Part Three: Treating the Symptoms of PCOS
In Parts one and two of this series we discussed PCOS, what it is and how women are diagnosed with PCOS. Today we will turn our attention to treatment options.
Even once women are diagnosed with PCOS they can struggle to get adequate treatment for their symptoms. The underlying cause of PCOS is not known, as a result there is not a treatment or cure for PCOS. In fact, we are not sure that all women with PCOS have the same underlying problem. We are left to treat symptoms. To that end, women are often prescribed birth control pills without a clear explanation of how they might help.
I mentioned that women with PCOS often have different symptoms, so treatment should not be one-size-fits-all.
I feel it is critical to have a detailed conversation with each individual woman with PCOS about the treatment options, including the benefits and limitations of each of them. Medications can be powerful additions to healthy lifestyle changes. But, medications should be tailored to an individual’s symptoms and goals.
It is important to note that there are zero FDA approved medications for PCOS. We use medications “off-label” to treat PCOS symptoms. The three most common treatments used are birth control pills, spironolactone and metformin*. Let’s talk about what they each do.
Combination birth control pills regulate irregular menstrual bleeding. They also lower male hormone levels leading to less acne, scalp hair loss and body hair growth. They do not help with weight loss or insulin resistance. However, contrary to popular belief they do not typically cause weight gain either.
Spironolactone blocks the action of several different hormones one of which happens to be testosterone. As a result it is especially helpful in reducing acne, but it can also help decrease body hair growth and scalp hair loss.
However, because spironolactone blocks the action of other hormones it can cause irregular bleeding from the uterus and can lower blood pressure leading to dizziness for some women. It is also unsafe in pregnancy and should be used in conjunction with an effective form of contraception. Many women take spironolactone with birth control pills if their symptoms are not well controlled on birth control pills alone.
Metformin works completely differently than the other medications we discussed so far. Instead of working on male hormone levels metformin tackles insulin resistance.
Metformin helps make the body more sensitive to insulin. So, it can help with weight loss and weight maintenance and it can help some women ovulate more regularly. More regular ovulation = more regular periods.
Metformin only affects testosterone indirectly so it is not as effective at treating acne, increased body hair growth or scalp hair loss. Many women will have side effects including stomach upset, cramping and diarrhea from metformin, especially when first taking it. Taking the medication exactly as prescribed can minimize these symptoms and for most women they go away after a couple of weeks.
Additionally, because metformin can cause more frequent ovulation in women with PCOS it can increase fertility. So, women not looking to get pregnant should use an effective form of contraception when taking it.
While these are the most common, there are several other medications used to treat the symptoms of PCOS. Diet, exercise and even some supplements can markedly improve symptoms. The most critical aspect of PCOS treatment is maintaining an open dialog between a woman and her doctor.
*You may have heard that metformin has recently been recalled. This was not due to a problem with metformin itself, but impurities in the binders used to make the tablets. If you take metformin, you can contact your pharmacy to see if you received metformin included in the recall.
The Endocrinologist Is In 