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Polycystic Ovary Syndrome (PCOS) – Treatment Options 

According to recent WHO statistics, PCOS is the most prevalent impediment to female fertility globally; hence, it is crucial to learn about PCOS treatment options. This article explores various PCOS treatment options, including lifestyle changes, medications, and surgery. Additionally, some of the most common symptoms and potential causes of PCOS will be highlighted to help you better understand this condition. 

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is a leading female endocrine disorder that manifests as disruptions in metabolic and reproductive functions. The fluctuations in hormone levels associated with PCOS, especially androgens, affect the ovary function, causing irregular ovulation. As a result, many women with PCOS experience irregular or missed menstrual periods and may struggle to get pregnant. 



Treatment for PCOS 

Presently, there is no proven cure for PCOS, and studies to establish one are ongoing. However, many different treatment options can help reduce the severity of the sickness and improve fertility. If diagnosed with PCOS, your fertility doctor can help determine the appropriate treatment option depending on your symptoms. The available treatments for PCOS include:

Medicines

Your physician may prescribe different medications based on your symptoms and whether or not you plan to have a baby. If you are trying to get pregnant, the prescription may include the following:

• Letrozole: although it is a cancer medication, letrozole also helps stimulate the ovaries to ovulate, increasing your chances of conception.
  
  
• Clomiphene: this drug stimulates the pituitary glands to secrete luteinizing hormone (LH) and follicle-stimulating hormone (FSH) that triggers ovarian follicle formation and ovulation, increasing your likelihood of getting pregnant.
  
  
• Metformin: high insulin levels contribute to delayed or missed ovulation in PCOS patients. Metformin helps induce ovulation by increasing your insulin sensitivity.
  
  
• Gonadotropins: Gonadotropin injection can increase your chances of conception by stimulating the maturation of follicles and regular egg release from the ovary.
  

If you still struggle with fertility problems, your healthcare provider may recommend Assisted Reproductive Technology (ART) treatment, such as IVF, in addition to medications, to enhance the chances of successful conception. However, if you do not intend to get pregnant, your doctor may prescribe medications such as:

• Diabetes medication: the action of diabetic medicines can help lower insulin resistance and limit androgen production, hence reducing acne and excessive hair growth.
  
  
• Birth control pills: the doctor may prescribe you oral contraceptives to help control your menstrual cycles and reduce androgen levels, helping minimise facial hair growth and acne.
  
  
• Other medications: your healthcare provider may recommend certain medicines like Eflornithine or Spironolactone to help reduce the impact of excessive androgen on your skin. Also, they may prescribe progestin to help reduce the risk of endometrial cancer and regulate your periods.

Surgery

If medication does not successfully limit androgen production, your doctor may recommend laparoscopic ovarian drilling (LOD). LOD is a simple, non-painful surgical procedure that involves the use of a laser with the help of a tiny camera (laparoscope) to destroy androgen-producing tissue in the ovaries. This procedure can help restore hormone balance and regular ovulation, increasing your chances of getting pregnant. 

Lifestyle Changes 

Certain lifestyle modifications can help manage PCOS symptoms, lower its long-term health risks, and improve fertility. They include:

• Reduce/Manage Stress: Persistent stress can contribute to hormonal imbalance. Apply stress-relieving methods such as yoga, meditation, or deep breathing. Also, ensure you get sufficient sleep and prioritise self-care.
• Eat Healthily: Adopt a balanced diet with more vegetables, fruits, whole grains, lean proteins, and less cholesterol. Also, avoid sugary drinks, snacks, and processed foods that can affect your insulin sensitivity. Moreover, eating complex carbohydrates and fibre-rich foods like legumes, non-starchy vegetables, and whole grains can help manage your blood sugar levels.
• Quit Smoking: Tobacco smoking can negatively impact insulin sensitivity and heighten the risk of cardiovascular issues already prevalent in women with PCOS.
• Weight management: If you have PCOS, it is crucial to maintain a healthy weight. Shedding excessive weight can help improve ovulation regularity, insulin sensitivity, and hormonal balance. Routine physical activity and reducing starch and cholesterol intake can help manage weight.

