How you get treated for PCOS will depend very much on your intentions, location and means. Today I’m going to talk a little bit about prescription medication available from your doctor and tomorrow I’m going to cover more natural alternatives for those who either can’t take the prescribed medication or who perhaps can’t afford to do so.
For the purposes of full disclosure, I am not a medical doctor or any kind of medical practitioner. Please do not take any of this as advice without doing your own research and/or discussing it with a fully qualified medical practitioner. I am just highlighting the options I have heard of within the community or been prescribed myself. I will attempt to give balanced descriptions of them from the research available but it is up to you to seek appropriate guidance for the treatment and management of your symptoms.
When I say that treatment will depend on your intentions, I mean that a doctor will treat you differently if you are actively trying to conceive than they would if you were just trying to manage your symptoms, because the first line of treatment is generally a contraceptive pill which, for obvious reasons, is no good for people trying to conceive. There are also other commonly prescribed drugs for PCOS that aren’t safe to take while pregnant.
In terms of trying to conceive, there are several approaches that a doctor could take. Clomid, (clomiphene citrate), is a drug that is commonly prescribed as a first course of action. It works by forcing the body to ovulate. While it will cause about 80% of patients to ovulate (see link above) approximately only 35 – 40% of those patients will actually get pregnant. In patients who are clomiphene resistant, doctors can attempt to induce ovulation with aromatase inhibitors such as Femara, with a similar success rate.
For patients who don’t want to get pregnant, the first port of call is usually an oral contraceptive. It used to be Dianette that was prescribed to PCOS patients but there are so many oral contraceptives on the market now that it’s worth trying a few over several months to try and find the one that minimises your symptoms without causing too many side effects.
One of the central drugs prescribed to treat PCOS, whether patients are trying to conceive or not trying to conceive, is Metformin, which is actually a diabetic drug. It can be prescribed on its own to women trying to get pregnant as it works on the insulin resistance pathway to reduce circulating androgens by bringing down the insulin. It is also sometimes prescribed at the same time as clomiphene.
Unfortunately Metformin has something of a bad reputation and many doctors will refuse to prescribe it. This is one of the better referenced articles I’ve seen about the negatives of Metformin, not including the side effects. It’s very hard on the stomach.
For women who are trying to manage their symptoms without going on the contraceptive pill, another line of treatment are antiandrogens. Typically in the UK this is Spironolactone, sometimes branded as Aldactone. This is often prescribed at the same time as Metformin.
Most other prescriptions I have seen or heard of are to treat specific symptoms, such as vaniquaa cream for hirsutism, or topical ointments/long-term antibiotics for acne. The important thing to note is that, whatever your circumstances, there are a number of different options for treatment out there and your doctor should be able to discuss them with you. Pretty much all of the drugs mentioned above have alternatives and you can try different combinations until you find something that works for you.