It is important to stress that the incidental discovery of polycystic-appearing ovaries on ultrasound scan, when present on its own, does not require treatment.
For PCOS, treatment should be targeted at the main problem, but should also consider the bigger picture of longer-term overall health. Some of the problems that women with PCOS experience include menstrual cycle irregularity, signs of male hormone excess and infertility.
For overweight PCOS patients, healthy eating and regular physical activity to lose weight are very important, and may be combined with the use of metformin. A healthy lifestyle not only helps to improve menstrual cycle regularity and fertility, it also reduces the risks of medical conditions that women with PCOS are prone to later in life such as diabetes.
The combined oral contraceptive pill can be used to help regularise periods and has beneficial effects when signs of male hormone excess (e.g. excess hair growth) are present. Because cycle irregularity in PCOS is due to problems with ovulation, women undergoing ovulation induction treatment for fertility reasons (see below) will also experience improved cycle regularity.
It is important that women with PCOS not go for more that 3 months without having a period since this risks the lining of the womb (or endometrium) getting too thick.
Women with PCOS have an increased risk of developing excessive thickening of the womb lining (known as endometrial hyperplasia), which leads in turn to a 2- to 6-fold increased risk of developing cancer of the womb.
Excessive thickening of the womb lining can be prevented by artificially inducing a period using a 7-10 day course of progesterone tablets at least once every 3 months.
Ovulation induction for infertility:
Because women with PCOS often do no release an egg (ovulate), many will experience infertility. If other factors that determine a couple’s fertility are normal (e.g. sperm quality), then the use of medication to cause the release of an egg (ovulation induction) is an effective treatment. Oral medications used for ovulation induction include letrozole, clomiphene citrate and metformin. In difficult cases, hormonal injections and laparoscopic surgery for “drilling” polycystic ovaries may be used. Letrozole is currently the recommended first line treatment for ovulation induction in women with PCOS. Ovulation induction should be closely supervised by a trained fertility specialist. In cases in which, ovulation induction is not successful, or there are other co-existing causes for infertility, such as tubal blockage or a significant sperm problem, assisted reproductive treatments (ART) like IVF may be required.