Medications for PolyCystic Ovary Syndrome (PCOS)

As a pharmacist, you will be asked more about polycystic ovary syndrome (PCOS). There's growing interest in PCOS, it's the MOST common endocrine disorder in young women. It affects up to 10% of reproductive-age women. These women usually have insulin resistance and evidence of increased androgens. This leads to irregular periods, infertility, obesity, and hirsutism.

Treatment is influenced by whether the woman wants to get pregnant. Metformin is often used to improve insulin sensitivity and therefore reduce androgen levels. This improves menstrual frequency and ovulation, allowing some women to get pregnant. Metformin is sometimes continued during pregnancy to reduce the risk of miscarriage and gestational diabetes. Glitazones (rosiglitazone, pioglitazone) are also used, especially for women who don't tolerate metformin AND aren't trying to get pregnant. There's concern that glitazones might be harmful during pregnancy.

Clomiphene (Clomid) is used to stimulate ovulation in women trying to get pregnant. It's given either alone or with metformin. Oral contraceptives can help regulate menstrual cycles in women who don't want to get pregnant. OCs also help decrease androgen levels. Spironolactone is used to treat androgen excess. It helps decrease hirsutism and may be added when OCs alone aren't enough. It's not used during pregnancy, due to possible harmful effects.

Weight loss and exercise are important for women who are overweight. Just a 5% weight loss can decrease androgen levels and return menstrual function. Warn patients who do NOT want to become pregnant that they may no longer be infertile once starting these treatments. Make sure they realize that birth control takes on new importance.

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References

1. Guzick DS. Polycystic ovary syndrome. Obstet Gynecol. 2004;103(1):181-193.
2. Barbieri RL. Metformin for the treatment of polycystic ovary syndrome. Obstet Gynecol. 2003 Apr;101(4):785-93.
3. Ganie MA, Khurana ML, Eunice M, et al. Comparison of efficacy of spironolactone with metformin in the management of polycystic ovary syndrome: an open-labeled study. J Clin Endocrinol Metab. 2004;89(6):2756-2762.

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