What are the treatment options for PCOS-related amenorrhea?

Updated: Oct 14, 2019
  • Author: Kristi A Tough DeSapri, MD; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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PCOS is characterized by oligomenorrhea or amenorrhea, an excess androgen hormone environment (either clinically or biochemically detected), and polycystic-appearing ovaries on ultrasonography. [54] A high body mass index (BMI) and insulin resistance also play an important role in the pathogenesis of PCO syndrome. Women with PCO syndrome have lifelong increased risks of developing adult-onset diabetes mellitus, hypertension, lipid disorders, hypothyroidism, and endometrial cancer. [55]

If pregnancy is not desired, monthly withdrawal bleeding should be induced. Both cyclic progesterone (10-12 days per month) and oral contraceptives can accomplish monthly withdrawal bleeding; however, oral contraceptives use different mechanisms to control other aspects of PCOS. Oral contraceptives decrease LH secretion, leading to lower androgen production and improvement in acne and hirsutism. Oral contraceptives atrophy the endometrial lining, decreasing the risk of endometrial hyperplasia and endometrial cancer.

Metformin is presently offered to improve ovulation. [56] There is no evidence that metformin improves live birth rates, although some studies have shown it to be associated with improved clinical pregnancy. [57] Further research is needed to determine whether metformin should be used for the prevention of the long-term development of adult-onset diabetes mellitus, cardiovascular disease, and lipid disorders. [58] Patients should be strongly encouraged to maintain a weight-to-height ratio within the reference range and to regularly exercise because both are first-line therapies used to control PCO syndrome. [59]

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