Polycystic ovary syndrome medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
The first step in the management of PCOS is weight loss if the patient is obese, and treatment of type 2 diabetes, if present, with metformin. In significantly overweight patients, weight loss alone usually effects a cure and should always be vigorously attempted. Diet and exercise are recommended in all women with PCOS. The next step is initiation of treatment to break the self-perpetuating anovulatory cycling, either by stimulating ovulation or suppressing androgenic and ovarian activity. The selection of treatment depends on whether pregnancy is desired. All | The first step in the management of PCOS is weight loss if the patient is [[obese]], and treatment of [[type 2 diabetes]], if present, with [[metformin]]. In significantly overweight patients, weight loss alone usually effects a cure and should always be vigorously attempted. Diet and exercise are recommended in all women with PCOS. The next step is initiation of treatment to break the self-perpetuating [[annovulation|anovulatory cycling]], either by stimulating ovulation or suppressing androgenic and ovarian activity. The selection of treatment depends on whether pregnancy is desired. All anti-androgen treatments will take at least 3 months to affect hirsutism. | ||
The goals of treatment are: | The goals of treatment are: | ||
*Exclude androgen-secreting tumors, endometrial tumors, and endometrial hyperplasia | *Exclude androgen-secreting tumors, endometrial tumors, and endometrial hyperplasia | ||
*Reduce ovarian androgen secretion and/or antagonist activity at target tissues | *Reduce ovarian androgen secretion and/or antagonist activity at target tissues | ||
*Interrupt the self-sustaining abnormal hormonal cycle | *Interrupt the self-sustaining abnormal hormonal cycle | ||
*Normalize the endometrium | *Normalize the [[endometrium]] | ||
*Restore fertility by correcting anovulation, if desired | *Restore fertility by correcting [[anovulation]], if desired | ||
*Reduce insulin resistance | *Reduce [[insulin resistance]] | ||
==If fertility is not desired== | |||
*Preferred regimen (1): Combined [[|OCP|oral contraceptive pills]] one tablet of formulations containing 30 to 35 μg [[estrogen]] orally daily for 21 days, then nothing for 7 days | |||
*Preferred regimen (2): Progesterone-only contraceptive pills (eg, [[norethindrone]], [[norgestrel]] ) are the treatment of choice if combined [[OCP|oral contraceptive pills]] are contraindicated | |||
*Alternative regimen(1): [[Medroxyprogesterone]] may be used, although it is not approved by the U.S. Food and Drug Administration (FDA) for this indication | |||
*Alternative regimen(2): [[Glucocorticoids]] (eg, [[hydrocortisone]], [[cortisone]], [[dexamethasone]] ) may be used to suppress adrenal androgen production, although they are not approved by the FDA for this indication | |||
*Alternative regimen(3): [[Spironolactone]] and [[flutamide]] are androgen receptor antagonists that may be added to the oral contraceptive pill, but they are not approved by the FDA for this indication; [[flutamide]] is not usually recommended because of its unproven efficacy and associated risk of hepatic impairment | |||
==If fertility is desired== | |||
*Preferred regimen (1): [[Clomiphene]], alone or in combination with [[glucocorticoids]], is the first-choice treatment | |||
*Preferred regimen (2): [[FSH|Follicle-stimulating hormone]] may be administered in conjunction with timed [[HCG|human chorionic gonadotropin]] for [[ovulation]] induction | |||
*Preferred regimen (3): [[Metformin]] | |||
==References== | ==References== | ||
Revision as of 14:07, 2 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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Overview
Medical Therapy
The first step in the management of PCOS is weight loss if the patient is obese, and treatment of type 2 diabetes, if present, with metformin. In significantly overweight patients, weight loss alone usually effects a cure and should always be vigorously attempted. Diet and exercise are recommended in all women with PCOS. The next step is initiation of treatment to break the self-perpetuating anovulatory cycling, either by stimulating ovulation or suppressing androgenic and ovarian activity. The selection of treatment depends on whether pregnancy is desired. All anti-androgen treatments will take at least 3 months to affect hirsutism. The goals of treatment are:
- Exclude androgen-secreting tumors, endometrial tumors, and endometrial hyperplasia
- Reduce ovarian androgen secretion and/or antagonist activity at target tissues
- Interrupt the self-sustaining abnormal hormonal cycle
- Normalize the endometrium
- Restore fertility by correcting anovulation, if desired
- Reduce insulin resistance
If fertility is not desired
- Preferred regimen (1): Combined [[|OCP|oral contraceptive pills]] one tablet of formulations containing 30 to 35 μg estrogen orally daily for 21 days, then nothing for 7 days
- Preferred regimen (2): Progesterone-only contraceptive pills (eg, norethindrone, norgestrel ) are the treatment of choice if combined oral contraceptive pills are contraindicated
- Alternative regimen(1): Medroxyprogesterone may be used, although it is not approved by the U.S. Food and Drug Administration (FDA) for this indication
- Alternative regimen(2): Glucocorticoids (eg, hydrocortisone, cortisone, dexamethasone ) may be used to suppress adrenal androgen production, although they are not approved by the FDA for this indication
- Alternative regimen(3): Spironolactone and flutamide are androgen receptor antagonists that may be added to the oral contraceptive pill, but they are not approved by the FDA for this indication; flutamide is not usually recommended because of its unproven efficacy and associated risk of hepatic impairment
If fertility is desired
- Preferred regimen (1): Clomiphene, alone or in combination with glucocorticoids, is the first-choice treatment
- Preferred regimen (2): Follicle-stimulating hormone may be administered in conjunction with timed human chorionic gonadotropin for ovulation induction
- Preferred regimen (3): Metformin