Like many women with PCOS, this has been a first line therapy for managing it. Oral contraceptives (OC) can assist with irregular menstrual cycles and hirsutism. When I was finally diagnosed as a teenager, I began taking Yasmin at around 16 years old. The combination of OC along with diet helped me lose the weight I had gained from the medications I was on when I was misdiagnosed which further impeded my diagnosis. However, the side effects of OC have been an issue for me and were the reasonings why I stopped trying various brands back in 2012. I have also tried a combination of medications and supplements throughout the years, and unfortunately, my PCOS symptoms have worsened, including further weight gain and increasing hirsutism. I tried medications (Metformin and Spironolactone) along with supplements without OC, and last year I went back on OC with the combination of supplements with no Metformin and Spironolactone and ugh… It has been a trial.
As I have continued to interact with more women within the PCOS community, it seems like treatment and management of it is a matter of trial and error. What may work for one woman may not for another, either due to side effects, contraindications, or the want to utilize more natural alternatives versus prescriptive. Whatever the reason, it’s a struggle for many women to find relief of her symptoms, which is frustrating for the estimated 5 to 10% of women in reproductive age who have PCOS.
The most current guidelines continue to recommend treatment of PCOS with OC, Metformin, Spironolactone, and/or other medications. The combination of medications addresses menstrual irregularities, hirsutism, and insulin resistance. The 2013 Endocrine Society released practice guidelines for the diagnosis and treatment of PCOS concluded:
- Use the Rotterdam criteria for diagnosing PCOS (presence of 2 of the following: androgen excess, ovulatory dysfunction, or polycystic ovaries).
- In adolescents with PCOS, hyperandrogenism is central to the presentation; hormonal contraceptives and metformin are treatment options in this population.
- Postmenopausal women do not have a consistent PCOS phenotype.
- Exclude alternate androgen-excess disorders and risk factors for cardiovascular disease, diabetes, endometrial cancer, mood disorders, and obstructive sleep apnea.
- For menstrual abnormalities and hirsutism/acne, hormonal contraceptives are first-line treatment.
- For infertility, clomiphene is first-line treatment.
- For metabolic/glycemic abnormalities and for improving menstrual irregularities, metformin is beneficial.
- Metformin is of limited or no benefit for managing hirsutism, acne, or infertility.
- Overall, thiazolidinediones have an unfavorable risk-benefit ratio.
- More investigation is needed to determine the roles of weight loss and statins in PCOS.
What also makes diagnosing and treating PCOS difficult is there is still a degree of controversy over the Rotterdam criteria. While overall it has been the gold standard for diagnosing, it’s apparent that more research is needed for evaluating whether the criteria can assist with guiding various treatment choices based on differing health aspects. Again, differing phenotypes of PCOS and ages of women, different treatment needs. Australia, for example, has the Centre for Research Excellence in Polycystic Ovary Syndrome, and they are currently reviewing the guidelines for diagnosing and treating PCOS. One of the more recent articles I cam across on PCOS reviews the pathophysiology, diagnosing, comorbidities, and treatment that I found refreshing due to the detail.
It’s clear that I am the classic phenotype for PCOS, and it is a bit scary to read the potential complications with health that can occur if left untreated. With that said, I know it sounds counterintuitive to go against the current guidelines for treatment by quitting my OC. I do plan to meet with my OB-GYN for follow up and discuss options and review lab work if needed. In addition, I am currently taking Ovasitol twice a day, N-Acetyl Cysteine 600mg twice a day, a multivitamin, Vitamin D3, Vitamin B-12, and Omega. This is why I strongly feel that more evidenced-based research is needed to review supplementation for treating PCOS for those who cannot tolerate prescriptive recommendations or want to have other options.
My goals are to utilize supplementation and lifestyle changes to make managing my symptoms successful. I am obese with my BMI being around 32. According to one article by Thabo Matsaseng (2017), obesity co-exists in 30-50% of those with PCOS, and with a weight loss of 5 to 10% it has been shown to restore ovulatory cycles. Of course, whenever I hear about losing weight and PCOS, I think of this guy:
I have tried multiple diets, along with various medications and supplements, as well as exercise routines. There’s nothing more frustrating than to be told lose weight when you’re trying and nothing happens. There is also a high amount of frustration over how many do not realize the degree of fatigue and inflammation felt when my PCOS is not managed efficiently. The continued trial and error is becoming quit tiresome to say the least.
This week, I’m going to read through a couple of PCOS books that I’ve ordered. (I had hoped they would have come in this weekend but it did not work out – dangit, Amazon!) I plan to follow up with my reviews on them, as well as give an update on the next course of action I am going to take. I have met a lot of women who are successfully managing their own PCOS with a lower carbohydrate or Ketogenic diets, primarily due to the effect it has for insulin resistance. And as many within the community know when you have insulin resistance it will increase the risk for type 2 diabetes.Thankfully, my A1C is normal with the use of Ovasitol.
Until my next post, I hope you all are continuing to find relief in your symptoms, and if you want to get in touch with me you can through my Instagram account.
Matsaseng, T. (2017). Polycystic Ovary Syndrome: Management Review & Update. Obstetrics & Gynaecology Forum, 27(1), 12-15.