Medication and Surgery for Treating Women with PCOS

Treatment of polycystic ovary syndrome (PCOS) depends on the individual case and desire of the patient to fall pregnant as soon as possible. It is important to note that dietary and lifestyle modification may be useful in PCOS and should be first be undertaken before medical and surgical treatment options are considered. This includes adopting a diet pattern similar to those for type 2 diabetes and regular exercise. For overweight and obese women the goal is to lose weight which can drastically improve menstrual patterns and could possibly lead to ovulatory cycles. Diet and lifestyle modification, however, is for all women with PCOS irrespective of the BMI (body mass index).

Medication for PCOS Treatment

Oral contraceptives are the first line treatment in polycystic ovary syndrome. It helps to regulate the menstrual cycle and may be used for 6 months or more before being discontinued. The cycle is then monitored to assess whether  it can retain some degree of regularity on its own and verify ovulation (ovulatory cycle). In women who are not seeking to fall pregnant, oral contraceptives may be used for longer periods or stopped a few months before conception is planned. It is important to note that having a regular cycle and menstruation while taking an oral contraceptive is chemically induced. It does not mean that the menstrual irregularity associated with PCOS has resolved. This can only be verified once the pill is stopped. Ovulation does not occur while on the oral contraceptive pill.

Clomiphene citrate is a drug used to stimulate ovulation. It acts by disrupting the negative feedback mechanism on FSH thereby allowing for maturation of the follicle and eventual rupture with the release of an egg cell (ovum). It is the most widely used drug to stimulate ovulation but several other drugs known as GnRH analogues may also have the same effect. These drugs are necessary in women with anovulatory cycles who desire pregnancy, which helps reduce the severity of the condition, or even leads to resolution of PCOS after childbirth.

Metformin is often prescribed for PCOS as it helps to reduce the elevated insulin and blood glucose levels which may be present. It also improves the ovulation rate especially if it is used with clomiphene citrate. There may be moderate weight loss which is beneficial as well in the management of PCOS. Other antidiabetic drugs may also be considered.

Surgery for PCOS Treatment

Surgery is considered if medical treatment (the use of drugs) fails to achieve the desired results and also in women with very large cysts. By removing the cysts and creating a focal area of damage, the healing process is stimulated and there is also the possibility of ovulation sooner.

These days laparoscopic surgery is preferred because of the minimal scarring and quicker healing time. This may be done through cauterization, ovarian drilling or multiple biopsies. It is not uncommon for laparoscopic surgery to be conducted more than once should the initial surgery fail to yield results. The preferred method previously involved wedge resection where a portion of the ovarian tissue was surgically removed and the ovary sutured. However, there were greater chances of complications like adhesions, hemorrhage (bleeding) and even ovarian atrophy with this method. Surgery does not guarantee resolution of the condition, ovulation and therefore pregnancy.

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