Getting a diagnosis of polycystic ovary syndrome likely came with a mix of emotions. You might have felt confused and frustrated. Perhaps even feelings of thankfulness now that you finally have an answer to the strange symptoms you’re experiencing.
Simply called PCOS by many, this common hormonal disorder affects 6-12% of women of reproductive age. And while there’s no cure for PCOS, a diagnosis can give you many things. It can open the door to a range of helpful treatment options. It can lead to a better quality of life. And as one of the most common causes of female infertility, it can help you and your doctor talk about options that may help you reach your pregnancy goals.
From symptom management to hormone medications to fertility treatments, here’s what you need to know about polycystic ovary syndrome self-care and treatment options and how they can help you reach your goals, whether it’s living more comfortably or getting pregnant.
How PCOS is treated depends on a few factors
The best polycystic ovary syndrome treatment plan for you will be unique. That’s because your doctor will work with you to make a plan that considers a range of personal factors. Below, we dive into some of the top considerations.
Your pregnancy goals
Polycystic ovary syndrome is one of the most common causes of infertility in women. During ovulation, the ovary releases an egg, which typically happens once per cycle. For people with PCOS, ovulation doesn’t happen consistently or at all. This is called anovulation — when an egg isn’t released — and it’s the cause of approximately 25% of infertility cases. The prevalence of PCOS in women with anovulatory infertility is around 80%. The hormone imbalance associated with PCOS interferes with ovulation, making it more challenging for women to get pregnant, but not impossible.
When discussing your treatment, your doctor will ask about your pregnancy goals. If you hope to become pregnant, they will focus on a plan that helps your body ovulate regularly to increase your chances of conceiving. This will help rule out other treatment options that include hormonal birth control or medications for symptom management that may cause birth defects.
Your age
Polycystic ovary syndrome directly impacts your menstrual cycle. And although the hormonal imbalance of PCOS doesn’t change with age, many women have noticed that their menstrual cycles become more regular as they get closer to menopause age. This is likely because the decrease in estrogen levels as you get older causes your body to eventually stop ovulating. But some may still experience symptoms during and after menopause.
Polycystic ovary syndrome is also linked to other medical conditions like heart disease, diabetes and stroke. And since the risk of these conditions often increases with age, it’s another factor your doctor will consider to guide your PCOS treatment plan.
The type and severity of your symptoms
There are many symptoms associated with PCOS, including an irregular menstrual cycle and irregular ovulation, acne, weight gain and hirsutism (excessive hair growth). But the type and severity of symptoms you experience will be unique, which means your PCOS treatment plan will also be unique. For example, cysts in a polycystic ovary aren’t usually painful.
PCOS self-care: How to manage symptoms naturally
Since polycystic ovary syndrome is a chronic condition, symptoms persist and may worsen over time. Symptom management is the first treatment step for most people, and this can often be achieved through lifestyle changes.
Maintaining a healthy weight
Many people with PCOS struggle with higher body weight because the condition can cause their body to become resistant to insulin. Insulin controls your blood sugar, and when your body can’t properly respond to insulin, it sends a signal to your pancreas to keep producing more. When this happens, your body isn’t able to process the extra insulin and blood sugar, so they’re stored in the body as fat.
Weight loss can help manage and relieve some of your symptoms. A weight loss of as little as 5% of your body weight can lead to more normal menstrual cycles and ovulation. Losing weight can also help regulate your body’s insulin levels and possibly decrease the androgen production that can lead to excessive hair growth and acne.
Eating a nutritious diet
To help you lose weight or maintain a healthy weight, your doctor may recommend some dietary changes. PCOS is also known to increase inflammation throughout the body, so many of the suggested foods for people with PCOS are anti-inflammatory. If you have PCOS, you’ll want to avoid excessive:
- Fried foods
- Sugary cereals
- Red meat
- Butter and margarine (saturated fats)
- Alcohol
- Soda
- Refined-flour pasta and bread
- White rice
Many nutrition experts recommend the Mediterranean diet for its emphasis on healthy fats, veggies and whole grains. A good diet for PCOS symptom management includes plenty of:
- Oily fish with healthy fats (omega-3s), like salmon
- Olive oil for sautéing
- Beans, lentils and other legumes
- Non-starchy vegetables, especially dark, leafy greens
- Whole wheat pasta and bread
- Brown rice
- Fruit
Increasing physical activity level
Regular exercise can help increase your body’s sensitivity to insulin and improve your mental health, while also aiding in weight loss or weight maintenance efforts. There’s no one best exercise for PCOS – it’s whatever you enjoy and will do most regularly, because experts recommend getting at least 150 minutes of exercise each week.
The most balanced workout routines tend to include both cardio and strength training, so you may want to mix up activities like running, swimming, dancing, playing tennis, Pilates, yoga, weightlifting and body-weight exercises for well-rounded fitness.
Hair removal procedures
Between 70-80% of women with PCOS experience excessive hair growth on their face, back, chest, abdomen or thighs. Managing your weight, diet and activity level can decrease excessive hair growth linked to PCOS, but doctors may recommend hair removal procedures like waxing, electrolysis or laser hair removal to further reduce this growth. Most hair removal procedures are not recommended while pregnant, but there are no studies to indicate that procedures like electrolysis or laser are unsafe up to the point of conception.
PCOS treatment if you hope to become pregnant
Doctors will use your pregnancy goals to recommend treatment options for PCOS-related infertility. Whether you’ve been trying to get pregnant or you’re hoping to conceive in the future, the irregular ovulation that happens when you have PCOS can make it harder to become pregnant naturally. Treatment options can include medications, intrauterine insemination and in vitro fertilization.
