What Can A Patient With PCOS Do About This Condition?
| The treatment of PCOS ultimately depends on symptoms and whether the patient desires pregnancy.
Insofar as menstrual irregularities and hormonal imbalance causing lack of ovulation is concerned, the birth control pill is the most effective method of providing regular, predictable cycles for those women not interested in childbearing. The birth control pill represents a safe and effective treatment for long-term hormonal imbalance in PCOS because the active ingredients in the pill reduce the ovarian production of male hormone and at the same time minimizes any risks of uterine cancer.
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Another benefit of the birth control pill is in the treatment of acne and hirsutism (excess central hair growth). Not all patients benefit from the effects of the birth control pill in reducing hair growth and acne. Nonetheless, many patients have reported improvement in these symptoms after six months of pill use. Besides oral contraceptives, other medications are available for the treatment of hirsutism. The most common of these is spironolactone, which can be used alone or in conjunction with oral contraceptives.
For women with PCOS who manifest obesity and insulin resistance, weight reduction will be the first positive step not only in the control of these symptoms, but weight loss may also regulate menstrual periods, improve fertility, and reduce male hormone levels. Gradual and slow weight reduction may also lower the incidence of coronary artery disease by improving cholesterol and trigliceride levels. Patients should consider a holistic approach to getting insulin levels under control by the following steps.
- Consult with a nutritionist to create a well-balanced diet (low carbohydrate, low fat, adequate protein) that will allow slow weight loss.
- Adopt an easy (low impact) exercise program.
- Learn to manage stress.
- Consider the use of insulin sensitizing agents such as Metformin to control insulin levels.
The ideal diet for PCOS is up for debate, however, there is some support for modestly reducing carbohydrate intake from the recommended 55% of calories to only 45% of calories. Carbohydrates generally increase insulin secretion after a meal. Thus limiting carbohydrate intake to about 45% (and replacing the missing carbohydrate calories with small amounts of "good" fats found in oily fish. nuts, olive and canola oil, for example) may in turn lower insulin levels.
For those women who desire fertility, the first line drug of choice to improve ovulation in some women with PCOS is clomiphene citrate. This is a fertility pill (tablet) taken for five days of a given cycle. If pregnancy is not observed after three to four ovulatory cycles with clomiphene, it is not unreasonable to consider the use of injectible fertility medications.
Although PCOS is a complex, heterogeneous disease, it can be approached in such a way as to help patients improve their fertility and ultimately lead healthier lifestyles.
