Some physicians prescribe metformin for women with PCOS, not just those with fertility problems. Some women resume regular menstrual cycles on metformin, but so far only one long-term study has been done, and it showed that the male-hormone symptoms didn’t get better (someone with severe male hormone problems would need an anti-androgen as well). Health care professionals are undecided on the issue of using insulin-sensitizers in PCOS patients not attempting conception.
If prescribed an insulin sensitizer, be sure to inform your health care professional of all other medications you take, including over-the-counter medicines, to prevent drug interactions.
If you are among the 7 to 8 percent of women with PCOS who already have type II diabetes, metformin is a good therapeutic option.
Another available option for women who fail to ovulate with clomiphene or metformin therapy, or who are unwilling/unable to use gonadotropins (or canâ€™t afford to use them), is a surgical procedure known as laparoscopic ovarian drilling. The technique employs a laser fiber or electrosurgical needle to puncture each ovary four to 20 times. This treatment results in a dramatic lowering of male hormones within days. Over a dozen studies have shown that up to 80 percent of women with PCOS will benefit from such treatment. Many who failed to ovulate with clomiphene or metformin therapy will respond when re-challenged with these medications after ovarian drilling. The success rates for laparoscopic ovarian drilling appear to be better for patients at or near their ideal body weight, as opposed to those with obesity. Interestingly, women in these studies who are smokers rarely responded to the drilling procedure. Side effects are rare, but may result in adhesion formation or the general complications of any surgical procedure.
PCOS is associated with insulin resistance and diabetes, but not all women who have PCOS are insulin-resistant or diabetic. If you have PCOS, you should also be evaluated for diabetes with both a fasting glucose test and a glucose challenge test with insulin levels. The fasting glucose test is the standard, but that test alone misses about half the women with concomitant elevated insulin levels with PCOS who have diabetes or insulin resistance.
Long-term non-medical treatment is geared toward modifying your risk factors for health problems that often are associated with PCOS, including diabetes, uncontrollable weight gain and heart disease. A healthy low-sugar diet and an exercise program to stabilize body weight can reduce the risk.
You can take care of some problems associated with PCOS without medications. Excess hair can be removed by shaving, tweezing, waxing or using depilatory creams, or by electrolysis or laser techniques administered by a trained professional. Since lasers work by attacking a skin pigment, they should be used with caution by darker skinned women.
If you are overweight and have PCOS, weight loss is recommended. Losing weight can lower levels of androgens and insulin, thereby reducing your risk of developing insulin resistance and diabetes. One study found that when obese women lose even seven percent of body weight, they cut androgen levels significantly and improve menstrual regularity.