Callalil's PCOS Pages - Treatment Options

Treatment Options For PCOS

This information is provided for informational purposes only and is in no way meant to replace advice from a qualified medical professional.

Until recently, only the symptoms of PCOS - hirsutism, acne, infertility - could be treated. In the past few years, however, there has been a great deal of research pointing to excess production of insulin and resulting insulin resistance as the root of the problem.

Treatment With Insulin-Sensitizing Medications - The Newest Option

A number of recent studies have shown that treating women with PCOS with insulin-lowering medications such as metformin (also known as Glucophage), Avandia (rosiglitazone) and Actos (pioglitazone), used to treat adult-onset diabetes, can not only reduce the risks of heart disease and diabetes in women with PCOS by treating the underlying problems with insulin production and usage, but also relieve many of the bothersome symptoms and even make weight loss possible.^{1,
2} (Please note that these are not weight-loss drugs; women whose weight problems stemmed from insulin resistance may lose weight when the problem is corrected.)

These drugs do not lower blood sugar and so are generally safe even for those with hypoglycemia³, but there may be side effects. Metformin often causes diarrhea and/or nausea, especially for the first few weeks and when the dosage is increased. This is most problematic if it's taken without food; these problems may be minimized by taking it halfway through a meal. A rare side effect is lactic acidosis, which may be fatal if not detected.

Rezulin (troglitazone) was also used for this purpose until recently, but has been taken off the market after reports of liver abnormalities and even a handful of deaths in some people who were taking it. Avandia and Actos are chemically related to Rezulin, but the effective dosages are far lower (4-8 mg/day of Avandia or 45 mg/day of Actos vs. 200-400 mg/day of Rezulin), making liver complications less likely. In clinical trials involving over 4500 patients, there have been no reports of Avandia-related liver toxicity or related problems^{4, 5}; there have also been no reports of such complications from Actos^{4, 6} Even so, the FDA has recommended that patients who already have elevated liver enzyme levels be monitored regularly. Some people who take Avandia or Actos experience a slight weight gain. (This hasn't been my experience, though - I've actually lost several pounds in the last few months.)

It is important to be aware that all of these medications are currently only approved by the FDA (in the US - I'm not entirely sure of their approval status in other countries) for the treatment of diabetes. There is a lot of convincing research showing that most if not all cases of PCOS can be improved by treating insulin resistance, and these drugs treat diabetes by treating insulin resistance. So, they're likely to be helpful to many women with PCOS, and doctors are allowed to prescribe an approved drug for any purpose they wish, but some (especially those who aren't up to date on the new research) may not be willing to do this.

I'm working on writing up some information about d-chiro-inositol, the first medication being studied specifically to treat PCOS-related insulin resistance, but I want to do more research before I post anything here. In the meantime, check out Ovulatory and Metabolic Effects of d-Chiro-Inositol in the Polycystic Ovary Syndrome. This is an abstract of an article that appeared last year in the New England Journal of Medicine summarizing the findings of a study of this drug in women with PCOS.

Birth Control Pills

Birth control pills treat a few of the symptoms of PCOS. They usually bring on a period each month (though some women with PCOS do not have regular periods even while taking birth control pills) which is important for women who do not have regular cycles because lack of menstruation puts a woman at higher risk for endometrial cancer. Some women find that hair problems either lessen or stop getting worse while on the pill, particularly with Diane-35 or Dianette (which contains cyproterone acetate, an anti-androgen), which is available in some countries in Europe and also in Ausralia and New Zealand but has not been approved in the United States. Acne may improve as well. Weight gain is highly variable - for some women weight gain may stabilize while on the pill; for others it may get worse. Changing brands may help if you find yourself gaining weight or having other unpleasant side effects.

The triphasic birth control pills, such as Ortho Tri-Cyclen, may be problematic in that the estrogen dose they provide in the early part of the cycle may be too low to prevent women with PCOS from developing follicles, possibly resulting in a greater number of cysts on the ovaries.¹

Treating Hirsutism

Hirsutism can an extremely difficult and emotional issue in a society where women are expected to be smooth and hairless. Shaving, plucking, waxing, electrolysis and laser hair removal treatments may work in many cases but can be, depending on the method, time-consuming, messy, painful and/or very expensive.

Spironolactone (brand name Aldactone), if taken over a period of time, will stop new hair growth in many women with hirsutism and may possibly decrease existing growth for some.

In countries where Diane-35 has been approved, it may be prescribed help with hair problems.

Provera

Provera or other forms of synthetic progesterone are often prescribed to women experiencing amenhorrea (lack of periods). It's common for a Provera-induced period to be more heavy or painful than usual, but it's important that something be done to cause regualar menstruation because prolonged amenhorrea may increase a woman's risk for endometrial cancer. This doesn't mean that if you haven't had a period for a very long time that you are destined to get cancer, but it does introduce a higher than usual risk. Some women have had success using progesterone cream as an alternative to Provera.