Polycystic ovarian syndrome

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Treatment

There is no cure for polycystic ovarian syndrome. Although there have been cases involving the spontaneous resumption of menstruation, most women will have progressive symptoms until after menopause. Treatment of PCOS is aimed at reducing its symptoms and helping to prevent future complications. The goals are to promote ovulation, prevent endometrial hyperplasia, counterbalance the effects of androgen, and reduce insulin resistance. Treatment options depend on the type and severity of the individual patient's symptoms and on the patient's desire to become pregnant.

Low-dose oral contraceptives are often used to stabilise hormones and oppose oestrogenic stimulation of the endometrium. Within several months, they can usually regulate menstrual periods, eliminate or minimise uterine bleeding, and reduce androgen levels (improving hirsutism and clearing up acne).

Antiandrogens, such as spironolactone and cyproterone are sometimes combined with oral contraceptives to help address more severe hirsutism and acne. Waxing, shaving, depilation and electrolysis may be used to remove unwanted hair, and antibiotics or retinoic acids may be used to treat acne.

Metformin is being used to reduce insulin resistance. It has also shown promising initial results in women with PCOS hirsutism and in helping to regulate menstrual cycles, but its effects on infertility and other symptoms are not yet known.

Weight loss and exercise are recommended to help decrease insulin resistance and to minimise lipid abnormalities. Weight reduction can also decrease testosterone, insulin, and LH levels.

Although sometimes performed, surgery is a rare PCOS treatment option. One surgical option, a "wedge resection", involves removing the part of the ovary that contains the cystic follicles to try to restore ovulation. Another option, ovarian drilling, involves using a needle with an electric current to make holes in the ovary. Both of these procedures may temporarily increase fertility but may also lead to scarring and adhesions

If a woman with PCOS wants to become pregnant, she is usually given clomiphene citrate, a drug that helps induce ovulation. She may also be given human menstrual gonadotropin, although this drug increases the risk of multiple pregnancies.

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