PCOS Treatment

1st line = weight loss

 • 5-10% weight loss can restore ovulatory cycles

 • Improvement of metabolic risk

Prevent endometrial hyperplasia risk due to chronic anovulation

Daily progestin exposure to ensure no unopposed estrogen driven endometrial proliferation

Combined Oral Contraceptives: 20 mcg ethinyl estradiol + norethindrone

 • Progesterone pill, Progestin IUD, Medroxyprogesterone acetate x 10-14d q1-2 mo

 • Metformin → restore menstrual cycle 30-50% of women with PCOS but does not have endometrial protection or anti-androgen effect

Ameliorate hyperandrogenic features:

1. COC x 6 months

2. Spironolactone 50-100 mg BID

3. Finasteride

4. Electrolysis, shaving, waxing



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