Management of PCOS
In this section
| Low glycemic eating | Exercise | Stress Management |
| Pharmacological Intervention | Help with skin and hair | The menopause and afterwards |
In the past, symptoms of PCOS such as excess testosterone, central obesity, irregular periods and infertility have been treated separately, when in reality they are mostly the result of insulin resistance, the metabolic basis of the syndrome.
The treatment of PCOS should focus on insulin resistance. Improvement of most symptoms of PCOS will follow. If need be, additional measures may be necessary to, for example, enhance fertility or provide relief from excessive body hair growth (hirsutism). We are cognizant that in many instances excessive hair growth may only be the main presenting feature. These women deserve the same level of attention as women with a multitude of PCOS symptoms. Hirsutism and associated skin problems may erode self-confidence, limit social interactions and indeed, have a negative impact on the woman's mental health, reducing her overall perception of her quality of life.
Insulin resistance should be addressed with low glycemic eating, aimed at weight reduction if necessary, exercise and the use of insulin sensitisers as well as stress management. We advocate aerobic exercises, building up gradually to 30 minutes three times per week. The target of the exercise is to at least double the resting pulse. For persons not accustomed to exercise, the exercise program should be discussed with their GP or fitness instructor or gym trainer.
Low glycemic eating
Low glycemic eating is an important cornerstone of our PCOS management program. We have little doubt that it contributes in a major way, together with other elements of the management plan, to the high success rate of the program and patient satisfaction.
Low glycemic eating is predicated on eating three main meals with an additional 2-3 snacks per day, partaking predominantly of foods that do not raise blood sugars and thus secretion of insulin by the pancreas inordinately. The steady, lower level of blood insulin helps in the short run to lift fatigue and sleep disorders and in the long term to achieve weight loss and eliminate many features of PCOS. Learn more about the low glycemic diet.
Exercise
Exercising regularly has many advantages including an enhanced sense of well-being, improved muscle strength and co-ordination, weight loss and stress reduction. Exercise also makes the body more sensitive to insulin, so that the pancreas does not have to work as hard to maintain bodily functions. Improved insulin sensitivity has to be maintained with regular exercise. You can see how exercise would work hand-in-hand with low glyceamic eating. Interestingly, the low GI diet improves athletic fitness and endurance.
Learn more about our graduated exercise program.
Stress Management
Stress is an inescapable part of modern life!
You will, therefore, need to learn new tricks or enhance techniques already learnt to minimize the effect of stress on your mind and body. As we have discussed, stress can cause and/or make insulin resistance worse and thus impact on the symptoms of PCOS.
You can minimize stress in your life by effective management of your time and prioritizing tasks. The working mother with a family who is trying to "please everyone", leaving her needs last is not an unusual scenario for women with PCOS and indeed, most women. Allow a time for yourself everyday for meditation, yoga, a walk in the park etc. Exercise regularly and maintain a positive outlook towards your health and be optimistic even when your PCOS symptoms along with everything else around you seem overwhelming.
It is important to verbalize your feelings to a friend or a relative. Talking about things often clarifies the issues and presents you with solutions. Remember that psychotherapists usually let you talk through your problems, gently leading you down paths they perceive to be relevant to these problems.
If everything fails, you might want to get counselling from somebody with experience in stress management.
You can also email a member of our team who will get back to you.
Pharmacological Intervention
The main drugs used in the management of PCOS are:
Help with skin and hair
Acne and an oily complexion, usually appearing around the time of puberty, may be the very first signs of PCOS. Hard-to-treat acne and acne which appears later in life can also be a symptom of PCOS. Acne associated with PCOS may respond to metformin, although in some cases the addition of antibiotics or androgen blockers may be necessary.
With treatment, excessive facial and body-hair growth will slow down. Hair will become finer as blood levels of testosterone fall. The benefits of any treatment for excess hair growth will not be realised before five to six months. In addition, many women with PCOS may still not be satisfied with the degree of excess body-hair growth achieved with metformin treatment. In these cases, testosterone blockers or drugs that influence testosterone metabolism are advised. We use flutamide at a fraction (62.5 mg daily) of the traditional dose of 250mg once or twice a day. Liver function tests must be carried out periodically and the drug discontinued if pregnancy is contemplated. Our experience over several years leads us to recommend flutamide as the treatment of choice for this purpose.
The water pill, spiranolactone, is less effective, although it has been used for many years at high doses for this purpose. The contraceptive pill may be effective in reducing excessive body hair too but using it over a long-term period has been questioned.
The medical treatment of excess facial and body hair may need to be supplemented with various methods for hair removal such as depilatory creams, electrolysis, flashlamps, intense pulsed light and laser hair removal. Electrolysis and laser therapy, in particular, often lead to a dramatic improvement in quality of life. The cream "Vanique" when used alongside traditional methods has been found to be effective by most users. Vanique is available in the UK as Vaniqua. Your GP or specialist should be consulted about its use.
Unfortunately there are many products and procedures, including those for "permanent hair removal" that do not stand up to the claims of the manufacturers.
You might find the website www.hairfacts.com a source of objective unbiased information.
The menopause and afterwards
Insulin resistance persists even after the ovaries have retired. We encourage an active lifestyle, low glycemic eating and continued use of insulin sensitizers after the menopause. The woman may explore the management of new stresses as a result of mental and physical changes associated with the menopause. Indeed, we are starting to see in our clinics a significant number of peri- or post- menopausal women with symptoms of insulin resistance.