Treatment for patients without fertility requirements Treatment objectives: immediate goals are menstrual cycle adjustment, treatment of hirsutism and acne, and weight control; long-term goals are prevention of diabetes, prevention of endometrial cancer, and cardiovascular disease.
(1) Lifestyle modification.
1. diet control.
2.Exercise.
3, Quit smoking and alcohol.
4.Reducing body weight to normal range, improving insulin resistance, and stopping the long-term development of PCOS with adverse consequences such as diabetes, hypertension, hyperlipidemia, and cardiovascular disease and other metabolic syndromes.
(2) Oral Contraceptive Pill (OC, Oral Contracptive).
1. Indications: hyperandrogenemia or hyperandrogenic manifestations.
2. Types: various short-acting oral contraceptives, with Daimler-35 being preferred.
3. Mechanism of action: as previously described.
4. Advantages:
a. Correction of hyperandrogenemia and improvement of the clinical manifestations of hyperandrogenism.
b. Effective contraception, establishment of regular menstruation, and prevention of endometrial cancer.
5. Usage: Take 1 tablet daily for 21 days on days 1-5 of natural menstruation or withdrawal bleeding. Stop the medication for about 5 days to start retreating bleeding and restart the medication on the 5th day of retreating bleeding. Or repeat initiation after 7 days of discontinuation. Repeatable for at least 3 to 6 months.
6. Precautions.
a. PCOS patients are a special population, often with disorders of glucose and lipid metabolism, and should be monitored for changes in blood glucose and lipids during drug administration.
b. For adolescent girls full informed consent should be given before applying OC.
c. Contraindications to oral contraceptives should be excluded before taking the drug.
(3) Progestin.
1. Indications: Anovulatory patients without obvious hyperandrogenic clinical and laboratory manifestations and without obvious insulin resistance may be treated with regular progestogen therapy alone to restore menstruation.
2. Types: Progesterone (MPA), micronized progesterone (QinetiQ), dydrogesterone (Dafabetone)
3. Dosage: MPA 6mg/day, or Kinen 200mg/day, or Dydrogesterone 10-20mg/day for 10 days per month during the second half of the menstrual cycle. Withdrawal bleeding at least once in two months.
4. Advantages.
a. Adjustment of menstrual cycle, protection of endometrium and prevention of endometrial cancer.
b. May reduce androgen levels to some extent by slowing down the frequency of GnRH-LH pulse secretion.
c. Suitable for patients without serious Kaohsiung symptoms and metabolic disorders.
5. Shortcomings: The androgen-lowering effect is weak and cannot improve the condition of Kaohsiung symptoms and metabolic disorders.
(4) Treatment of insulin resistance – metformin
1. Indications: obese patients with insulin resistance.
2.Mechanism: as described before.
3, Usage: 500mg, 2 or 3 times daily. Treatment should be repeated every 3 to 6 months for recovery of menstruation and ovulation, any adverse effects, and rechecking blood insulin, LH, and testosterone. If menstruation does not resume, additional progestin must still be used to regulate menstruation.
4. Side effects: The most common ones are gastrointestinal reactions, such as abdominal distension, nausea, vomiting and diarrhea, which are dose-dependent. Serious side effects are possible renal impairment and lactic acidosis.