Approach to treating polycystic ovary syndrome

Treatment of polycystic ovary syndrome (PCOS) aims to address the symptoms and long-term health risks arising from abnormal follicular development and ovarian hormone synthesis, while taking account of the individual’s goals for treatment. Symptoms and health risks of PCOS include:

• consequences of anovulatory menstrual cycles
  • irregular menstrual bleeding of variable volume
  • a lack of progesterone-induced endometrial shedding, which leads to proliferation of the endometrium and increased risk of endometrial cancer
  • subfertility
• consequences of excess ovarian androgen production
  • hirsutism
  • acne 
  • androgenetic alopecia 
• obesity, which affects the majority of individuals with PCOS and increases the risk of complications
• insulin resistance 
  • exacerbation of hyperandrogenism
  • increased risk of type 2 diabetes and cardiovascular disease
• additional cardiovascular risk factors such as dyslipidaemia
• poor mental health (in particular, body-image concerns related to excess weight and hirsutism).

Most aspects of PCOS can be managed in general practice, but specialist referral is appropriate if:

• diagnosis is uncertain (eg in adolescents)
• hirsutism is not responding to antiandrogen therapy after 6 to 12 months
• seeking fertility treatment.

For more detailed information on the management of PCOS, see the International evidence-based guideline for the assessment and management of polycystic ovary syndrome and the PCOS Practice Tools for Health Practitioners.