While there's no cure for PCOS, there are various PCOS treatments, from lifestyle changes and supplements to medication and assistive reproductive technology.
Polycystic ovarian syndrome (PCOS) is a condition that causes hormonal imbalances that can affect ovarian function and therefore fertility. While there is no cure for this condition, there are various PCOS treatment options that can help manage symptoms and improve your reproductive health. We spoke with Dr. Tara Brandner, DNP, FNP-C, doctorate nurse practitioner, and fertility coach, to get insights on PCOS treatments. Dr. Brandner works with her clients to help them regain control of their stories and accomplish their health goals. The Oova team asked her to share some of what she has learned while working with patients navigating PCOS.
First: what is polycystic ovarian syndrome?
PCOS is a condition that can affect anyone with ovaries. It causes hormonal imbalances that can affect ovarian function. Common characteristics of the condition include
menstrual cycle irregularities, high levels of androgen (a hormone more abundant in biological males), and polycystic ovaries. >>MORE: Irregular Cycle? A Standard Fertility Test Isn't Going to Cut It — Here's Why
There are four types of PCOS, with insulin resistance being the most common. Insulin resistance occurs when the body becomes resistant to insulin, leading to an increase in blood sugar levels. The other three types of PCOS are known as Adrenal PCOS, Inflammatory PCOS, and Post-Pill PCOS.
Each type of PCOS has unique symptoms and treatment approaches, so it's essential to work with a healthcare provider to determine the best course of treatment for the type of PCOS that you have.
How is PCOS diagnosed?
Providers follow several criteria to diagnose PCOS, and the most common ones are the
Rotterdam criteria and the Androgen Excess and PCOS Society (AE-PCOS) guidelines.
The AE-PCOS guidelines outline two factors that should be present for making a PCOS diagnosis if other diagnoses have been ruled out:
Hyperandrogenism: an excess of androgens or “male” hormones Ovarian dysfunction: an absence of ovulation or cysts on the ovaries
The Rotterdam criteria look for three factors:
Oligo-anovulation: an absence of ovulation Hyperandrogenism: an excess of androgens or “male” hormones Polycystic ovaries: cysts on the ovaries
According to the Rotterdam criteria, two out of the three criteria must be present for a provider to diagnose PCOS.
The main difference between the two diagnostic criteria guidelines is that the Rotterdam criteria emphasize the presence of cysts on the ovaries. However, many PCOS patients do not have polycystic ovaries. Because of this, I prefer not to rely on ultrasound imaging for diagnosing ovarian dysfunction in possible PCOS patients. Instead, I look for signs of pelvic discomfort or pain during ovulation and only look at an ultrasound if necessary.
PCOS treatment options
PCOS has become one of the top diseases I treat, but ironically many patients do not know they have it when they come to me. I begin by acknowledging the frustration and confusion my patients may feel. The mental health aspect of these conditions is significant, and I tell my patients that it is not their fault, their hormones are simply out of balance. I often use prescription medications to help, but I work with my patients to wean them off eventually and find the root cause of their symptoms.
I believe it's important to take an individualized and educational approach. What works for one person may not work for another, so it's important to find a treatment plan that's right for you.
PCOS treatments can especially differ depending on whether you’re actively trying to become pregnant.
PCOS treatment for people who aren’t trying to become pregnant
If you aren’t trying to become pregnant, but rather aim to manage your PCOS symptoms, a few
PCOS treatments include:
Hormonal birth control: Birth control pills can help regulate periods and reduce the production of androgens (male hormones). This can help manage the symptoms of PCOS. Medication: Drugs like Metformin which are often used to treat diabetes, can be effective in managing the symptoms of PCOS. These medications can help improve insulin resistance and reduce the production of androgens. Lifestyle changes: Making lifestyle adjustments, such as ensuring your weight is at a healthy level for your body, exercising regularly, and eating a healthy diet, can help manage the symptoms of PCOS and improve fertility. PCOS treatment for fertility
Getting pregnant with PCOS involves some of the same steps people without PCOS should take for a healthy pregnancy, like maintaining a healthy weight, eating foods high in vitamins and minerals, and keeping balanced blood sugar levels. Some people with PCOS need additional support to get pregnant. There are many common fertility treatments for people with PCOS.
>>MORE: Fueling Your Body for Fertility: 9 Essential Vitamins and Nutrients Increasing progesterone naturally
If you're trying to conceive, it's a good idea to have your progesterone levels checked and tracked so that you can start supplementation when appropriate. Many people with PCOS have low progesterone levels.
