PCOS treatment – MENSTRUAL CYCLE
PCOS women who are currently not interested in having a baby can be interested in just regulation of menstrual cycles. Most common type of menstrual cycle in PCOS women is oligomenorrhea which can be treated with Birth Control Pills (oral contraceptives). It is usually doctors’ first choice as a traditional therapy to regulate menstrual periods in women with PCOS. Birth control pills contain a combination of hormones (estrogen and progesterone) - used properly and regularly these pills can assure that women menstruate regularly every four weeks.
As birth control pills make cycles regular and cause women to menstruate every month (and shed the endometrial lining), oral contraceptives as treatment for PCOS help to reduce women’s risk of endometrial cancer. This therapy can also help with hirsutism (male-type hair growth) and acne.
If necessary, some clinics can offer a medication called Provera (medroxyprogesterone) which will induce bleeding if you have not had a period in a while. Provera is an oral medication which is taken for 5-7-10 days and will bring on a period. You may need a blood test prior to beginning this medication to confirm that you are not pregnant.
In PCOS cases with hirsutism androgen-lowering spironolactone (Aldactone) is often used with birth control pills. This helps with hair loss, acne, and male-pattern hair growth on the face and body (hirsutism).
PCOS treatment - OBESITY
In PCOS cases with obesity usually lifestyle modifications are needed. The most important PCOS treatment is to lose weight if you are overweight. By reducing calories and simple sugars, increasing lean protein and fiber and beginning a regular exercise routine, you can help your body increase its response to insulin, and possibly decrease androgen production. This may help reduce symptoms, restore normal menses and make it easier to conceive. While there are medications that can help manage the symptoms you are experiencing, losing weight is the best thing you can do to help treat the disease.
Proper nutrition and dietary restriction are critical aspects of PCOS treatment. Some women with PCOS find success by reducing their total intake of refined carbohydrates (sugars and starches) and replacing them with complex carbohydrates (fruits and vegetables). Refined carbohydrates include white flour foods such as cereals, breads, and pastas. Complex carbohydrates, in comparison, are less processed foods such as those prepared with stone ground whole-wheat flour. Replacing manufactured white-flour foods with a wide variety of whole grains, fruits, and vegetables can help to reduce your insulin response. Your diet should also include enough protein to control the amount of sugar in your blood.
You can discover all recommendations and advices concerning healthy food on next page.
Regular exercise, a healthy diet, not smoking, and weight control are all important parts of treatment for PCOS. Exercise helps the body use insulin more effectively and is highly recommended as well. It helps with weight loss and keeping off weight. Many scientific studies have shown that exercising for at least 30 minutes a day, about five days a week, is highly beneficial to your health.
If you smoke, consider quitting because smoking obese women have higher levels of androgens (male hormones) than women who don't smoke. Smoking also increases your risk of heart disease.
PCOS treatment - INFERTILITY
Metformin is a drug which can be helpful in the formation of insulin. Metformin is safe for women without diabetes because it affects insulin production without lowering blood sugar levels. This drug improves the body’s sensitivity to insulin - it helps your body to use insulin better so that you do not produce as much insulin to control blood sugar. High insulin levels appear to be what creates the high levels of male hormones. By reducing insulin levels, male hormones also decrease. Often Metformin reduce level of androgens (male hormones) which is becoming enough for resuming normal ovulation.
Clomid (or Clomifene citrate) is the most commonly used drug to stimulate ovulation in PCOS infertile women - this drug tricks the brain into thinking that the body is low in estrogen and PCOS body will then comply by beginning ovulation. Clomid works by blocking estrogen receptors in the brain. With estrogen receptors blocked the brain is tricked into thinking there are low estrogen levels. Low estrogen levels trigger the body to produce more FSH and LH. FSH and LH are what signal the body to ovulate. Clomid is often successful at bringing about ovulation but only 30-40% of the women who do ovulate from Clomid will actually become pregnant.
In most cases clomid is taken in the early days of the cycle (usually days 2 to 6) and results in ovulation in around 80% of women overall, and a six month successful pregnancy rate of 45% to 50%.
Clomid users should know that there are some side effects associated with the use of clomid, including an increased chance of having a multiple pregnancy. It is well known that prolonged use of clomid has not found to be beneficial. In general, it is recommended that clomid be prescribed for three to six cycles. If ovulation does not occur in this time, it is advised to move on to another type of treatment.
If clomid is unsuccessful, the next step is to use injectable hormones to stimulate the ovary to produce eggs. Injections of gonadotropins (FSH and LH) work directly to stimulate follicle production and ovulation. These injections require more monitoring than Clomid and are generally used only after other options are tried first.
Like clomid, the hormone treatment must be monitored by blood tests and ultrasound scans to avoid over-stimulation. Multiple pregnancy is always a risk with this type of treatment, but especially so for women with PCOS, whose ovaries are particularly sensitive to the hormones.
