• Credits
  • Section Writer: Dr. Om J Lakhani
  • Section Editor: Dr. Om J Lakhani

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Also see

1. Ovulation Induction
2. Diagnosis of PCOS
3. Clinical manifestations of polycystic ovary syndrome in adults
4. Pathogenesis of PCOS

• Q. Summarize the components of management of PCOS?

  • Management of Hyperandrogenism
    • OC pills- 1st line
    • 2nd line- spironolactone
    • 3rd line – finasteride
    • 4th line- GnRH agonist  + Add back of estrogen and progesterones
  • Infertility
    • 1st line- Weight loss
    • 2nd line- Clomiphine in BMI <30 and Letrozole in BMI > 30
    • 3rd line  - gonadotropins
    • 4th line- laparoscopic ovarian drilling
  • Menstrual irregularity
    • OC pills
    • Intermittent progestins
    • Metformin
  • Glucose intolerance
    • Metformin

• Q. In which group of patient caution must be applied before prescribing OCP?

  • Women >40 years with BMI >30
  • They have an increased risk of VTE

• Q. If the patient refuses to take the OC pill, what is done?

  • Progestin alone may be given for endometrial protection
  • Progesterone only pill- daily
  • Medroxyprogesterone 5-10 mg cyclically for 10-14 days every 1-2 months
  • Levonorgestrel containing IUCD (Mirena)

• Q. Can metformin improve ovulatory function?

  • Yes

• Q. Should metformin be used to treat hyperandrogenism?

  • No
  • It is not indicated for this purpose

• Q. What are the benefits of weight loss?

  • Improve ovulatory function
  • Improve fertility
  • Reduce hyperandrogenism

• Q. Can bariatric surgery improve PCOS symptoms?

  • Yes

• Q. Is TZD recommended in the treatment of PCOS?

  • No
  • Only in diabetic PCOS patients

• Q. What is the impact of OCP on insulin sensitivity?

  • OCP may worsen insulin sensitivity
  • However, data is conflicting
  • Metformin for treatment of the polycystic ovary syndrome

• Q. Where is metformin used in PCOS?

  • PCOS women with glucose intolerance or type 2 diabetes – an only indication as per Endocrine society
  • 2nd/3rd line therapy to improve menstrual cycle in women who refuse OCP

• Q. What is the current data on metformin vis clomiphene in PCOS patients for ovulation induction?

  • Metformin may be as effective as clomiphene for ovulation induction. However, it is less effective for the number of live births

• Management of PCOS in Adolescents

• Q. What is the first-line therapy in adolescents with PCOS?

  • OC pill

• Q. How long is OCP continued in adolescents?

  • Its effect is generally seen after 3-6 months
  • It is continued generally till five years post menarche
  • Then, a trial off medication is tried to see if the symptoms have resolved without medications

#Updates - Monday, 4 October 2021

• Q. What are the benefits of weight loss in patients with PCOS ?
  • Increase of SHBG
    • Less free testosterone levels
  • Reduction of insulin resistance and IGF-1
  • Improvement in glucose tolerance and lipid levels
  • 30% improvement in ovulatory cycles
  • Reduced risk of gestational diabetes mellitus