To increase progesterone levels, it's essential to focus on overall hormone balancing. I often recommend starting with hormone-supporting vitamins:
vitamin B, vitamin C, and zinc. A great way to do this is by consuming more foods like spinach, pumpkin, nuts, kale, cauliflower, brussels sprouts, broccoli, and beans. Increasing progesterone with supplements
Some of my favorite supplements to help increase progesterone include
Vitex, which stimulates the secretion of LH hormone from the brain. Ashwagandha is a great adaptogen that helps regulate cortisol levels and reduce stress. Myo-Inositol and N-acetylcysteine can also help promote healthy insulin levels, regulate blood sugars, and reduce androgen levels. Berberine is a potent insulin stabilizer that can help with gut health and inflammation. Vitamin D and fish oil are also recommended for general health and to fight inflammation. >>MORE: What Supplements Should I Take When Trying to Conceive?
These supplements can generally be purchased over-the-counter at a pharmacy or health store. Some companies sell supplements containing a combination of multiple vitamins or ingredients. It's important to choose a high-quality product with appropriate dosing.
There are some tests that supplement companies go through, which they typically list on the bottle. I look for these when determining the quality of a supplement. Additionally, I pay attention to the company's focus. Some companies specifically focus on conditions like PCOS and infertility whereas some are more general.
It’s important to consider the actual dose of the supplement. I often speak with the representatives at the company to ask about their dosing suggestions. Sometimes, the dose may not be enough for your needs, so you may need additional supplements to reach the full dose your provider recommends. The world of supplements can be complex and it is always important to work with a doctor when making decisions about what vitamins and supplements to add to your care regimen.
Let your doctor know if you are thinking about starting a new supplement so they can help you figure out if it is the best option for you. It's recommended to give the supplements 90 days to see if there is a need to adjust something.
There are also various types of medication you can take to stimulate ovulation:
Clomiphene (Clomid): This medication stimulates ovulation by blocking the effects of estrogen on the brain and causing the pituitary gland to release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones help stimulate the growth and release of an egg from the ovary. Metformin: Often used to treat type 2 diabetes, this medication can also improve insulin resistance and reduce androgens production in people with PCOS. Metformin may help improve fertility in people with PCOS by improving insulin resistance and reducing androgen levels. Early research studies also suggest that Metformin may help reduce the risk of miscarriage in people with PCOS. Letrozole: Like Clomiphene, Letrozole is a medication that can also help stimulate ovulation by inhibiting estrogen production in the body. Letrozole does this by inhibiting aromatase, an enzyme responsible for converting androgens into estrogen. Limiting aromatase helps reduce estrogen production to stimulate the brain’s pituitary gland to release more FSH and LH. Assisted reproductive techniques
Assisted reproductive techniques such as in vitro fertilization (IVF) may be recommended for people with PCOS who do not respond to drug treatments alone. IVF involves retrieving eggs and fertilizing them with sperm in a laboratory dish. The fertilized embryos are then transferred back into the uterus.
>>RELATED: Navigating the Medications of IVF Does insurance cover PCOS treatment?
Most health insurance policies cover the diagnosis and treatment of pre-existing conditions, including PCOS.
While many insurance companies do not cover fertility treatment, they can cover treatment for addressing symptoms of PCOS, which could improve the chances of conception.
Consequences of undiagnosed or untreated PCOS
PCOS often goes undiagnosed, or is diagnosed only after a woman has started facing fertility challenges.
PCOS is a long-term disease that can have serious consequences if left untreated. If PCOS goes untreated, it can lead to other
health problems, such as type 2 diabetes, high cholesterol, heart disease, and endometrial cancer. Because of this, it’s important to catch PCOS early, even if you're trying to conceive.
I think healthcare providers need to be better educated about PCOS so they can help women identify it early on and set the right course for treatment. It's a journey that takes time and can be frustrating for women who are trying to start a family.
I want to start an educational course for providers, such as nurse practitioners and physician assistants, to help fill in some gaps around PCOS and how to best support their patients.
PCOS treatment: the bottom line
Unfortunately, some patients may feel frustrated with their late diagnosis and feel dismissed by their healthcare practitioners. I want to empower my patients to speak up if they feel their symptoms are being dismissed and to seek second opinions if necessary. I also encourage them to view their healthcare as a team approach and to find a healthcare provider they are comfortable with.