgen levels
  • Reduce hair growth
  • Clear acne

Because anti-androgens can cause congenital anomalies, they are often taken with oral contraceptives to prevent pregnancy.14 Be sure to talk with your health care provider about the risks of these treatments, especially if you want to become pregnant.

Anti-androgen medications are not FDA approved to treat PCOS but may help reduce symptoms. Currently, the best type of anti-androgen for treating PCOS symptoms is not known.

Those who wish to remove or otherwise address unwanted hair or increased growth for personal aesthetic reasons can use the following methods instead of or in combination with other approaches:13

  • Daily application of an eflornithine cream slows hair growth, especially on the face, by blocking an enzyme hair needs to grow. The hair will grow back when use of the cream stops, so those interested should talk with a 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 people with PCOS.13
    • Some studies in animal models suggest that combining the cream use with mechanical methods, such as microneedles, may improve outcomes.15
    • Pregnant people should not use this cream because it can cause harm to a fetus. Talk to your health care provider about risks, benefits, and your fertility goals before using the cream.16
  • Mechanical methods, such as shaving, bleaching, plucking, waxing, and using depilatories (creams that dissolve hair), are also effective at temporarily 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. Similarly, some depilatories can cause irritation and rashes.
  • Electrolysis, lasers, and intense pulsed light (IPL) therapy are options for permanent or long-term hair removal. These treatments may require multiple sessions to remove hair.2 Electrolysis uses an electric current applied to each hair follicle to destroy its root. Laser hair removal uses a laser beam to destroy the root of the hair follicle. IPL therapy uses an intense flash of light in a specific wavelength to target the melanin, or color, in hair to destroy the hair follicle.

Retinoids, antibacterial agents, and antibiotics are common ways to treat acne; the specific treatment recommended depends on the severity of the acne. The treatments come in a variety of forms, such as pills, creams, or gels, and in different strengths; higher strength options may require a prescription.

Because retinoids can cause congenital anomalies, those who are or wish to become pregnant should not use the treatments.2

Citations

  1. Teede, H. J., Tay, C. T., Laven, J. J. E., Dokras, A., Moran, L. J., Piltonen, T. T., Costello, M. F., Boivin, J., Redman, L. M., Boyle, J. A., Norman, R. J., Mousa, A., & Joham, A. E. (2023). Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. The Journal of Clinical Endocrinology and Metabolism, 108(10), 2447–2469. PMID: 37580314
  2. American College of Obstetricians and Gynecologists. (2022) FAQs: Polycystic ovary syndrome (PCOS). Retrieved July 26, 2024, from https://www.acog.org/en/womens-health/faqs/polycystic-ovary-syndrome-pcos external link
  3. Badawy, A., & Elnashar, A. (2011). Treatment options for polycystic ovary syndrome. International Journal of Women's Health, 3, 25–35. PMID: 21339935
  4. National Heart, Lung, and Blood Institute. (2005). Aim for a healthy weight. Retrieved July 26, 2024, from https://www.nhlbi.nih.gov/resources/aim-healthy-weight-patient-booklet
  5. Moran, L. J., Hutchison, S. K., Norman, R. J., & Teede, H. J. (2011). Lifestyle changes in women with polycystic ovary syndrome. The Cochrane Database of Systematic Reviews, (2), CD007506. PMID: 21328294
  6. Lamb, J. D., Johnstone, E. B., Rousseau, J. A., Jones, C. L., Pasch, L. A., Cedars, M. I., & Huddleston, H. G. (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.e3526. PMID: 21288501
  7. Azarbayjani, K., Jahanian Sadatmahalleh, S., Mottaghi, A., & Nasiri, M. (2024). Association of dietary inflammatory index with C-reactive protein and interleukin-6 in women with and without polycystic ovarian syndrome. Scientific Reports, 14(1), 3972. PMID: 38368454
  8. National Cancer Institute. (2018). Oral contraceptives and cancer risk. Retrieved July 26, 2024, from https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet
  9. Mathur, R., Levin, O., & Azziz, R. (2008). Use of ethinylestradiol/drospirenone combination in patients with the polycystic ovary syndrome. Therapeutics and Clinical Risk Management, 4(2), 487–492. PMID: 18728832
  10. Nandi, A., Chen, Z., Patel, R., & Poretsky, L. (2014). Polycystic ovary syndrome. Endocrinology and Metabolism Clinics of North America, 43(1), 123–147. PMID: 24582095
  11. Legro, R. S., Barnhart, H. X., Schlaff, W. D., Carr, B. R., Diamond, M. P., Carson, S. A., Steinkampf, M. P., Coutifaris, C., McGovern, P. G., Cataldo, N. A., Gosman, G. G., Nestler, J. E., Giudice, L. C., Leppert, P. C., Myers, E. R., & Cooperative Multicenter Reproductive Medicine Network (2007). Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. The New England Journal of Medicine, 356(6), 551–566. PMID: 17287476
  12. Barbieri R. L. (2003). Metformin for the treatment of polycystic ovary syndrome. Obstetrics and Gynecology, 101(4), 785–793. PMID: 12681887
  13. Radosh L. (2009). Drug treatments for polycystic ovary syndrome. American Family Physician, 79(8), 671–676. PMID: 19405411
  14. Martin, K. A., Anderson, R. R., Chang, R. J., Ehrmann, D. A., Lobo, R. A., Murad, M. H., Pugeat, M. M., & Rosenfield, R. L. (2018). Evaluation and treatment of hirsutism in premenopausal women: An Endocrine Society Clinical Practice guideline. The Journal of Clinical Endocrinology and Metabolism, 103(4), 1233–1257. PMID: 29522147
  15. Kumar, A., Naguib, Y. W., Shi, Y. C., & Cui, Z. (2016). A method to improve the efficacy of topical eflornithine hydrochloride cream. Drug Delivery, 23(5), 1495–1501. PMID: 25182303
  16. U.S. Food and Drug Administration. (2000). VANIQA™ (eflornithine hydrochloride) cream, 13.9%. Retrieved July 26, 2024, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/21145lbl.pdf (PDF 236 KB)
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