The alternative PCOS surgical treatment called laparoscopic ovarian diathermy (LOD) - known as "ovarian drilling". Similar to laparoscopy, this involves a day case operation, a short general anaesthetic, and a telescope look into the abdomen. The ovaries are identified and several small holes made in each ovary, either with a fine hot diathermy probe or via laser.
Ovarian drilling is a procedure where a small needle can be used to puncture tiny holes in the ovary with an electrosurgical needle. The electric current destroys a small portion of the ovary. This may result in lowering androgen levels and restoring ovulation and can also make the ovary more sensitive to clomid.
During 12 months after ovarian drilling the average pregnancy rate is about 60-80%, the greatest success rates being in women with a shorter length of infertility (less than 3 years) and a higher level of the hormone LH (>10 iu/l). Advantages of ovarian drilling include the fact that it may improve other symptoms of PCOS, such as menstrual disturbance, as well as avoiding the need for stimulatory drugs and their increased risk of over-stimulation and a multiple pregnancy.
Less common is Ovarian Wedge Resection. Due to the increased risk of scarring and permanent ovarian damage, if your doctor suggests this procedure, please get a second opinion. It is no longer recommended in the treatment of PCOS.
In vitro fertilization (IVF) is another option for PCOS infertility treatment. In vitro fertilization is procedure where mature eggs are collected from the woman’s ovary. The eggs are then fertilized and implanted in the woman’s uterus. During IVF usually special medications are used to produce mature eggs.
Success rate of IVF procedure can depend very much upon individual characteristics such as age, length of infertility and weight. Additionally, neither IVF nor ovarian stimulation is likely to be successful if a woman is severely overweight (body mass index is greater than 30). This is why most hospitals and fertility clinics restrict these treatments until a woman’s weight is within the normal range.
IVM (in vitro maturation) is a procedure where immature eggs are harvested early in a woman’s cycle. The eggs are matured in a laboratory and can then be used for fertilization. During IVM the eggs are matured in the laboratory – this method can be helpful for PCOS women who do not respond to drug therapy. This type of in vitro fertilization has a better chance of success because of the eggs being allowed to mature before they are placed in the woman’s uterus.
In general all anti-hirsutism tablets may help to slow hair growth down so that hairs become thinner and less noticeable. For significant effect the anti-hirsutism tablets should be taken up to 12 months and usually need to be continued for several years at least. In most cases, hirsutism will return once tablets have been
stopped.
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Oestrogens (eg. oral contraceptives – 1 pill per day) suppress ovarian androgen production and reduce free androgens (Yasmin).
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Diane 35 or Dianette (1 pill per day). This contains oestrogen (female hormone – similar to contraceptive pills) and a low dose of Cyproterone-acetate (anti-androgen). |
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Cyproteron-acetate (anti-androgen) - 50 -200mg per day. Anti-androgens counteract male hormones. Cyproterone must be used along with an oral contraceptive pill to avoid this happening. Cyproterone is also available in doses that are larger and more effective than the dose found in Diane 35 and Dianette. It is necessary to prevent pregnancy during and for up to 6 months following treatment with anti-androgens as they have potential to damage a developing baby (can cause a male fetus to appear female). |
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Spironolactone (200 mg per day) is a diuretic and it has some anti-androgen activity. It should be taken along with an oral contraceptive pill to avoid pregnancy. Can cause useful improvements in hirsutism in selected cases. |
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Metformin. This drug is normally used in the treatment of diabetes. It has been shown to be beneficial in women with PCOS. |
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Vaniqa cream (eflornithine) applied twice daily slows the growth of facial hair by inhibiting a key enzyme involved in hair growth. |
PCOS HIRSUTISM COSMETIC TREATMENT - see on next page.
PCOS treatment – new approaches
(Chicago University - http://www.uchospitals.edu/specialties/pcos/treatment.html)
Rather than focusing on relieving specific symptoms, the newer treatments aim at what may be the root cause of PCOS, i.e., insulin resistance. Many of these new therapies are designed to lower insulin levels, thus reducing production of testosterone.
New evidence suggests that using medications which lower insulin levels in the blood may be effective in restoring menstruation and reducing some of the health risks associated with PCOS. Lowering insulin levels also helps to reduce the production of testosterone, thus diminishing many of the symptoms associated with excess testosterone: hair growth on the body, alopecia (scalp hair loss), acne, and, possibly, cardiovascular risk.
Pioglitazone (Actos®) and Rosiglitazone (Avandia®) are insulin-sensitizing agents that improve glucose tolerance and insulin resistance. These drugs are approved by the Food and Drug Administration (FDA) for the treatment of diabetes. Although they are not approved for treatment of PCOS, they have been shown to be effective for this purpose in many studies.
Metformin (Glucophage®). Metformin is an insulin-lowering drug. It is approved by the FDA as a treatment for diabetes, but is not yet FDA-approved for use in treating PCOS. In clinical trials, metformin has been shown to be very effective in restoring menstrual cycles in many, but not all, patients with PCOS.
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