Therapy for fertility

The therapy of polycystic ovarian syndrome depends primarily on whether the patient wishes to have a child or not. If left untreated, pregnancy can be difficult or impossible. If there is no desire to have children, the production of androgens in the ovaries can be inhibited by the administration of ovulation inhibitors (“pill”) or glucocorticoids (cortisone).

Ovulation inhibitors with the active ingredient cyproterone acetate are frequently used in this case (“Diane”). This leads to a compensatory inhibition of the androgen receptors and, through combination with ethinyl estradiol, to a reduction of LH and FSH. Aldosterone antagonists, such as spironolactone, inhibit the formation of androgens and the formation of androgen receptors and thus lead to a reduction of the described symptoms.

If there is a desire to have children, the presence of polycystic ovarian syndrome is a serious problem. If the symptoms are pronounced, the administration of clomiphene, gonadotropins (HMG,FSH), cortisone or comparable glucocorticoids or a time-dependent administration of the gonatotropin-releasing hormone (GnRH) may be considered. However, there is a risk of ovarian hyperstimulation, which can lead to multiple pregnancies.

Prophylaxis

Since the mechanism of origin is largely unexplained, prophylactic measures are still unknown.

Prognosis

Many disorders affecting androgen and hormone production are unfortunately chronic or not curable. Patients with polycystic ovarian syndrome must be prepared for long-term therapy.After a period of 9-12 months the therapy should be adjusted accordingly and an increase or extension of the medication should be made. Cosmetic treatment of the accompanying symptoms (shaving, epilation, acne treatment) may also be useful. Taking the “pill” can also reduce or completely eliminate acne.

Is a cure possible?

Unfortunately, a cure for polycystic ovarian syndrome (PCO syndrome) is not yet possible. There are only supportive measures which aim to reduce the symptoms and improve the quality of life of the affected persons. This means that the symptoms, i.e.

the consequences of the PCO syndrome, are combated, but not the cause, i.e. the disease itself. The treatment must be individually adapted in order to find the most effective therapy for the respective patient. In this way the symptoms can be brought under control or reduced.

In some cases it is even possible to eliminate the symptoms completely. It is important to consult a physician who is familiar with the treatment of PCO patients and has a good expertise. Among the drugs that can be used to alleviate symptoms are, for example, contraceptives (contraceptive drugs).

These can provide relief from cycle irregularities, such as those frequently found in polycystic ovarian syndrome. It is important to talk to your doctor about whether you currently wish to have a child or not in order to adjust your therapy accordingly. The preparations also have a preventive effect with regard to endometrial carcinoma, i.e. cancer of the uterine lining.

In particularly severe cases with symptoms that cannot be controlled, surgical measures are also treatment options. In hirsutism, an excessive amount of body hair, contraceptives can also provide relief, as they better adjust the imbalance between male and female hormones. This also applies to acne.

If you are overweight, you should exercise regularly and change your diet. The active ingredient metformin is also frequently used in polycystic ovarian syndrome, as it interferes with the blood sugar balance and can normalize it. Metformin also reduces the production of male hormones, which can reduce acne, improve cycle irregularities and can also increase fertility.

It is advisable to undergo long-term treatment and regular check-ups in order to prevent the symptoms from progressing and to detect possible late effects early on. Despite the lack of prospects for a cure, some patients report having more regular menstrual cycles after pregnancy, which makes further drug support for cycle control unnecessary. This also often makes it easier to achieve a new pregnancy. Furthermore, many symptoms of some PCO patients improve with the onset of menopause.