Wednesday, March 28, 2007

Treatments and Options

It isn't known why some women develop PCOS and others don't. But if a close family member has it, you are more likely to have it too. The immediate cause of all the various symptoms is known to be hormonal, and medical treatments are generally designed to change hormone levels.

Treatment tends to be different for each symptom and a treatment for one may not help another, so it is important to decide which symptom is troubling you most.

What treatments are available?

Treating absent or irregular periods
Since the follicles don't ripen with PCOS, the corpus luteum doesn't form and progesterone isn't produced. As a result the endometrium (the lining of the uterus) doesn't thicken. It's the thickened endometrium which is lost with a normal menstrual period. Many women feel better for having a period each month. If a woman doesn't want to get pregnant, the usual way to manage PCOS is either a low dose combined contraceptive pill, or a progestogen only pill.

Treating infertility
Although not ovulating is likely to be the cause of infertility, it is important to check for other possible causes in yourself or your partner before starting any treatment.

Treatment with the pill for other symptoms will stop you from getting pregnant. If you want to induce ovulation, you will probably be offered fertility drugs such as clomiphene. 80% of women with PCOS ovulate on clomiphene but only 30 to 50% will conceive. If you're not pregnant after three clomiphene treatments, you may be given hormones directly by injection or a small wearable pump. If hormone treatment doesn't work you may be offered other options that your doctor will explain to you.

Treatments for unwanted body hair
Unwanted hair growth (hirsutism) is caused by excess male hormones (androgens). Polycystic ovaries produce excess amounts of an androgen (testosterone). Although all women have some testosterone, people think of it as a male hormone because it influences male characteristics such as body hair and balding.

For women who don't want to conceive, excess hair is usually treated with the combined contraceptive pill and an anti-androgen. If you decide to use these treatments they may take several months to take effect. In the meantime, or as an alternative, you may wish to control hair growth with treatments such as waxing, electrolysis or lasers, or use bleaching and foundation creams to disguise growth.

Treatment for acne
Like hair growth, acne is caused by high levels of androgens and may be helped by similar treatments. The combined contraceptive pill can help with acne as well as regulating your cycle. The progestogen-only pill can make acne worse. Over the counter or prescribed spot treatments might be worth trying, but they dry the skin. Antibiotics, while useful in treating some forms of acne, are not going to solve the problem when it is hormonal.

Weight gain
The metabolism of a woman with PCOS is thought to differ from that of a woman without it. Women with PCOS use energy from food more efficiently, so relatively more is stored as fat. Advice to eat healthily and get plenty of exercise can be very frustrating for women with PCOS because it is more difficult to lose weight if you have PCOS. Try five smaller meals each day to help regulate blood sugar levels and reduce cravings for sweet or high fat foods. Loss of between 5 and 10% of body weight leads to a significant loss of symptoms.

Treating pelvic discomfort
This may be helped by regulating periods. But if you have had investigations to make sure it is nothing more serious then you may feel it is worth trying alternative therapies such as acupuncture, aromatherapy or relaxation. Some women find that regular exercise such as walking eases aches and pains throughout the body.

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