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Medical treatment of PCOS is tailored to the patient's goals. If restoration of ovulation and fertility are desired, then metformin and or clomiphene citrate are indicated. In cases of clomiphene resistance, injections of follicle stimulating hormone may be used. If hirsutism is a primary concern, then oral contraceptives and either cyproterone acetate or spironolactone (a blocker of androgen receptors) are indicated. If the goal is to prevent the unopposed estrogen effect of anovulation, which can lead to endometrial hyperplasia and endometrial cancer, then oral contraceptives or cyclic progestins are indicated.
Low-carbohydrate diets and sustained regular exercise are also beneficial. More recently doctors and nutritional experts are recommending a low-GI diet in which a significant part of the total carbohydrates are obtained from fruit, vegetables and wholegrain sources. These diets help women with PCOS to maintain steady blood sugar and insulin levels and may assist in weight loss. A diet composed of mainly low-GI foods combined with regular exercise will also help to combat the effects of insulin resistance.
Many women find insulin-lowering medications such as metformin hydrochloride (Glucophage®), pioglitazone hydrochloride (Actos®), and rosiglitazone maleate (Avandia®) helpful, and ovulation may resume when they use these agents. Many women report that metformin use is associated with upset stomach, diarrhea, and weight-loss. Such side effects usually resolve within 2-3 weeks. Both symptoms and weight loss appear to be less with the extended release versions. Most published studies use either generic metformin or the regular, non-extended release version. Starting with a lower dosage and gradually increasing the dosage over 2-3 weeks and taking the medication toward the end of a meal may reduce side effects. Though the use of basal body temperature or BBT charts is sometimes advised to predict ovulation, clinical trials have not supported a useful role. It may take up to six months to see results, but when combined with exercise and a low glycemic index diet up to 85% will improve menstrual cycle regularity and ovulation.
Initial research also suggests that the risk of miscarriage is significantly reduced when Metformin is taken throughout pregnancy (9% as opposed to as much as 45%); however, further research is needed in this area.
For patients who do not respond to insulin-sensitizing medications and who wish to achieve pregnancy, there are many options available including, clomiphene citrate to induce ovulation or ART procedures such as controlled ovarian hyperstimulation and IVF. Ovarian stimulation has an associated risk of ovarian hyperstimulation in women with PCOS - a dangerous condition with morbidity and rare mortality. Thus recent developments have allowed the oocytes present in the multiple follicles to extracted in natural, unstimulated cycles and then matured in vitro, prior to IVF. This technique is known as IVM (in-vitro-maturation)
Though surgery is usually the treatment option of last resort, the polycystic ovaries can be treated with surgical procedures such as
* laparoscopy electrocauterization or laser cauterization
* ovarian wedge resection (rarely done now because it is more invasive and has a 30% risk of adhesions, sometimes very severe, which can impair fertility) was an older therapy
* ovarian drilling
Alternative approaches
Ian Stoakes, a UK-based scientist has recently claimed some success in treating PCOS through tailored diets; believing that there is a strong link between PCOS, diabetes (and associated diseases) and inflammation caused by the failure of the blood to absorb specific foods.[citation needed] Blood samples are tested to see how they react to different food types to provide the patient with a list of foods they can eat and foods to avoid. Weight loss, alleviation of symptoms and successful pregnancies are claimed for this approach.[citation needed] It however remains a totally unproven approach with no research papers listed in PubMed by Stoakes concerning PCOS.
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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