Medications for Polycystic Ovary Syndrome (PCOS)

Treatment Options for the Different Symptoms of PCOS

PCOS medications
What medications are used to treat polycystic ovary syndrome (PCOS)?. Tetra Images/Getty

What medications are used to treat polycystic ovary syndrome and how do these work? What are the goals of treatment and how can you decide what's best for you?

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a complex and under-recognized condition affecting roughly 10 percent of women of childbearing age. Women with PCOS present with a variety of signs and symptoms, including dermatological concerns (such as acne and hair growth on the face), mood changes, reproductive, and metabolic conditions.

If not managed, PCOS can lead to chronic conditions such as type 2 diabetes. 

Types of Medications Which May Be Used to Treat PCOS

There are a wide variety of treatments available for women with polycystic ovary syndrome (PCOS). For the most part, the specific medications used are given to address the symptoms caused by the disease, rather than the underlying disease itself. As will be noted by looking at these options, it's very important to consider your goals in treatment and what symptoms are interfering with your life enough to wish to address them. The most common symptoms for which women with PCOS seek treatment include:

  • Irregular periods
  • Acne 
  • Hirsutism (hair growth on the face)
  • Oily skin and hair
  • Male pattern balding (androgenic alopecia)
  • Infertility - If you're trying to conceive, medications to improve ovulation may be needed
  • Weight gain and obesity
  • Insulin resistance - Nearly 50 percent of women with PCOS develop diabetes or "pre-diabetes" by the age of 40

    Let's take a look at the medications used for some of these symptoms.

    Medications to Regulate the Menstrual Cycle

    Hormonal abnormalities with PCOS often result in infrequent periods (oligomenorrhea) or absent periods (amenorrhea), and medications can be used to regulate hormones and restore a normal menstrual cycle.

    For women who do not plan on becoming pregnant, regulating periods is still important as going for an extended period of time without periods may raise the risk of uterine cancer. Approaches may include:

    • The birth control pill
    • Provera (progesterone)
    • Myo and d-chiro Inositol (see below)

    Medications to Improve Insulin Resistance

    Typically known as diabetes medications, insulin-sensitizers can reduce blood sugar (glucose) and insulin levels in people with pre-diabetes, diabetes, or those at risk for insulin resistance (which includes at least 70 percent of women with PCOS). 

    • Glucophage (metformin) - Metformin can lower blood gluose in several different ways. Also, in addition to addressing insulin resistance, metformin may help control some of the other symptoms of PCOS, such as hirsutism and obesity.
    • Victozia (linaglutide) - Victozia is a gut hormone used by injection that stimulates insulin secretion (among other functions). While Victozia was found to significantly decrease hemoglobin A1C levels (a measure of average blood sugar over a period of months), it is also associated with significant weight loss. In one study, the average weight loss was 20 pounds over a period of seven months on the medication. Victozia is also being studied in combination of metformin. There is some concern that linaglutide is associated with thyroid tumors as well as pancreatitis. (Note that Vicotozia is the same medication as Saxenda listed below under weight loss.)
    • Actos
    • Avandia
    • Inositol

    Weight Loss Medications

    It can be hard separating out the role of PCOS alone or excess body weight in the insulin resistance that accompanies PCOS. Roughly half of people with PCOS struggle with excess weight or obesity, and there are a few reasons why it is harder for women with PCOS to lose weight.

    • Xenical and Alli over-the counter (orlistat) - Orlistat is a "fat blocker" which can lead to weight loss by blocking the absorption of fat in the gut. Due to its function in blocking fat absorption, fats which are eaten may pass all the way through the digestive tract creating oily stools and sometimes "leaking." These medications may interfere with the absorption of fat soluble vitamins and should not be used by women who have cholestasis (sluggish bile flow) or malabsorption syndromes.
    • Qsymia (phentermine/topiramate) - Qsymia was approved for the treatment of obesity in 2012. It may increase heart rate and should not be used in people with hyperthyroidism or glaucoma. Most importantly, it should be avoided in women who are pregnant or may become pregnant due to the risk of birth defects such as cleft palate.
    • Belviq (lorcasem) - Belviq was approved for obesity in 2012, and like Qsymia, carries a risk of birth defects if used by pregnant women. Of note is that this medication, when combined with other medications involved in the metabolism of serotonin, may lead to serotonin syndrome.
    • Contrave (naltrexone/bupropion) - Concave was approved in 2014 for the treatment of obesity, but has several warnings. It may lead to suicidal thoughts in some people. It may also cause seizures and should not be used by people with seizure disorders. In addition, it should be avoided in people with high blood pressure as it can raise blood pressure and heart rate.
    • Saxenda (liraglutide) - As noted above under Victozia for the treatment of insulin resistance, Saxenda (liraglutide) can help with both insulin resistance and obesity, but carries some important warnings.