PCOS Symptoms

Some of the primary symptoms of polycystic ovary syndrome (PCOS) include: 

• Irregular menstruation: the most prevalent symptom of PCOS is irregular, prolonged, or unpredictable menstrual cycles
  
  
• Elevated androgen levels: another common symptom of PCOS is excessive androgen, which may cause severe acne and excess hair growth.
  
  
• Polycystic ovaries: PCOS may contribute to underdeveloped follicles (small cysts) on the ovaries that can't release eggs.
  
  
• Insulin resistance: this is also common in many women with PCOS, and it increases the risk of type 2 diabetes.
  
  
• Weight management issues: many PCOS patients struggle with insulin resistance, leading to high blood sugar levels that can result in body weight gains. Moreover, PCOS patients often have trouble losing weight.
  
  
• Mood changes: another common PCOS symptom is that you may experience anxiety, depression, or mood induced by hormonal imbalances.
  
  
• High blood pressure: women suffering from PCOS are also more likely to experience high blood pressure.
  
  

Importantly, different women experience different sets and severity of PCOS symptoms. Therefore, your situation may differ from others. Most importantly, you should consult a fertility doctor for appropriate diagnosis and treatment if you experience these symptoms.

PCOS Causes

Research is still ongoing to establish the exact cause of PCOS. However, studies suggest that various factors may contribute to the development of this condition. Such potential causes of PCOS include:

• Hormonal Imbalances: PCOS is associated with excessive androgen (male hormone) production and imbalances in other hormones, including FSH, LH, and insulin. The imbalances disrupt ovary function and may also increase the risk of endometrial cancer.
• Chronic Inflammation: Some studies suggest low-grade chronic inflammation may impact insulin sensitivity and hormone production, affecting ovulation and fertility.
• Insulin Resistance: Many PCOS patients have low insulin sensitivity. Thus, their bodies can't effectively use insulin, causing elevated insulin levels. High insulin levels may trigger excessive androgen production, which can affect ovulation.
• Lifestyle Factors: Some lifestyle factors like being obese or overweight, inactive, and eating a poor diet can lead to PCOS. Moreover, poor lifestyle choices can also contribute to pregnancy complications.
• Environmental Factors: Research shows that prolonged exposure to some environmental elements, like endocrine-disrupting chemicals (EDCs), can cause PCOS. Chemicals such as pesticides, plastics, and various pollutants contain EDCs.
• Genetic Factors: Statistics show that PCOS runs in some families, which suggests that it could be a hereditary disease. Therefore, specific genes may be responsible for this condition.

It's crucial to remember that these are potential causes, and PCOS is a complex condition with multiple factors at play. Your individual PCOS experience may differ from others. Therefore, seeking guidance from a fertility specialist for proper diagnosis and treatment is always advisable.

Conclusion

PCOS is a complex hormonal problem responsible for most female factor infertility cases globally. While its cure is still unknown, several PCOS treatment options can significantly help improve the symptoms and prevent the associated long-term health problems. Management may include medications or surgery, depending on your symptoms and fertility preference. 

 Some primary signs of PCOS are irregular periods, insulin resistance, polycystic ovaries, mood swings, and elevated androgen levels. There is no conclusive information on the exact cause of polycystic ovary syndrome. However, studies suggest potential contributing factors, including hormonal imbalances, inflammation, insulin resistance, and genetic and environmental factors. 

Remember, you can still achieve your dream of having a baby even if diagnosed with PCOS. It is crucial to consult a qualified reproductive andrologist. They can help identify a personalised treatment plan that suits your requirements. Moreover, healthy lifestyle choices significantly help in managing PCOS.

References

• Hoeger, K. M., Dokras, A., & Piltonen, T. (2021). Update on PCOS: consequences, challenges, and guiding treatment. The Journal of Clinical Endocrinology & Metabolism, 106(3), e1071-e1083. Retrieved from https://academic.oup.com/jcem/article/106/3/e1071/5992309

• Badawy, A., & Elnashar, A. (2011). Treatment options for polycystic ovary syndrome. International journal of women's health, 25-35. Retrieved from https://www.tandfonline.com/doi/full/10.2147/IJWH.S11304

• Ndefo, U. A., Eaton, A., & Green, M. R. (2013). Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches. Pharmacy and therapeutics, 38(6), 336. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737989/

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