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POLYCYSTIC OVARY SYNDROME TREATMENTS |
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Polycystic Ovary Syndrome treatment is aimed at correcting
anovulation, restoring normal menstrual periods, improving fertility,
eliminating hirsutism and acne, and preventing future complications
related to high insulin and blood lipid (fat) levels. Treatment
consists of weight loss, drugs or surgery, and hair removal,
depending upon which symptoms are most bothersome, and whether the
patient desires pregnancy. Weight loss In overweight women, weight loss (as little as 5%) through diet and exercise may correct hyperandrogenism, and restore ovulation and fertility. This is often tried first. Drugs Hormonal drugs Patients who do not want to become pregnant and require contraception (spontaneous ovulation occurs occasionally in Polycystic Ovary Syndrome patients) are treated with low-dose oral contraceptive pills (OCPs). OCPs bring on regular menstrual periods and correct heavy uterine bleeding, as well as hirsutism, although improvement may not be seen for up to a year. If an infertile patient desires pregnancy, the first drug usually given to help induce ovulation is clomiphene citrate (Clomid), which results in pregnancy in about 70% of patients but can cause multiple births. In the 20-25% of women who do not respond to Clomid, other drugs that stimulate follicle development and induce ovulation, such as human menstrual gonadotropin (Pergonal) and human chorionic gonadotropin (HCG), are given; however, these drugs have a lower pregnancy rate (less than 30%), a higher rate of multiple pregnancy (from 5-30%, depending on the dose of the drug), and a higher risk of medical problems. Polycystic Ovary Syndrome patients have a high rate of miscarriage (30%), and may be treated with the gonadotropin-releasing hormone agonist leuprolide (Lupron) to reduce this risk. Since Polycystic Ovary Syndrome patients do not have regular endometrial shedding due to high estrogen levels, they are at increased risk for overgrowth of this tissue and endometrial cancer. The drug medroxyprogesterone acetate, when taken for the first 10 days of each month, causes regular shedding of the endometrium, and reduces the risk of cancer. However, in most cases, oral contraceptive pills are used instead to bring about regular menstruation. Other drugs Another drug that helps to trigger ovulation is the steroid hormone dexamethasone. This drug acts by reducing the production of androgens by the adrenal glands. The antiandrogen spironolactone (Aldactazide), which is usually given with an oral contraceptive, improves hirsutism and male-pattern baldness by reducing androgen production, but has no effect on fertility. The drug causes abnormal uterine bleeding and is linked with birth defects if taken during pregnancy. Another antiandrogen used to treat hirsutism, flutamide (Eulexin), can cause liver abnormalities, fatigue, mood swings, and loss of sexual desire. A drug used to reduce insulin levels, metformin (Glucophage), has shown promising results in Polycystic Ovary Syndrome patients with hirsutism, but its effects on infertility and other Polycystic Ovary Syndrome symptoms are unknown. Drug treatment of hirsutism is long-term, and improvement may not be seen for up to a year or longer. Acne is treated with antibiotics, antiandrogens, and other drugs such as retinoic acids (vitamin A compounds). Surgical treatment Surgical treatment of Polycystic Ovary Syndrome may be performed if drug treatment fails, but it is not common. A wedge resection, the surgical removal of part of the ovary and cysts through a laparoscope (an instrument inserted into the pelvis through a small incision), or an abdominal incision, reduces androgen production and restores ovulation. Although laparoscopic surgery is less likely to cause scar tissue formation than abdominal surgery, both are associated with the potential for scarring that may require additional surgery. Laparoscopic ovarian drilling is another type of laparoscopic surgery used to treat Polycystic Ovary Syndrome. The ovarian cysts are penetrated with a laser beam and some of the fluid is drained off. From 50-65% of patients may become pregnant after either type of surgery. Some cases of severe hirsutism are treated by hysterectomy and removal of the ovaries, followed by estrogen replacement therapy. Other treatment Hirsutism may be treated by hair removal techniques such as shaving, depilatories (chemicals that break down the structure of the hair), tweezing, waxing, electrolysis (destruction of the hair root by an electrical current), or the destruction of hair follicles by laser therapy; however, the treatments may have to be repeated. Alternative treatments Polycystic Ovary Syndrome can be addressed using many types of alternative treatment. The rebalancing of hormones is a primary focus of all these therapies. Acupuncture works on the body's energy flow according to the meridian system. Chinese herbs, such as gui zhi fu ling wan, can be effective. In naturopathic medicine, treatment focuses on helping the liver function more optimally in the horomonal balancing process. Dietary changes, including reducing animal products and fats, while increasing foods that nourish the liver such as carrots, dark green vegetables, lemons, and beets, can be beneficial. Essential fatty acids, including flax oil, evening primrose oil (Oenothera biennis), and black currant oil, act as anti-inflammatories and hormonal regulators. Western herbal medicine uses phytoestrogen and phytoprogesteronic herbs, such as blue cohosh (Caulophyllum thalictroides) and false unicorn root (Chamaelirium luteum), as well as liver herbs, like dandelion (Taraxacum mongolicum), to work toward hormonal balance. Supplementation with antioxidants, including zinc, and vitamins A, E, and C, is also recommended. Constitutional homeopathy can bring about a deep level of healing with the correct remedies. |
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