By Nicole Galan, RN 

 Medically reviewed by Lindsay Cook, PharmD

There is no cure for polycystic ovary syndrome (PCOS), so the condition is typically treated by managing and improving symptoms. This is often achieved with medications that help mitigate the effects of the disease, like menstrual dysfunction, weight changes, infertility, and insulin resistance.1

Read on to learn about the medications used to manage PCOS symptoms.

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Menstrual Dysfunction

PCOS is characterized by hormonal abnormalities that can result in infrequent periods (oligomenorrhea) or absent periods (amenorrhea).

Some drug therapies can regulate hormones to restore a normal menstrual cycle.

There are two types of oral medications commonly used to treat menstrual irregularities in PCOS:

• Birth control pills, which override the menstrual cycle by preventing ovulation

• Provera (medroxyprogesterone), an oral form of the female hormone progesterone that's used to treat secondary amenorrhea

In addition to these oral medications, vaginal contraceptive rings and intrauterine devices (IUDs) containing progesterone can also help treat menstrual irregularities.2

Infertility

For many women, PCOS-related hormonal dysfunction can make it difficult to get pregnant. This is often related to irregular or absent ovulation (anovulation), which means that a woman doesn't release an egg that can be fertilized.

There are medications that can improve the chances of getting pregnant for those experiencing infertility. these treatments are used either alone or in combination.

Medications used for treating infertility n PCOS include:

• Clomid (clomiphene citrate), the most commonly used fertility drug, works better for some women with PCOS than others.

• Femara (letrozole), a medication mainly used to treat breast cancer, has also been shown to stimulate ovulation and it is used off-label for this purpose.

• Glucophage (metformin), a commonly prescribed diabetes drug, may enhance the effectiveness of fertility drugs and improve menstrual regularity. It is not approved for use in people with PCOS without diabetes.

• Gonadotropins, injectable hormones comprised of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH), are commonly used when Clomid or Femara don't induce ovulation.

Although Clomid is considered the first-line treatment of female infertility in general, Femara may work better in women with PCOS as it neither raises estrogen levels nor increases the risk of multiple births to the same degree as Clomid.3

In experimental studies, the non-hormonal supplement inositol has also been shown to improve egg and embryo quality while increasing pregnancy rates in women with PCOS.4

Insulin Resistance

Around 50% to 70% of women with PCOS will develop diabetes or prediabetes by the age of 40 due to the onset of insulin resistance, a condition influenced by imbalances in estrogen production. These women are also at greater risk of gestational diabetes, a condition caused by the impairment of glucose metabolism during pregnancy.5

Diabetes drugs are commonly used to treat insulin resistance in women with PCOS, the options of which include:6

• Glucophage (metformin), the first-line oral drug of choice that can control diabetes while promoting weight loss

• Actos (pioglitazone), an oral drug used to reduce high blood sugar

• Avandia (rosiglitazone), an oral drug of the same class as pioglitazone

• Avandamet, a combination of rosiglitazone and metformin

• Victoza (liraglutide), an injectable drug used to control insulin and glucose levels

In addition to medications, lifestyle modifications (including routine exercise and diets low in fat and refined sugars) are considered central to treatment.

Weight Gain

Roughly half of women with PCOS are overweight or obese.7 Not only does PCOS contribute to weight gain, but it also makes it far more difficult for women to lose weight. In addition to exercise and diet, drug therapies are sometimes used to assist with weight loss.

Current options may include:7

• Contrave (naltrexone/bupropion), which curbs food cravings by stimulating both the reward and hunger centers of the brain

• Qsymia (phentermine/topiramate), an appetite suppressant that works similarly to Contrave

• Saxenda (liraglutide), used to treat insulin resistance and obesity

• Wegovy (semaglutide), a once-weekly injection that helps suppress appetite and delay emptying of the stomach8

• Xenical (orlistat), a drug that can prevent the absorption of fat

• Zepbound (tirzepatide), a once-weekly injection used with diet and exercise to suppress appetite and slow gastric emptying

It's important to note that Belviq (lorcaserin), a previously prescribed weight-loss medication, was withdrawn from the market in February 2020 due to concerns regarding an increased occurrence of cancer in those taking the drug.9

Hyperandrogenism

Women with PCOS often have elevated levels of male hormones (androgens), including testosterone. The condition, referred to as hyperandrogenism, can lead to lead to the onset of secondary male characteristics in such as male-pattern hair loss and hirsutism (excessive facial and body hair growth).10

Hyperandrogenism is commonly treated with drugs that either block androgen production or counteract the effects of abnormal hair growth.

These include:10

• Aldactone (spironolactone), a diuretic that exerts potent anti-androgenic effects

• Propecia (finasteride), used off-label to treat hair loss in women with PCOS

• Vaniqa (eflornithine hydrochloride), a topical cream used to block hair growth

 Sources

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Legro RS. Evaluation and treatment of polycystic ovary syndrome. In: Endotext.

Ghahiri A, Mogharehabed N, Mamourian M. Letrozole as the first-line treatment of infertile women with poly cystic ovarian syndrome (PCOS) compared with clomiphene citrate: A clinical trial. Adv Biomed Res. 2016;5:6. doi:10.4103/2277-9175.175237

Lisi F, Carfagna P, Oliva MM, et al. Pretreatment with myo-inositol in non polycystic ovary syndrome patients undergoing multiple follicular stimulation for IVF: a pilot study. Reprod Biol Endocrinol. 2012;10:52. doi:10.1186/1477-7827-10-52

Ibricevic D, Asimi ZV. Frequency of prediabetes in women with polycystic ovary syndrome. Med Arch. 2013;67(4):282-5. doi:10.5455/medarh.2013.67.282-285

Dashti S, Latiff LA, Zulkefli NABM, et al. A review on the assessment of the efficacy of common treatments in polycystic ovarian syndrome on prevention of diabetes mellitus. J Family Reprod Health. 2017;11(2):56-66.

Legro RS. Obesity and PCOS: Implications for diagnosis and treatment. Semin Reprod Med. 2012;30(6):496-506. doi:10.1055/s-0032-1328878

U.S. Food and Drug Administration. FDA approves new drug treatment for weight management, first since 2014.

U.S. Food and Drug Administration. FDA requests the withdrawal of the weight-loss drug Belviq, Belviq XR (lorcaserin) from the market.

Pasquali R, Zanotti L, Fanelli F, et al. Defining hyperandrogenism in women with polycystic ovary syndrome: A challenging perspective. J Clin Endocrinol Metab. 2016;101(5):2013-22. doi:10.1210/jc.2015-4009

Kumar P, Arora S. Orlistat in polycystic ovarian syndrome reduces weight with improvement in lipid profile and pregnancy rates. J Hum Reprod Sci. 2014;7(4):255. doi:10.4103/0974-1208.147492

Lee R, Joy Mathew C, Jose M, Elshaikh A, Shah L, Cancarevic I. A review of the impact of bariatric surgery in women with polycystic ovary syndrome. Cureus. 2020. doi:10.7759/cureus.10811

By Nicole Galan, RN
Nicole Galan, RN, is a registered nurse and the author of "The Everything Fertility Book."