Post by Angie on Oct 24, 2008 20:07:46 GMT -5
Lifestyle changes
Loss of weight
Even a 5% loss of weight will reduce insulin resistance and result in symptom improvement.
It will restore ovulation
reduce symptoms
reduce risk of diabetes & insulin resistance and cardiovascular disease (CVD)
dietary plan similar for diabetics with low GI (Glycaemic Index) foods
high protein/ low carbohydrate diets good in initial weight loss phase
Physical Activity
Even without weight loss, this effectively reduces insulin resistance, 10,000 steps per day with a simple pedometer is very effective cheap and achievable for most women.
regular low fat burning
improves self esteem
reduces CVD risk
reduces weight
Medications
Period Problems
Oral contraceptives (Diane/Brenda/Juliet or low dose pills) “the pill” will regulate the period, eliminate a troublesome period or and may reduce risks of endometrial cancer. Because of the lack of ovulation oestrogen levels may be normal or high and therefore increase the risk of abnormal cell changes in the lining of the uterus (endometrium).
Hirsuitism – Anti-androgen therapies:
Oral contraceptives (Diane/Brenda/Juliet) contain small amount of anti-androgen, cyproterone acetate, but concerns of possible side effects of weight gain, ovarian cysts and change in glucose tolerance.
Cyproterone acetate is an effective anti-androgen often used with “the pill”. Side effects may include weight gain, depression, reduced libido and tiredness.
Spironolactone is a diuretic (fluid tablet) which also is an effective anti-androgen and should be used only in women who are not trying to conceive because of the possibility of foetal abnormalities (birth defects)
Metformin, a drug for diabetes, reduces the insulin level and insulin resistance leading to a reduction in testosterone and therefore an effect on hair growth.
Topical treatment options (e.g. creams) exist also.
Acne
The pill effectively reduces acne.
The anti-androgens, cyproterone acetate; “the pill” or spironolactone reduce acne by reducing testosterone.
Roacutane for acne.
Metformin by reducing testosterone.
Alopecia
Alopecia can occur due to an increase in androgens so it is appropriate to use the same therapies as for hirsuitism.
Reduced fertility
Ovulation needs to be monitored and sexual intercourse timed to coincide with ovulation. There are over-the-counter kits available to measure LH, which goes up at ovulation. Temperature charting can show ovulation change but is not a reliable indicator. A progesterone level taken about seven days after expected ovulation will determine if ovulation has occurred (day 21 progesterone in a 28 day cycle). If ovulation is not regular, even modest lifestyle change and weight loss can effectively improve ovulation. Also medications to induce ovulation maybe required.
Referral to a fertility specialist is necessary for further treatment. Ovulation may be induced by oral Clomiphene,. Metformin (based on recent Cochrane review) or FSH injections. It may be necessary to proceed to assisted reproduction techniques including IVF although these are more effective in those women who have instituted lifestyle change effectively first.
Alternative therapies
Natural remedies should only be prescribed by an experienced qualified practitioner with an interest in women’s health including fertility. There are no clinical trials at present that have been completed on alternative therapies in this area.
Long term, the most important aspect of treatment is managing cardiovascular risks such as obesity, high blood cholesterol, diabetes or pre-diabetes and high blood pressure. To help guide ongoing treatment decisions, a physician will want to see the patient regularly for a physical examination and measurement of blood pressure and glucose and lipid levels. A physician may also refer patients to a trained dietitian for guidance on weight management.
Hormone Treatments
These are prescribed for irregular periods. Oral contraceptives or birth control pills that contain a combination of estrogen and progesterone regulate menstrual periods.
Hormone Blockers
These are used to treat excessive production of androgens. The drugs block the effects of male hormones such as unwanted hair, male pattern baldness and acne.
Insulin Resistance
New medications lower insulin levels. Though not yet approved for PCOS treatment, they show some promise. It may take six months to see results, but insulin lowering medication plus exercise and diet may result in regular menstruation and ovulation for most patients.
Lifestyle Modification
Weight loss and exercise help to lower insulin levels, which reduce the ovaries' production of testosterone. This is often effective for overweight PCOS patients.
Infertility Treatments
If infertility problems are not resolved with drug therapy or lifestyle modification, gynecologists and gynecologic surgeons use standard fertility treatments such as ovulation induction and in vitro fertilization.
Surgery
If medications don't help achieve pregnancy, an outpatient surgical procedure (laparoscopic ovarian drilling) may be recommended. The surgeon makes small punctures on the stroma (outer layer of the ovary) with a needle electrode, to decrease androgen production and increase the chances of ovulation.
