Polycystic Ovary Syndrome (PCOS): Medications

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Medications

As part of polycystic ovary syndrome (PCOS) treatment, medicines can be used to help control reproductive hormone or insulin levels.

Medication Choices

Medicines to treat reproductive or metabolic problems of PCOS include:

• Combination estrogen and progestin hormones in birth control pills, vaginal rings, or skin patches. These hormones correct irregular menstrual bleeding or absent menstrual cycles. They may also improve your androgen-related acne problems, male-type hair growth, and male-pattern hair loss. The progestin makes your endometrial lining build up and shed, similar to a menstrual period. This monthly shedding is what prevents uterine precancer and uterine cancer. The Yasmin birth control pill is considered "potentially ideal" for PCOS hormone treatment.¹² This is because it contains the progestin called drospirenone, which is an antiandrogen.³
• Synthetic progestin. If you are not able to use the hormone estrogen, talk to your doctor about using progestin shots or pills for part of your cycle. The progestin makes your endometrial lining build up and shed, similar to a menstrual period. This monthly shedding is what prevents uterine cancer. There are three prescription progestins that do not increase androgen levels and are best for PCOS treatment: norgestimate, desogestrel, and drospirenone.³ Possible side effects include headaches, fluid retention, and mood changes.
• Androgen-lowering spironolactone (Aldactone), which is a diuretic. It is often used with estrogen-progestin therapy. This improves hair loss, acne, and abnormal hair growth on the face and body (hirsutism).
• Metformin (Glucophage). This diabetes medicine is a newer PCOS treatment for controlling insulin, blood sugar levels, and androgen levels. This lowers your diabetes and heart disease risks and helps restore regular menstrual cycles and fertility.³
• Clomiphene citrate (Clomid, Serophene) (fertility medicines) and gonadotropin injections (LH and FSH). Clomiphene can be combined with metformin if metformin has not triggered ovulation. Combining the two treatments can make it more likely that clomiphene will work.¹¹

Eflornithine (such as Vaniqa) is a prescription skin cream that slows hair growth for as long as you use it regularly. Talk to your doctor about whether it is right for you.

Treatment for acne includes nonprescription and prescription medicines that are applied to the skin (topical) or taken by mouth (oral). For more information, see the topic Acne Vulgaris.

Combination hormone pills can improve acne that is related to high androgen levels.³

What To Think About

Metformin has been shown to be a useful treatment for many of the problems in PCOS. Taking metformin may improve fertility, reduce miscarriages and gestational diabetes, and reduce long-term health problems.³ The use of metformin in pregnancy remains controversial although the risk appears to be small. Metformin is only FDA-approved for the treatment of diabetes, so the use of this medicine for treating PCOS symptoms should be discussed with your doctor.

Some prescription progestins raise androgen levels. There are three prescription progestins that do not increase androgen levels and are best for PCOS treatment. The combination birth control pills that contain these progestins are drospirenone (Yasmin, or "Yaz"); norgestimate (Ortho-Cyclen and Ortho Tri-Cyclen Lo); and desogestrel (Mircette, Desogen, Ortho-Cept, and Cyclessa).³

Some medicines to treat abnormal hair growth may increase your risk for insulin-related metabolic problems, so it is important to discuss medicine side effects with your doctor.

Last updated:	January 23, 2008
Author:	Kathe Gallagher, MSW
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Samuel S. Thatcher, MD, PhD - Obstetrics and Gynecology, Reproductive Endocrinology
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC