Polycystic Ovary Syndrome: Treatment Options and Concerns

Polycystic Ovary Syndrome (PCOS)

Hello, Doctor: I was diagnosed with polycystic ovary syndrome (PCOS) due to abnormal menstrual bleeding, so I went to see a doctor.
The doctor informed me that I have PCOS and prescribed medication for me to take during the evening of my menstrual ovulation period.
After taking the medication, I was advised to return for a follow-up when my period started.
During the follow-up, the doctor presented me with two medication options: the first was a menstrual regulation medication, and the second was a contraceptive pill.
I chose the contraceptive pill because it can also help treat acne.

So, Doctor, I have a few questions:
1.
Are there any side effects of taking contraceptive pills?
2.
I've heard that long-term use of contraceptive pills can make it difficult to conceive later on.
Is that true?
3.
What are the benefits of taking contraceptive pills? Can they really treat polycystic ovary syndrome? If so, how?
4.
What is insulin resistance, and why does it occur?
5.
What causes excess androgens?
6.
What causes abnormal gonadotropin levels?
7.
Can contraceptive pills provide 100% contraception?

Guai, 20~29 year old female. Ask Date: 2002/07/10

Dr. Zhan Deqin reply Obstetrics and Gynecology

1.
Long-term use may lead to reduced menstrual flow or even amenorrhea, which can be restored after discontinuation of the medication.

2.
No.

3.
Low-dose contraceptive pills can regulate menstrual cycles, alleviate dysmenorrhea, treat acne, and counteract hyperandrogenism.

4.
Insulin resistance refers to the body's diminished response to insulin, meaning that insulin's effects are impaired, although the exact cause is unclear.

5.
This is due to a defect in hormone conversion within the body, which prevents the conversion of androgens produced by the ovaries into estrogens, leading to accumulation in the ovaries and resulting in anovulation.

6.
Prolonged anovulation leads to abnormal gonadotropin levels, and additionally, insulin resistance contributes to elevated insulin levels in the blood.

7.
Approximately 99%.

Reply Date: 2002/07/10

More Info

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder that affects many women of reproductive age. It is characterized by a combination of symptoms, including irregular menstrual cycles, excess androgen levels, and polycystic ovaries. Understanding the treatment options and concerns associated with PCOS is crucial for managing the condition effectively.

Treatment Options for PCOS
1. Hormonal Birth Control: One of the most common treatments for PCOS is hormonal birth control, such as combined oral contraceptives (COCs). These medications can help regulate menstrual cycles, reduce androgen levels, and improve symptoms like acne and excessive hair growth. While you mentioned concerns about potential side effects, many women tolerate these medications well. Common side effects may include nausea, breast tenderness, and mood changes, but serious side effects are rare.

2. Metformin: This medication is primarily used to treat type 2 diabetes but has also been found effective in managing insulin resistance associated with PCOS. Insulin resistance can lead to weight gain and difficulty in ovulation. Metformin can help improve insulin sensitivity, which may aid in weight management and restore normal ovulation in some women.

3. Lifestyle Modifications: Weight management through diet and exercise is crucial for women with PCOS, especially those who are overweight. Even a modest weight loss of 5-10% can significantly improve symptoms and restore regular menstrual cycles. A balanced diet low in refined carbohydrates and high in fiber can help manage insulin levels.

4. Ovulation Induction: For women trying to conceive, medications like Clomiphene citrate or letrozole may be prescribed to stimulate ovulation. If these are ineffective, more advanced treatments like gonadotropins or assisted reproductive technologies may be considered.

Concerns Regarding Birth Control Pills
1. Long-term Use and Fertility: There is a common misconception that long-term use of birth control pills can lead to infertility. In reality, COCs do not affect long-term fertility. Once you stop taking the pills, your menstrual cycles should return to their pre-treatment state, allowing for the possibility of conception.

2. Benefits of Birth Control Pills: Besides regulating menstrual cycles, COCs can help manage symptoms of PCOS, such as acne and hirsutism (excessive hair growth). They work by suppressing ovarian androgen production and providing a steady level of hormones, which can alleviate many symptoms associated with PCOS.

