Polycystic ovary syndrome – Treatment – NHS

Lifestyle changes

In overweight women, the symptoms and overall risk of developing long-term health problemsfrom PCOS can be greatly improved by losing excess weight.

Weight loss of just 5% can lead to a significant improvement in PCOS.

You can find out whether you're a healthy weight by calculating your body mass index (BMI), which is a measurement of your weight in relation to your height.

Anormal BMIis between 18.5 and 24.9. UsetheBMI healthy weight calculator to work out whether your BMI is in the healthy range.

You can lose weight byexercising regularlyand eating a healthy, balanced diet.

Your diet should include plenty of fruit and vegetables, (at least 5 portions a day),whole foods (such as wholemeal bread, wholegrain cereals and brown rice), lean meats, fish and chicken.

Your GP may be able to refer you to a dietitian if you need specific dietary advice.

Read more about losing weight,healthy eating and exercise.

A number of medicinesare available to treat different symptoms associated withPCOS.

These are described below.

Thecontraceptive pillmay be recommended to induce regular periods, or periods may be induced using anintermittent course of progestogen tablets (which are usually given every 3 to 4 months, but can be given monthly).

This will also reduce the long-term risk of developing cancer of the womb lining (endometrial cancer) associated with not having regular periods.

Other hormonal methods of contraception, such as anintrauterine system (IUS), will also reduce this riskby keeping the womb lining thin, but they may not cause periods.

With treatment, most women with PCOSare able toget pregnant.

The majority of women can be successfully treated with a short course of tablets taken at the beginning of each cycle for several cycles.

If these are not successful, you may be offered injections orIVF treatment. There's an increased risk of a multiple pregnancy (rarely more than twins) with these treatments.

A medicine calledclomifeneis usually the first treatment recommended for women with PCOS who are trying to get pregnant.

Clomifene encourages the monthly release of an egg from the ovaries (ovulation).

If clomifene is unsuccessful in encouraging ovulation, another medicine called metformin may be recommended.

Metformin is often used to treat type 2 diabetes, butit can also lower insulin and blood sugar levels in women with PCOS.

As well as stimulating ovulation, encouraging regular monthlyperiods and lowering the risk of miscarriage, metformin canalso have other long-termhealth benefits, such as loweringhigh cholesterol levels and reducing the risk of heart disease.

Metformin is not licensed for treating PCOS in the UK, but because many women with PCOS have insulin resistance, it can be used"off-label" in certain circumstances to encourage fertility and control the symptoms of PCOS.

Possible side effects of metformin include nausea, vomiting, stomach pain,diarrhoea and loss of appetite.

As metformin can stimulate fertility, if you're considering using itfor PCOS and not trying to get pregnant, make sure you use suitable contraception if you're sexually active.

TheNational Institute for Health and Care and Excellence (NICE) has more information about the use ofmetformin for treating PCOS in women who are nottrying to get pregnant, including a summary of the possible benefits and harms.

Letrozole is sometimes used to stimulate ovulation instead of clomifene. This medicine can also be used for treating breast cancer.

Use of letrozole for fertility treatment is "off-label". This means that the medicine's manufacturer has not applied for a licence for it to be used to treat PCOS.

In other words, although letrozole is licensed for treating breast cancer, it does not have a license for treating PCOS.

Doctors sometimes use an unlicensed medicine if they think it's likely to be effective and the benefits of treatment outweigh any associated risks.

Find out more about unlicensed and off-label use of medicines

If you're unable to get pregnant despite taking oral medicines, a different type of medicine calledgonadotrophins may be recommended.

These are given by injection. There's a higher risk that they may overstimulateyour ovaries and lead to multiple pregnancies.

Medicines to control excessive hair growth (hirsutism) and hair loss (alopecia) include:

These medicines work by blocking the effects of "male hormones", such as testosterone, and some also suppress production of these hormones by the ovaries.

A cream called eflornithinecan also be used to slow down the growth of unwanted facial hair.

This cream does not remove hair or cure unwanted facial hair, so you may wish to use it alongside a hair removal product.

Improvement may be seen 4 to 8 weeks after treatment with this medicine.

But eflornithine cream is not always available on the NHS because some local NHS authorities have decided it's not effective enough to justify NHS prescription.

If you have unwanted hair growth, you may also want to remove the excess hair by using methods such as plucking, shaving, threading, creams or laser removal.

Laser removal of facial hair maybe available on the NHS in some parts of the UK.

Medicines can also be used to treat some of the other problems associated with PCOS, including:

Polycystic ovary syndrome - Treatment - NHS

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