Treatment of polycystic ovary syndrome in adults
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- David A Ehrmann, MD
David A Ehrmann, MD
- Professor of Medicine
- University of Chicago
The polycystic ovary syndrome (PCOS) is an important cause of both menstrual irregularity and androgen excess in women. When fully expressed, the manifestations include irregular menstrual cycles, hirsutism, obesity, insulin resistance, and anovulatory infertility.
The treatment of PCOS will be reviewed here. The epidemiology and pathogenesis, diagnostic criteria, and clinical manifestations of PCOS are described in detail separately. (See "Epidemiology and pathogenesis of the polycystic ovary syndrome in adults" and "Diagnosis of polycystic ovary syndrome in adults" and "Clinical manifestations of polycystic ovary syndrome in adults".)
OVERVIEW OF APPROACH
Women with polycystic ovary syndrome (PCOS) have multiple abnormalities that require attention, including oligomenorrhea, hyperandrogenism, anovulatory infertility, and metabolic risk factors such as obesity, insulin resistance, dyslipidemia, and impaired glucose tolerance. Weight loss, which can restore ovulatory cycles and improve metabolic risk, is the first-line intervention for most women. Our overall approach is similar to that described by the 2013 Endocrine Society Clinical Guidelines .
Goals — The overall goals of therapy of women with PCOS include:
●Amelioration of hyperandrogenic symptoms (hirsutism, acne, scalp hair loss)
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- OVERVIEW OF APPROACH
- Lifestyle changes
- Oral contraceptives and risk assessment
- WOMEN NOT PURSUING PREGNANCY
- Menstrual dysfunction
- - Endometrial protection
- Androgen excess
- - Hirsutism
- - Choice of oral contraceptive
- - Antiandrogens
- - Other
- - Acne and androgenetic alopecia
- Metabolic abnormalities
- - Obesity
- Weight reduction
- - Bariatric surgery
- Insulin resistance/type 2 diabetes
- Metabolic effects of OCs in PCOS
- - Dyslipidemia
- - Obstructive sleep apnea
- - Nonalcoholic steatohepatitis
- WOMEN PURSUING PREGNANCY
- Weight loss
- Laparoscopic surgery
- In vitro fertilization
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS