Managing PCOS: Medications for Irregular Cycles and Hirsutism

Medications for Polycystic Ovary Syndrome (PCOS)

1.
I have polycystic ovary syndrome (PCOS) with irregular menstrual cycles.
My periods are not heavy, but I also experience hirsutism.
I am not significantly overweight, but I do have increased body hair, which is quite bothersome.
I would like to know if taking oral medication for hirsutism will help.
Will it improve the situation, and will the excess body hair fall out on its own?
2.
I visited a gynecologist, and the doctor prescribed a medication that seems to be an ovulation induction drug.
He advised me to start taking it on the third day of my menstrual cycle.
However, I found online that some people say it can reduce menstrual flow, which makes me hesitant to take it.
Is this true? The active ingredient is Clomiphene Citrate.

Jen, 10~19 year old female. Ask Date: 2018/05/04

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the treatment for polycystic ovary syndrome (PCOS) varies based on the patient's age and needs.
Since the cause of PCOS is attributed to genetic factors, it cannot be cured, but symptoms can be improved or alleviated through medication and lifestyle changes.
Treatment methods are divided into two main categories:
For patients who do not wish to become pregnant: Regular administration of progesterone (every 45 to 60 days) can induce menstruation and reduce the risk of endometrial cancer.
Alternatively, oral contraceptives can suppress gonadotropin secretion, inhibit ovarian production of androgens, and maintain regular menstrual cycles.
For those with significant masculinization, stronger anti-androgen contraceptives may be prescribed.
The occurrence of PCOS is primarily due to the body's poor utilization of insulin, so medications used to treat type 2 diabetes, such as metformin, can be effective for managing PCOS.
For patients with PCOS who wish to conceive: The main reason for infertility in PCOS patients is anovulation.
The most commonly used medication is the oral ovulation inducer Clomiphene Citrate.
For those who do not respond to oral ovulation medications, injectable ovulation drugs such as HMG, FSH, and r-FSH may be considered.

In addition to medication, controlling weight and developing an exercise routine can improve symptoms.
Changes in dietary habits, regular exercise, and maintaining a healthy weight are more effective than medication alone in controlling hyperinsulinemia and reducing insulin resistance, thereby improving the clinical manifestations of PCOS and promoting ovulation.
Weight control is especially important; for obese PCOS patients, weight loss is the first-line treatment, often restoring normal hormonal balance, resuming ovulation, and reducing the risk of miscarriage.

Exercise not only helps control weight but also improves insulin sensitivity.
If there is sudden weight gain or irregular menstrual cycles, it is advisable to consult a gynecologist for proper diagnosis and treatment.
Individuals diagnosed with PCOS, even in the absence of symptoms, should not take this condition lightly.
They should improve their lifestyle, dietary habits, and exercise to promote better health.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2018/05/04

More Info

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects many women of reproductive age. It is characterized by irregular menstrual cycles, hirsutism (excessive hair growth), and often, weight gain. Managing PCOS can be multifaceted, involving lifestyle changes, medications, and sometimes surgical interventions.
1. Hirsutism and Medication: For women dealing with hirsutism, medications can indeed help manage this symptom. Anti-androgens, such as spironolactone, are commonly prescribed to reduce hair growth by blocking the effects of androgens (male hormones) that contribute to excessive hair growth. Other options include hormonal contraceptives, which can help regulate menstrual cycles and reduce androgen levels, thereby improving hirsutism.
It's important to note that while these medications can significantly reduce hair growth, they do not cause existing hair to fall out immediately. Instead, they work by slowing down the growth of new hair and may eventually lead to a reduction in the density of hair over time. Some women may also consider laser hair removal or electrolysis for a more permanent solution to unwanted hair.
2. Clomiphene Citrate and Menstrual Flow: Clomiphene citrate (often known by the brand name Clomid) is a medication commonly used to induce ovulation in women who have irregular menstrual cycles due to PCOS. It works by stimulating the pituitary gland to release hormones that promote ovulation.
Concerns about clomiphene citrate leading to lighter menstrual flow are not uncommon. While some women may experience changes in their menstrual patterns, including lighter periods, this is not universally the case. The response to clomiphene can vary significantly among individuals. Some may find that their cycles become more regular and that their flow normalizes, while others might experience changes in flow.
If you are hesitant about starting clomiphene due to concerns about menstrual flow, it is essential to discuss these worries with your healthcare provider. They can provide personalized advice based on your specific health profile and may suggest monitoring your response to the medication closely.
In addition to medication, lifestyle changes such as maintaining a healthy weight, regular exercise, and a balanced diet can also play a crucial role in managing PCOS symptoms. Weight loss, even a modest amount, can help improve insulin sensitivity and may lead to more regular menstrual cycles and reduced hirsutism.

In summary, managing PCOS, particularly symptoms like irregular cycles and hirsutism, often involves a combination of medications and lifestyle modifications. Anti-androgens and hormonal contraceptives can help with hirsutism, while clomiphene citrate can assist with inducing ovulation. It is crucial to maintain open communication with your healthcare provider to tailor a treatment plan that best suits your needs and addresses any concerns you may have about the medications. Regular follow-ups can help ensure that your treatment is effective and that any side effects are managed appropriately.

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