Treatment of polycystic ovarian syndrome (PCOS) centers on lifestyle modifications and medication. Surgical procedures — cauterization of ovarian cysts or wedge resection to reduce the size of cysts — are less likely to be performed today, due to recent successes with ovulation-inducing medications. Usually, a health care professional will recommend surgical removal only if a cyst is thought to be potentially cancerous.
Because the primary cause of PCOS is unknown, treatment is presently directed at the symptoms of the disorder. For some women, the most bothersome symptom is hirsutism (excess facial and/or body hair, often dark and coarse). This symptom, as well as acne and oily skin, stems from overproduction of androgens. For women with such symptoms, spironolactone (Aldactone or Spironol) may be prescribed. The drug, a diuretic, has few side effects, and at high doses can clear oily skin and make unwanted hair finer (electrolysis or laser processes can remove hair permanently). It works by blocking the action of testosterone at the hair cell level. Flutamide (Eulexin) is similar to spironolactone, but has potentially severe side effects. If you are trying to conceive, however, an anti-androgen medication cannot be used because it can cross the placenta and cause defects in a male fetus.
Bear in mind that it can take up to nine months to see effects on hair growth, and a year to achieve peak effect. The hair will still be there, but will generally grow more slowly and will be lighter and finer. Electrolysis or repeated laser treatments are the only ways to get rid of the already present hair for extended periods or permanently.
Recently, the U.S. Food and Drug Administration (FDA) approved Vaniqa (eflornithine hydrochloride), a prescription medication cream that reduces unwanted facial hair. The medication is applied to the face twice per day in the same manner as moisturizer and works by blocking a key enzyme that makes hair grow. It must be used regularly or else hair growth will resume.
For acne, spironolactone and birth control pills (which decrease ovarian androgen production) are often particularly effective in combination, although other medications may also be prescribed for acne, such as oral or topical antibiotics, Accutane (which can cause birth defects) or peeling medications such as Retin-A.
A steroid such as dexamethasone or prednisone may be prescribed if the primary source of excess androgens appears to be the adrenal glands (as evidenced by high levels of DHEA-S). Because these steroids are used at very low doses, they do not cause the usual side effects associated with steroids.