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- Treatment for enhancing fertility
- Treatment for symptoms other than infertility
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Treatment for symptoms other than infertility |
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| Irregular Periods |
Irregular periods can be tackled in two ways. Oral Contraceptive pills (mentioned below) are a good method for treating irregular periods, especially if associated with acne or hirsutism. However, occasionally we do face resistance by the mothers of young adolescents for the use of oral contraceptive pills. In that case, treatment with only the hormone Progesterone, for 10 days of the month, taken cyclically , takes care of irregular cycles. |
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| Insulin Resistance |
Treatment of PCOS, in the earlier years, was restricted to separating out the symptoms and treating each individual one. Research has led to scientists focusing on what may be the underlying cause of PCOS, insulin resistance. Treatment of the underlying cause therefore benefits all aspects of PCOS rather than the specific targeting on each symptom. |
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Medications that lower insulin levels in the blood may be effective in restoring menstruation and reducing some of the health risks associated with PCOS. It can also lead to the reduction of testosterone, thus diminishing many of the symptoms associated with excess testosterone: hair growth on body, alopecia (hair loss on head), acne, obesity and cardiovascular risk.
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| Metformin, an insulin lowering agent, is now commonly being used to treat some women with PCOS. Metformin improves both glucose tolerance and insulin sensitivity. |
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Metformin is available in 500mg, and 850mg tablets. The therapeutic dose for PCOS has been found to be around 1500mg. |
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| Approximately 30 % of patients started on Metformin will experience gastrointestinal symptoms (diarrhoea, nausea, vomiting, abdominal bloating, flatulence, and loss of appetite). These symptoms are usually temporary (1-4 weeks) and will disappear during continued therapy. It is advisable for new patients to initiate therapy slowly to minimize the gastrointestinal side effects. |
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| Internationally there are a wider range of insulin sensitising drugs available for PCOS. They are Pioglitazone, Rosiglitazone and Troglitazone. |
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| Acne |
There are 3 main treatments for women suffering from acne due to PCOS, Oral contraceptive pills (OCPs), Spironolactone (Aldactone) and Roaccutane. |
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| OCPs |
Diane-35 / Gynette 35 is an oral contraceptive pill with an anti-androgen, cyproterone acetate. The cyproterone acetate helps reduce the testosterone and therefore helps control acne and hirsutism (excess hair growth) of PCOS.
The amount of cypreterone acetate in Diane-35 is quite small and if not found to be adequate to control the acne it can be prescribed by itself or other drugs can be used such as Roaccutane or Spironolactone. |
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Spironolactone works very similarly to cyproterone acetate as it is also an anti androgen, it can be used to treat acne and hirsutism caused by high testosterone. |
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Roaccutane is used for severe cases of acne. It cannot be used by women who are trying to conceive as it can cause defects to fetuses. It is usually taken for 4-7 months and then stopped once the acne is under control. Roaccutane works by reducing sebum production and shrinking the sebaceous glands. Treated skin is dry, inhibiting the growth of bacteria.
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| It can cause a number of side effects that can be unpleasant (extremely dry skin, eczema, increased susceptibility to sunburn, hair loss, fragile skin etc). |
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| Hirsuitism |
Hirsuitism is excess body hair, such as on chins, chest and necks. This hair is different from the hair that some women have on their upper lip, chin, breasts, stomach or the fine "baby" hair all over their body, tending to be longer and more coarse. |
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Hirsuitism is caused by hair follicles that are overly sensitive to male hormones (called androgens), or when there are abnormally high levels of these hormones as is the case with PCOS. Treatment is usually various types of antiandrogens which reduce the testosterone levels which cause the male like hair growth. |
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| Cosmetic Treatments |
| Laser - may cause hyperpigmentation. Most suited to pale skinned, dark haired women. |
Electrolysis - can cause scarring.
Waxing/creams |
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Lifestyle
Diet - exercise to keep weight off, and low carbohydrate diets mean less excess insulin is produced thus reducing the amount of androgens in the body. |
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| Conventional |
Doctors can prescribe medicine to decrease excess hair growth. However, depending on the medicine, it will usually takes three to six months to work and may only decrease the amount of new hair growth. Existing hairs may have to be removed by electrolysis or laser. |
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| Metformin increases the effectiveness of insulin at the peripheral cell level, reduces hyperinsulinemia, and reduces hyperandrogenemia in turn, thus correcting this biochemical domino effect by correcting it at the source. When insulin levels drop on Metformin, PCOS patients lose weight, drop their blood pressure, and may lose the extra body hair (caused by high testosterone). |
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Spironolactone (Aldactone) is a powerful anti-androgen reducing body hair growth over time and is also used to treat alopeocia. It can only be used by women who aren't trying to conceive a baby as it can cause defects in a developing foetus. |
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Cyproterone is another anti-androgen available, considered as effective as spironalactone. It can cause weight gain and may cause depression. |
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Oral contraceptives (Gynette/Diane 35/Yasmin etc) inhibit ovarian steroid production with consequent reduced hair growth. They contain a small amount of the anti-androgen Cyproterone Acetate in combination with the normal pill hormones. |
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Herbal Remedies
Saw palmetto, licorice and peony can all be prescribed in tincture forms. Both saw palmetto and licorice have been researched properly and found to have anti-androgenic properties. Peony is a traditional ingredient in Chinese herbal medicine (for menstruation problems) |
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