Polycystic ovarian syndrome (PCOS) is one of the most common endocrine conditions in women of childbearing age. PCOS comes with a range of hormonal abnormalities, such as menstrual irregularity, insulin resistance, infertility, and clinical hyperandrogenism or hyperandrogenemia. Grapelike clusters of ovarian cysts are a key marker on ultrasound.
PCOS seen on Voluson™ ultrasound
Given its complexity, the condition defies a one-size-fits-all path to PCOS treatment. That said, there are proven and emerging adjunct therapies that can tame elements of the disease, opening byways to customize long-term treatment.
Take Aim at Insulin Resistance
By age 40, more than half of women with PCOS develop type 2 diabetes, according to the Centers for Disease Control and Prevention. Metformin, an insulin-lowering drug, offers the dual advantage of reducing insulin resistance and restoring ovulation.
Recent international evidence-based guidelines published in Reproductive Biology suggest pairing metformin with a regime of diet and exercise. Physicians should also consider metformin in combination with ovulation-induction drugs as a treatment option for patients seeking to become pregnant. A meta-analysis in Reproductive Biomedicine Online found mixed evidence for the benefits of combining metformin and clomiphene, but also noted that some studies found women administered both were more likely to ovulate than those administered clomiphene alone.
The trade-offs with metformin include side effects—namely, a reduction in the absorption of vitamin B12, along with mild cases of diarrhoea, bloating, and other gastrointestinal problems.
Targeting Androgens
Combination birth control pills have proven effective in lowering androgen levels among PCOS patients. But for women who want to become pregnant, contraception is not an appealing option.
In the quest for alternatives, new research points to the promise of statins to reduce androgen levels in women with PCOS, either alone or in tandem with other therapies.
A 2020 meta-analysis published in BMC Women's Health reviewed the effectiveness of various interventions, including oral contraception, an array of statins, combinations of statins, and metformin and metformin alone. Atorvastatin alone proved more effective than the other therapies in lowering total testosterone levels in patients with PCOS. Even so, a 12-week regime of atorvastatin was found to hamper insulin sensitivity.
An earlier Cochrane meta-analysis reports that statins reduce testosterone levels while improving cholesterol and triglyceride levels.
Antioxidant Alternatives
Resveratrol is a naturally occurring antioxidant found in grapes, mulberries, peanuts, and rhubarb. Previous research suggests the plant compound carries anti-inflammatory, antioxidant, and heart-protective properties—perks that may prove beneficial in PCOS treatment.
A double-blind study in the Journal of Clinical Endocrinology and Metabolism showed resveratrol significantly lowered testosterone and dehydroepiandrosterone-sulfate (DHEA-S) levels among women with PCOS. Total testosterone levels fell by 23 percent among the women taking the antioxidant, compared to a nearly 3 percent uptick seen in the placebo group.
DHEA-S slid 22 percent in the resveratrol group, while climbing 10.5 percent in the placebo group. Among the resveratrol group, fasting insulin levels also sank almost 32 percent during the three-month study. Yet, the study dosage of 1,500 mg of resveratrol produced noticeable side effects, including nausea, vomiting, diarrhoea, and liver dysfunction. Research is now underway to investigate lower dosages.
Science on Supplements
In the quest for PCOS treatments with fewer side effects, melatonin appears promising. A small but encouraging study in Reproductive Sciences reports that a six-month regime of the supplement reduced androgen levels and regulated the cycles of women with PCOS. Two ongoing clinical trials are now investigating PCOS treatment with melatonin.
Meanwhile, the latest research on inositol, a dietary supplement, has yielded mixed results. A Cochrane review reported no significant changes among sub-fertile women with PCOS who took the supplement. Just a year earlier, a meta-analysis found quite the opposite. This research, published in BJOG, suggests two forms of the supplement—myo-inositol and D-chiro-inositol—improve metabolic measures and menstrual regularity among PCOS patients. Noting the mixed results, the authors have pressed for well-designed multi-centre trials to explore this treatment possibility further.
The pursuit of a treatment plan that addresses all the facets of PCOS remains a work in progress. Still, adjunct therapies offer promising avenues to tailor treatment to your patient.