3. Insulin Resistance: Insulin resistance occurs when the body's cells do not respond effectively to insulin, leading to higher blood sugar levels. This condition is often associated with obesity and can exacerbate the symptoms of PCOS. Factors contributing to insulin resistance include genetic predisposition, sedentary lifestyle, and poor dietary habits.

4. Excess Androgens: Elevated levels of male hormones (androgens) in women with PCOS can lead to symptoms such as acne, hirsutism, and irregular periods. The exact cause of increased androgen production in PCOS is not fully understood, but it is believed to be linked to insulin resistance and ovarian dysfunction.

5. Abnormal Gonadotropins: In PCOS, the levels of luteinizing hormone (LH) may be elevated compared to follicle-stimulating hormone (FSH), leading to an imbalance that affects ovulation. This hormonal imbalance is a hallmark of PCOS and contributes to the irregular menstrual cycles experienced by many women with the condition.

6. Effectiveness of Birth Control Pills: When taken correctly, hormonal birth control pills are over 99% effective at preventing pregnancy. However, it is essential to take them consistently and as directed to maintain their effectiveness.

Conclusion
Managing PCOS requires a multifaceted approach that includes medication, lifestyle changes, and regular monitoring by a healthcare provider. While hormonal birth control can effectively manage symptoms, it is essential to discuss any concerns with your doctor, especially regarding side effects and long-term fertility. Understanding the underlying mechanisms of PCOS, such as insulin resistance and hormonal imbalances, can empower you to make informed decisions about your treatment options. Always consult with your healthcare provider to tailor a treatment plan that best suits your individual needs and health goals.

Similar Q&A

Understanding Polycystic Ovary Syndrome: Symptoms, Diagnosis, and Treatment Options

Hello Dr. Lu, I seem to have Polycystic Ovary Syndrome (PCOS) with the following symptoms: 1. My menstrual cycle occurs every month, but the flow has been decreasing, lasting about 5-7 days. 2. I have an overweight body type, along with excessive body hair. 3. I was previously t...

Dr. Lü Lizheng reply Obstetrics and Gynecology
1. If blood tests are required, you need to come to the hospital on days three to five of your menstrual cycle. 2. Treatment is still possible; weight loss is an effective treatment. There are many other pharmacological treatment options available, please consult a gynecologist...

Exploring Treatment Options Beyond Medications for PCOS Management

Hello Doctor, I am the questioner of #112170. I read your response to the question #96188 where you mentioned, "There are many treatment options for polycystic ovary syndrome (PCOS), and it is not just about using medications to induce menstruation; I recommend seeking medic...

Dr. Lin Manying reply Obstetrics and Gynecology
It is recommended to conduct a blood test to check blood glucose levels, as well as levels of testosterone, LH, and FSH for reference. Additionally, medications to lower testosterone (such as oral contraceptives like Diane) and antidiabetic medications may be administered based o...

Understanding Polycystic Ovary Syndrome: Treatment and Fertility Options

I went to the obstetrics and gynecology department for an examination, and the doctor said I have polycystic ovary syndrome (PCOS). What should I do? Will treatment help? Am I really going to be unable to conceive forever? I only developed this condition after having one child; w...

Dr. Zhan Deqin reply Obstetrics and Gynecology
1. Infertility is not always permanent. 2. Ovulation medications or ovulation injections can be used for treatment. 3. Laparoscopy can also be performed to create a small hole in the ovaries using laser treatment.

Managing Polycystic Ovary Syndrome: Natural Ovulation and Treatment Options

Polycystic ovary syndrome (PCOS) often requires long-term use of gynecological medications to help regulate ovarian function and promote normal ovulation. However, there are ways to support your ovaries in achieving natural ovulation. While it's true that PCOS is a chronic c...

Dr. Cao Guotao reply Obstetrics and Gynecology
If you have many cystic ovaries, you may consider taking ovulation-stimulating medication to induce menstruation. If you still have concerns, you can consult your regular obstetrician-gynecologist. Wishing you good health.