There is one major consideration when deciding how best to treat a woman with PCOS, whether she wishes to retain her fertility or not. If you do not wish to become pregnant, treatment is usually with the combined oral contraceptive pill or with a special type of pill that contains cyproterone acetate. This drug reduces testosterone levels and is particularly useful if there are problems with testosterone, e.g. with acne or hirsutism. The pills stop the ovary trying to produce an egg, so the build up of hormones does not take place. If a woman wishes to become pregnant, or does not wish to use contraception, she can take treatment that allows the ovaries to function normally again.
While the typical drugs used are tablets such as clomiphene, which amplify the brain signals that produce eggs, it is interesting that drugs that affect other parts of the homone system of the body can also correct the problems with PCOS. For instance, giving steroids which affect the adrenal gland (e.g. Finasteride) or drugs that are used for diabetes (lack of insulin hormone), e.g. Metformin, can also correct PCOS. This suggests that we need to learn more about exactly why and how PCOS occurs.
If you’re not pregnant after 6 months of simple treatments such as above, you may require more powerful injectable drugs (e.g. FSH), or a procedure called a laparoscopic ovarian diathermy. This is similar to a laparoscopy except that, as well as looking inside, small holes are made in your ovaries as this can make it easier for the ovary to release eggs.