Treatment of polycystic ovary syndrome PCOS.

PCOS treatment

pcos treatment pakistan┬áis only symptomatic. It is based on a modification of one’s lifestyle, the possible taking of certain medications, the monitoring of possible complications, and the management of infertility.

THE GOAL OF TREATMENT FOR POLYCYSTIC OVARY SYNDROME

There is no treatment to cure PCOS. The treatment is, therefore, only symptomatic and must be followed by the patient until menopause. It aims to:

  • Correct symptoms related to hyperandrogenism ( acne, hirsutism, etc.);
  • Restore menstrual cycles to increase the chances of fertility and protect the patient from the risk of endometrial cancer;
  • Improve metabolic abnormalities and, in particular, blood sugar ;
  • Correct overweight, if necessary;
  • Induce ovulation if a pregnancy is desired.

Thus, this treatment is based on modifying his lifestyle, drug treatment, if necessary, and monitoring specific symptoms. For infertile women, solutions are also offered.

AN ADAPTATION OF HIS LIFESTYLE TO REDUCE THE SYMPTOMS OF PCOS

For a woman suffering from PCOS, especially if she is overweight, an improvement in hygiene of life is essential to promote well-being. A loss of approximately 10% of the initial weight is then recommended thanks to the following:

  • A suitable and balanced diet ;
  • Increased physical activity.

The adoption of a new eating and physical behavior:

Reduces hyperandrogenism and its symptoms. It leads, in particular, to a reduction in hair loss and a reduction in hypervelocity, and acne ;

has positive effects on amenorrhea, with potential benefits on fertility and mood.

In the longer term, weight loss positively impacts the risk of metabolic complications associated with PCOS, including a reduced risk of developing type 2 diabetes.

Women with PCOS who are not overweight can adjust their lifestyle, but losing weight will not improve their symptoms.

At the same time, it is essential to have support and management of psychological problems taking into account the phenomena of anxiety or depression.

MEDICATIONS TO REDUCE SYMPTOMS OF HYPERANDROGENISM IN PCOS

In the case of hirsutism, an estrogen-progestogen pill is recommended as first-line treatment. This type of contraception has several positive effects:

  • A decrease in androgen levels;
  • Regulation of menstrual cycles;
  • A reduction in acne, hair loss, and hypervelocity.

Suppose the estrogen-progestogen pill has no effect or is not tolerated by the woman with PCOS. In that case, the treatment is based on an anti-androgen (cyproterone acetate) combined with natural estrogen. This type of medicine is effective:

in 3 months on acne ;

in 6 months on hirsutism.

However, hormonal treatments combining cyproterone acetate and ethinylestradiol (such as the drug Diane 35 or its generics) increase the risk of venous or arterial thrombosis and the risk of occurrence of meningioma, a benign tumor of the meninges of the brain. It is, therefore, necessary to take precautions because:

  • it should not be prescribed in combination with the treatment of acne by isotretinoin;
  • it is contraindicated in case of a history of meningioma.

The usefulness of the patient card

A patient card is an information document that complements the leaflet available in a medicine box. It is part of the additional risk reduction measures (MARR) that the National Agency can implement for the Safety of Medicines and Health Products (ANSM). It helps to ensure the safe and effective use of a specific drug.

MONITORING AND TREATING PROBLEMS ASSOCIATED WITH PCOS

In addition to the monitoring put in place in the event of being overweight, women with PCOS must benefit from monitoring for cardiovascular risk, blood sugar levels, blood cholesterol levels, blood pressure, etc.

An increase in blood sugar that can lead to type 2 diabetes is treated as a first-line treatment by lifestyle and dietary measures and weight loss, if necessary. Oral antidiabetic drugs (metformin) may be prescribed if needed. Patients must then be informed of the possible side effects of metformin: discomfort, headache, etc.

The management of being overweight is, above all, hygiene-dietetic. In the event of significant obesity, bariatric surgery should be discussed with your doctor, taking into account the risks of pregnancy in women who are incredibly overweight.

POLYCYSTIC OVARY SYNDROME: WHAT TREATMENT IN CASE OF INFERTILITY?

Infertility treatment is possible.

Before starting this type of treatment, it is necessary to make sure that there are no other factors causing infertility, such as an anatomical abnormality of the uterine tubes or, in men, sperm abnormalities, which would modify the therapeutic approach.

Ovulation induction or ovarian stimulation

The induction of ovulation involves taking medication to induce ovulation. It is recognized as the first step in treating infertility in the case of PCOS. Clomiphene citrate is the recommended first-line treatment. New treatments have emerged, such as letrozole and aromatase inhibitors. It has the advantage of inducing fewer multiple pregnancies (at least two fetuses) than other ovulation induction treatments. However, the marketing authorization for the use of this drug in this type of care is not, to date, in force in Pakistan.

In case of failure, injectable gonadotropins are used as the second intention.

Depending on the treatment chosen by the doctor, the patient (and her partner) must be informed of the risks of multiple pregnancies.

Ovarian surgery by drilling in case of PCOS

Ovarian surgery by “drilling” is a laparoscopic surgical technique. It consists of making micro-perforations in the superficial layer of the ovaries to obtain regular ovulation and spontaneous pregnancies. This surgery allows ovulation to be restored in approximately 50% of cases. It can be offered:

  • After treatment with clomiphene citrate has failed or in the event of resistance to this type of treatment;
  • As an alternative to ovulation induction treatments with gonadotropins;
  • As an alternative to the use of in vitro fertilization, which potentially produces more side effects in patients with PCOS;
  • In first intention, if laparoscopy is indicated for reasons other than the problem of ovulation (tubal problem, endometriosis, etc.).

In vitro fertilization

In vitro fertilization (IVF) is a medically assisted procreation technique (MAP). It represents the final stage of management in patients with PCOS, after the failure of ovulation induction or as an alternative to ovarian surgery.

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