    You can learn more about the medications approved for obesity and the possible side effects. It's important to note that some of these medications have several different uses and are marketed under different brand names.

    Infertility Medications

    With PCOS, underlying hormone abnormalities result in irregular or absent ovulation (anovulation). A variety of medications can be used to improve egg quality, ovulation, and fertility. Keep in mind that, in addition to these treatment approaches, even mild weight loss (for example, five to ten percent of body weight) is very helpful in improving fertility. The choice of treatment will vary between different women but may include:

    Other treatments, such as metformin, and even weight loss alone may help with conception. Learn more about the treatment options for getting pregnant with PCOS.

    Anti-Androgens

    Women with PCOS often have elevated levels of androgens (male hormones such as testosterone). Anti-androgens work by blocking the manufacture of these androgens. These medications have the potential to cause birth defects and should be used with a form of contraceptive if sexually active while taking them. 

    • Eulexia (flutamide) - Flutamide, while not FDA approved for this use, can reduce unwanted hair growth, but takes several months to work.
    • Aldactone (spironolactone) - Spironolactone is a diuretic (water pill) which has anti-androgenic properties.
    • Proscar or Propecia (finasteride) - Finasteride, a medication used to suppress prostate growth in men, is sometimes used off label to address the hair loss in women with PCOS.

    Acne Medications

    A variety of different types of medications and lotions to reduce the appearance of acne in women with PCOS. Some of these include:

    • Benzoyl peroxide
    • Salicylic acid
    • Topical retinoids
    • Topical antibiotics

    Learn more about the options available for treating acne in this overview of acne.

    Medications for Hirsutism

    Hirsutism refers to unwanted hair growth on the face (and also between the breasts, on the nipples, on the abdomen, and on the inner thighs) which results from an excess of androgens (male hormones) in women with PCOS. It is one of the most distressing symptoms of the condition.

    These medications work to reduce the levels of androgens or male hormones in women with PCOS to reduce the appearance of hair loss and excessive hair growth. 

    • Vaniqa (a topical medication to help remove unwanted hair)
    • Spironolactone
    • The birth control pill

    Learn more about the methods for removing unwanted hair.

    Inositol for PCOS

    Inositol is a very promising treatment option for PCOS. As the most studied dietary supplement for women with PCOS, it may help with several of the associated symptoms including:

    • Weight gain
    • Irregular periods
    • Infertility - Including improved egg quality with in vitro fertilization
    • Elevated cholesterol
    • Insulin resistance
    • Symptoms of elevated androgens such as acne and hirsutism
    • Gestational diabetes in pregnant women with PCOS

    Non-Medication Treatments for PCOS

    In our pill-driven society, it's easy to forget that there are often many other treatment options available. Diet modification stressing foods with a low glycemic index is very helpful. Check out these tips of foods women with PCOS should eat more often. Exercise, as with most medical conditions, can be helpful in many ways. Treatments such as electrolysis or laser hair removal may be considered instead of or in addition to medications.

    Choosing Treatment Options for PCOS

    A variety of prescribed medications and alternative supplements are available to women with PCOS. It is important to remember that whichever medication you choose, you should speak with your doctor about any concerns that you may have, potential side effects, and interactions with other medications or supplements. And of course, if you start something that doesn't work for you, don't hesitate to try a different medication or treatment regimen. Some medications can take months of regular use in order to see an improvement in symptoms. 

    Sources:

    Bordewijk, E., Nahuis, M., Costello, M. et al. Metformin During Ovulation Induction with Gonadotrophins Followed by Timed Intercourse or Intrauterine Insemination for Subfertility Associated with Polycystic Ovary Syndrome. Cochrane Database of Systematic Reviews. 2017. 1:CD009090.

    Jensterle, M., Kravos, N., Goricar, K., and A. Janez. Short-Term Effectiveness of Low Dose Liraglutide in Combination with Metformin Versus High Dose Liraglutide Alone in the Treatment of Obese PCOS: Randomized Trial. BMC Endocrine Disorders. 2017. 17():5.

    Kasper, Dennis L.., Anthony S. Fauci, and Stephen L. Hauser. Harrison's Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.

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