3 Goals for Medical Management of PCOS
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Last week, we discussed 3 ways to naturally manage PCOS. Since it is a lifelong disorder, I strongly recommend incorporating natural methods into your management routine, even if you have to use medication to meet certain goals. For myself and my patients, I advocate exhausting natural resources first before venturing into medical management, and to view medical management as temporary. Many women do require medication for proper insulin resistance and/or fertility assistance, so we're going to discuss those options today.
Goal: Regulate Menstrual Cycles
One of the hallmark symptoms of PCOS is irregular periods. Many women either have periods every couple of months or not at all. As I mentioned when I discussed complications of PCOS, the absence of periods over time could lead to endometrial hyperplasia and even cancer. This is because every month the endometrium (lining of your uterus) builds up in preparation for a potential pregnancy. When ovulation fails to occur, the lining stays thick instead of shedding. Sometimes the tissue that is built up on the endometrium can change into cancer cells. So, it's important to shed your lining at least every 3 months.
Some women like seeing their period every month, so they choose to use birth control to achieve this goal, as well as to help lower androgen levels, which are responsible for hirsutism and acne. Combination birth control methods, such as the pill, ring, or patch are most effective at giving you a regular, once a month, period. However, some women have the opposite effect and experience heavy and/or prolonged bleeding due to their PCOS. They may be interested in progestin only methods, such as the shot, implant, or IUD to decrease their bleeding. I also want to note that when you don't have a period due to birth control, this is normal. When you're on birth control, your lining does not build up, so there is nothing to shed. So not having a period on birth control will not harm you or be dangerous. If you don't desire a period every month, but want to ensure that you shed your lining every 3 months, your provider can prescribe progesterone which you would only take once in the 3 month time span. Obviously, both birth control and progesterone are used when a woman doesn't desire pregnancy.
Goal: Decrease Insulin Resistance
Women with PCOS are resistant to insulin, which increases their risk for type 2 diabetes. The statistics are scary as over 50% of women with PCOS will develop diabetes by the time they are 40. Your provider can do a blood test called a hemoglobin A1C to see if you are pre-diabetic. If you are, they can start you on a medicine called Metformin, which is actually used to treat diabetes. It helps your body break down and use insulin more effectively. Remember, the most effective way to treat your insulin resistance is to change your diet and exercise regularly, but this could be helpful as you work on those changes. Metformin also has an off label use of helping women with PCOS ovulate. Sometimes this will be prescribed if you are trying to become pregnant, as birth control will not give you this result. Some people have also lost weight on this medication while incorporating the proper lifestyle changes. Like all medications, Metformin has its side effects, such as nausea, vomiting, diarrhea, hypoglycemia (low blood sugar), and even serious complications that could be more life threatening.
Goal: Increase Fertility
Ovulation is critical for fertility, but many women with PCOS fail to ovulate every month, which decreases their chances of conceiving. A woman with normal, regular periods has 12 chances to get pregnant throughout the year. If you have your period every other month, your chances are already cut in half to 6. If you have your period every 3 months, your chances are even slimmer at 4. So, the goal is to have you ovulating every single month if you desire to be pregnant. Although birth control can give you a period every month, it doesn't help you actually ovulate. If you've tried lifestyle changes and still haven't been able to regulate your period, you may want to consider fertility meds, such as Clomid or Femara. Femara has actually been proven to be most effective for women with PCOS, so your provider will probably start with that one. This medicine works by reducing estrogen levels in order to stimulate ovulation, and you usually take it for 5 days every month while you are on your cycle. Common side effects include headaches, fatigue, dizziness, bloating, hot flashes, breast pain, and spotting. Many women are able to get pregnant once they start ovulating regularly, but if not, they move on to more advanced fertility assistance, which I will discuss next week.
There are various medications that can be used for PCOS, but it all boils down to what your individual goals are. Just remember medication is not in place of lifestyle changes, but in addition to!
xoxo, Global Midwife
Disclaimer: This is only to be used for educational purposes, not as medical advice. Always check with your individual healthcare provider.