Pharmacological Management of Symptoms Associated with Polycystic Ovarian Syndrome

Introduction

Polycystic ovarian syndrome (PCOS) is an array of symptoms, such as irregular menstrual cycles and ovarian cysts, caused by a hormonal imbalance, affecting women of reproductive capacity¹. Given that the exact physiological mechanisms of PCOS are widely misunderstood among the scientific community, management of PCOS is largely linked to minimizing symptoms present in affected individuals ¹. This article aims to discuss current, well-researched pharmacological management strategies for PCOS.

While these strategies have been shown to be clinically effective, pharmacological management is personal and unique to each individual ². Each individual may have different goals and symptoms they aim to tackle, requiring different management strategies ². Beyond this, certain harmful side effects may be present in some individuals and not others, which is why consulting with a physician is of utmost importance ². Management for PCOS is not a one-size-fits-all solution.

Combined Oral Contraceptive Pill (COCP)

The combined oral contraceptive pill (COCP) is typically the first-line treatment for most individuals with PCOS, as the drug alleviates symptoms of irregular menstruation and hyperandrogenism (hirsutism, acne, etc.) ². The COCP improves symptoms through multiple pathways that are impaired in those with PCOS: inhibition of excess androgen production in the ovaries, increased production of sex-hormone binding globulin, and general anti-androgenic effects ². COCP formulations with low-dose estrogen are generally preferred to those with high-dose of estrogen as an additional dosage does not yield increased clinical benefits ². It is important to note that COCPs are prescribed to patients who want to control symptoms of irregular periods and hyperandrogenism, not as a cure for PCOS ².

Metformin

Metformin is used to treat metabolic effects (e.g., insulin resistance and weight gain) associated with PCOS ². The drug works by improving insulin sensitivity in the liver and peripheral tissues, which reduces hepatic glucose production². Studies have shown metformin to reduce body weight, improve metabolic parameters such as blood glucose concentrations and lipid profiles, and re-establish a regular menstrual cycle ². Metformin is typically prescribed alongside significant lifestyle changes such as increased daily low-impact physical activity and diet changes.

GLP-1 Receptor Agonists

Considering the novelty of GLP-1 receptor agonists, there is limited research tied to their efficacy in individuals with PCOS ². However, given the nature of both PCOS and GLP-1 receptor agonists, there is evidence that the drug can be considered to manage symptoms of weight gain and insulin resistance present in affected individuals ². GLP-1 receptor agonists are tied to adverse gastrointestinal symptoms and are not suitable for long-term usage ².