Loss of weight
Even a 5% loss of weight will reduce insulin resistance and result in symptom improvement.
It will restore ovulation
reduce symptoms
reduce risk of diabetes & insulin resistance and cardiovascular disease (CVD)
dietary plan similar for diabetics with low GI (Glycaemic Index) foods
high protein/ low carbohydrate diets good in initial weight loss phase
Physical Activity
Even without weight loss, this effectively reduces insulin resistance, 10,000 steps per day with a simple pedometer is very effective cheap and achievable for most women.
regular low fat burning
improves self esteem
reduces CVD risk
reduces weight
Medications
Period Problems
Oral contraceptives (Diane/Brenda/Juliet or low dose pills) “the pill” will regulate the period, eliminate a troublesome period or and may reduce risks of endometrial cancer. Because of the lack of ovulation oestrogen levels may be normal or high and therefore increase the risk of abnormal cell changes in the lining of the uterus (endometrium).
Hirsuitism – Anti-androgen therapies:
Oral contraceptives (Diane/Brenda/Juliet) contain small amount of anti-androgen, cyproterone acetate, but concerns of possible side effects of weight gain, ovarian cysts and change in glucose tolerance.
Cyproterone acetate is an effective anti-androgen often used with “the pill”. Side effects may include weight gain, depression, reduced libido and tiredness.
Spironolactone is a diuretic (fluid tablet) which also is an effective anti-androgen and should be used only in women who are not trying to conceive because of the possibility of foetal abnormalities (birth defects)
Metformin, a drug for diabetes, reduces the insulin level and insulin resistance leading to a reduction in testosterone and therefore an effect on hair growth.
Topical treatment options (e.g. creams) exist also.
Acne
The pill effectively reduces acne.
The anti-androgens, cyproterone acetate; “the pill” or spironolactone reduce acne by reducing testosterone.
Roacutane for acne.
Metformin by reducing testosterone.
Alopecia
Alopecia can occur due to an increase in androgens so it is appropriate to use the same therapies as for hirsuitism.
Reduced fertility
Ovulation needs to be monitored and sexual intercourse timed to coincide with ovulation. There are over-the-counter kits available to measure LH, which goes up at ovulation. Temperature charting can show ovulation change but is not a reliable indicator. A progesterone level taken about seven days after expected ovulation will determine if ovulation has occurred (day 21 progesterone in a 28 day cycle). If ovulation is not regular, even modest lifestyle change and weight loss can effectively improve ovulation. Also medications to induce ovulation maybe required.
Referral to a fertility specialist is necessary for further treatment. Ovulation may be induced by oral Clomiphene,. Metformin (based on recent Cochrane review) or FSH injections. It may be necessary to proceed to assisted reproduction techniques including IVF although these are more effective in those women who have instituted lifestyle change effectively first.
Alternative therapies
Natural remedies should only be prescribed by an experienced qualified practitioner with an interest in women’s health including fertility. There are no clinical trials at present that have been completed on alternative therapies in this area.
Long term, the most important aspect of treatment is managing cardiovascular risks such as obesity, high blood cholesterol, diabetes or pre-diabetes and high blood pressure. To help guide ongoing treatment decisions, a physician will want to see the patient regularly for a physical examination and measurement of blood pressure and glucose and lipid levels. A physician may also refer patients to a trained dietitian for guidance on weight management.
Hormone Treatments
These are prescribed for irregular periods. Oral contraceptives or birth control pills that contain a combination of estrogen and progesterone regulate menstrual periods.
Hormone Blockers
These are used to treat excessive production of androgens. The drugs block the effects of male hormones such as unwanted hair, male pattern baldness and acne.
Insulin Resistance
New medications lower insulin levels. Though not yet approved for PCOS treatment, they show some promise. It may take six months to see results, but insulin lowering medication plus exercise and diet may result in regular menstruation and ovulation for most patients.
Lifestyle Modification
Weight loss and exercise help to lower insulin levels, which reduce the ovaries' production of testosterone. This is often effective for overweight PCOS patients.
Infertility Treatments
If infertility problems are not resolved with drug therapy or lifestyle modification, gynecologists and gynecologic surgeons use standard fertility treatments such as ovulation induction and in vitro fertilization.
Surgery
If medications don't help achieve pregnancy, an outpatient surgical procedure (laparoscopic ovarian drilling) may be recommended. The surgeon makes small punctures on the stroma (outer layer of the ovary) with a needle electrode, to decrease androgen production and increase the chances of ovulation.