Choice of Treatment for Women with Polycystic Ovary Syndrome
July 2006
in “
Fertility and Sterility
”
TLDR The conclusion is that metformin is a first-line treatment for PCOS, particularly for restoring ovulation and increasing pregnancy rates, with other treatments depending on specific symptoms.
The document discusses various treatment options for women with polycystic ovary syndrome (PCOS), a heterogeneous disorder characterized by symptoms such as menstrual irregularity, hyperandrogenism, and metabolic issues like insulin resistance. For infertility due to ovulatory dysfunction, treatments include metformin, clomiphene, letrozole, gonadotropins, and ovarian drilling. Metformin has been highlighted as a first-line treatment, with a reported odds ratio of 3.88 for restoring ovulatory function and a higher cumulative pregnancy rate compared to clomiphene. Skin manifestations like hirsutism, acne, and alopecia related to androgen excess are typically treated with antiandrogens and oral contraceptives. Dysfunctional bleeding is managed with cyclic progestogens or oral contraceptives, while metabolic and weight concerns are addressed through lifestyle changes and metformin, with bariatric surgery as a less preferred option. The document emphasizes the importance of managing the metabolic disorder aspect of PCOS in all treatment strategies.
