New Treatment in PCOS

Polycystic ovary syndrome (PCOS) is now recognized as an important metabolic as well as reproductive disorder conferring substantially increased risk for type 2 diabetes. Affected women have marked insulin resistance, independent of obesity.

Prolonged (6 months) medical therapy for hirsutism is necessary to document effectiveness . Many drugs used for the treatment of hirsutism are not FDA approved for this indication.

No effective treatment for alopecia is known. Anti-androgens should not be used without effective contraception. Flutamide is of limited value because of its dosedependent hepatotoxicity. Drospirenone in the dosage used in some OCs is not antiandrogenic. The best medical therapy and long of treatment for hirsutism is unclear. Measurement of serum androgens is fraught with error but is the best estimate we have for hyperandrogenism. Overall, the benefits of OCPs outweigh the risks in most patients with PCOS. Women with PCOS are more likely to have contraindications for OCP use than normal women. In the absence of other risk factors, there is no evidence that women with PCOS are at increased risk of cardiovascular disease (CVD) with OCP treatment compared with normal women. There is no evidence for differences in effectiveness and risk among the various progestogens and when used in combination with a 20 versus a 30 mg daily dose of estrogen. OCPs do not negatively affect subsequent fertility. There is no definitive evidence that the type of OCP determines efficacy of hirsutism control.

Statins can reduce the concentration of total testosterone, Total Cholesterol, TG and LDL. However, it cannot be concluded that statins have long-term benefit. Efficacy and safety of newer drugs for treatment of type2 DM in PCOS (including GLP-1 agonists) is unclear.

The efficacy of bariatric surgery and its long-term effect is unclear.