Ovulation medications for people with PCOS
To increase your chances of getting pregnant, doctors may prescribe ovulation medications that help your ovaries release eggs more regularly, including:
Clomiphene
Clomiphene is an ovulation stimulant that works similarly to estrogen – a female sex hormone that helps the body develop eggs in the ovaries and release them. Regular ovulation is one key factor in increasing your chances of conception each month. Women who benefit the most from using clomiphene are those diagnosed with polycystic ovary syndrome. However, it’s not recommended if you have ovarian cysts.
Clomiphene treatment usually happens in cycles so your doctors can assess the impact, including whether you get pregnant, if cysts have formed on your ovaries, or if the ovaries are enlarged. Clomiphene is designed to stay at a low dosage and treatment time.
Letrozole
Letrozole is an ovulation medication prescribed to women with irregular ovulation. It improves fertility by stimulating the body’s follicle-stimulating hormone (FSH) production. The ovaries have hundreds of follicles that contain an egg, and FSH helps them grow, mature and prepare for ovulation. Letrozole can increase ovulation rates in women with PCOS, and 60-80% of those who take the drug ovulate normally after using it.
Gonadotropins
Gonadotropins can be used as a second line of treatment for PCOS infertility for women who did not ovulate or were unable to conceive after trying clomiphene treatment. Unlike clomiphene and letrozole, the hormone is administered as an injection. Nearly identical to FSH – the hormone the body produces to start ovulation – gonadotropins stimulate the growth and maturation of ovarian follicles. Rather than with a routine women’s health specialist, management with injectable medications is usually done with a reproductive endocrinology and infertility (REI) trained doctor.
Possible risks of ovulation medications
Like other medications, ovulation medications can come with some possible side effects. Those side effects may include headache, upset stomach, blurred vision, shortness of breath and multiple births.
Your doctor can walk you through all the potential risks of ovulation medications and help you decide if they're right for you.
Intrauterine insemination (IUI)
IUI is a fertility treatment where millions of sperm are placed – artificially inseminated – in the uterus. During intercourse, millions of sperm cells leave the body, but only a couple hundred sperm reach the egg. And there’s no guarantee that the sperm are healthy enough to fertilize it.
During an IUI procedure, a doctor will collect a sperm sample and process it to isolate the healthy sperm. They’ll insert a thin tube (catheter) directly into the uterus so more healthy sperm can be placed closer to the egg, increasing the likelihood of fertilization.
IUI is a minimally invasive procedure and shouldn’t cause much discomfort. Your doctor may recommend IUI during reproductive counseling if you’ve been trying to conceive for at least one year.
In vitro fertilization (IVF)
IVF may be an option for PCOS-caused infertility if more conservative treatments don’t work. Typically, your primary care doctor or women’s health specialist would refer you to a specialty fertility clinic if you’re considering IVF.
IVF is a multi-step process. But at a high level, the first step is for you and your partner’s overall health and fertility to be evaluated to determine the best next steps. Then, to actually start the conception process, you’ll begin taking fertility medications for a certain period of time to boost egg production.
Sometime around the middle of your menstrual cycle, the eggs are retrieved through a minor surgical procedure. If you’re using your partner’s sperm, they’ll likely provide a semen sample on the day of the egg retrieval, which will be used to fertilize the eggs in a laboratory. Over several days, the fertilized eggs will be monitored, with some progressing into viable embryos. Embryos are frozen until they’re ready to be transferred to your uterus to hopefully develop.
When compared to medication, IVF has higher pregnancy rates. However, IVF isn’t covered by many insurances, so it can be very expensive.
PCOS treatment if you don’t plan to become pregnant ever or in the near future
If getting pregnant isn’t part of your plans ever or in the near future, doctors may prescribe a series of medications to regulate your hormones and manage your PCOS. Some of these treatments can be discontinued if you decide later that you want to try to become pregnant.
Hormonal birth controls
Hormonal birth control can be an effective, short- or long-term treatment for polycystic ovary syndrome in women who don’t want to become pregnant now or in the future. There are several options, including birth control pills, an intrauterine device (IUD) or a birth control patch.
A combination of estrogen and progestin in these medicines can help even out the hormone imbalance caused by PCOS. They work by increasing estrogen and lowering androgens like testosterone, which can help regulate your menstrual cycle, improve acne and reduce hair on your face and body.
It is also not good for your body to not have periods when your estrogen level is normal. Your uterus needs the protection of progesterone, or it can lead to increased risk of a type of uterine cancer called endometrial cancer. If you are not having periods at least every three months, your doctor will talk to you about ways to protect your uterus.
Diabetes medication
Your doctor may prescribe diabetes medication because PCOS can impact the pancreas just like diabetes. These medications make your body more responsive to insulin. This prevents your pancreas from producing excess insulin and can lower insulin and androgen levels. These medicines can also keep glucose levels stable.
Prescription medications aren’t specifically approved for treating PCOS, but they are often used to treat symptoms as they can clear acne, reduce hair growth from hirsutism, regulate periods, improve weight loss and lower cholesterol levels.
Hormone-blocking medications
To treat your PCOS symptoms, your doctor may prescribe hormone blockers like anti-androgen medicines. These medicines are meant to block the effects that come with excess androgen production to prevent acne and excessive hair growth.
Some common hormone blockers used to treat PCOS include finasteride, eflornithine hydrochloride, and oral and topical spironolactone. Anti-androgen medicines are not recommended if you’re pregnant or actively trying to conceive as they can cause birth defects if taken while pregnant.
Take the next step to get treatment for PCOS
There are several options available for treating polycystic ovary syndrome. Although it’s a chronic condition that persists over time, you can manage your PCOS symptoms and significantly improve your quality of life. Talk to your doctor about your goals. Whether you’ve been trying to get pregnant or looking for relief from your symptoms, they can help you create a unique treatment plan that works for your needs.