Treatment of women with PCOS should begin with lifestyle measures:
- for those who are obese, a combination of weight loss and exercise may stimulate ovulation
If the woman is not overweight or weight loss is ineffective then:
- taking into account potential adverse effects, ease and mode of use, the woman's BMI, and monitoring needed (1):
- clomifene citrate or
- metformin
- or a combination of the above
- for women who are taking clomifene citrate, offer ultrasound monitoring during at least the first cycle of treatment to ensure that they are taking a dose that minimises the risk of multiple pregnancy
- for women who are taking clomifene citrate, do not continue treatment for longer than 6months
- women prescribed metformin should be informed of the side effects associated with its use (such as nausea, vomiting and other gastrointestinal disturbances)
- if woman known to be resistant to clomifene citrate, consider one of the following second-line treatments, depending on clinical circumstances and the woman's preference:
- laparoscopic ovarian drilling or
- combined treatment with clomifene citrate and metformin if not already offered as first-line treatment or
- gonadotrophins
- women with polycystic ovary syndrome who are being treated with gonadotrophins should not be offered treatment with gonadotrophin-releasing hormone agonist concomitantly because it does not improve pregnancy rates, and it is associated with an increased risk of ovarian hyperstimulation
Note that weight loss can be difficult to achieve, there should not be undue delay in referring a woman who is overweight for specific treatment to induce ovulation if she has failed to lose weight, particularly if she is aged over 35 years (2).
Reference:
- NICE (August 2016).Fertility problems: assessment and treatment
- Drug and Therapeutics Bulletin (2004); 42(4):28-32.