PCOS

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Treatment

There is no cure for PCOS. Although there have been cases involving the spontaneous resumption of menstrual periods, most women will have progressive symptoms until after menopause. Treatment of PCOS is aimed at reducing its symptoms and prevention of further complications. The goals are to promote ovulation, prevent endometrial hyperplasia, counterbalance the effects of androgens, and reduce insulin resistance. Treatment options depend on the type and severity of the individual woman's symptoms and her desire to become pregnant.

Low-dose oral contraceptives are often used to stabilize hormones and oppose estrogenic stimulation of the endometrium. Within several months, they can usually regulate menstrual periods, eliminate or minimize uterine bleeding, and reduce androgen levels  - improving hirsutism and clearing up acne.

Antiandrogens such as spironolactone, flutamide, and cyproterone are sometimes combined with oral contraceptives to help address more severe hirsutism and acne. Waxing, shaving, depilatory and electrolysis may be used to remove unwanted hair, and antibiotics or retinoic acids may be used to treat acne.

Metformin is being used to reduce insulin resistance. It has also shown promising initial results in women with PCOS hirsutism and in helping to regulate menstrual cycles, but its effects on infertility and other symptoms are not yet known. If a woman with PCOS wants to become pregnant, she is usually given clomiphene citrate, a drug that helps induce ovulation. She may also be given human menstrual gonadotropin, although this drug increases the risk of multiple pregnancies. However, as with any drug regimen, certain side effects and risks may be present.

Although sometimes performed, surgery is a rare PCOS treatment option. One surgical option, a "wedge resection." involves removing the part of the ovary that contains the cystic follicles to try to restore ovulation. Another option, ovarian drilling, involves using a needle with an electric current to make holes in the ovary. Both of these procedures may temporarily increase fertility but may also lead to scarring and adhesions; concerns in long-term ovarian function limit this practice. 

Lifestyle changes through better diet, weight loss, and exercise are recommended to help decrease insulin resistance and to minimize lipid abnormalities. Weight reduction can also decrease testosterone, insulin, and LH levels. Regular exercise and healthy foods, such as vegetables, fruits, nuts, and whole grains, will also lower blood pressure and cholesterol as well as improve sleep apnea problems. Smoke cessation also may lower androgen levels.

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