Skip to main content
Submitted by CD on 27 November 2016
Image shows a women holding a brush with clumps of hair during PCOS

Could Polycystic Ovary Syndrome (PCOS) be the cause of your hair loss or excessive facial hair? If it isn't treated or the underlying causes not addressed, over time it can lead to infertility, diabetes and heart disease. Obstetrician & gynaecologist Dr. Chandan Dubey advises on the key treatments for PCOS:

What is the first line of treatment for most PCOS patients?

PCOS is characterised by and diagnosed when two of the following 3 features are seen in a woman:

  1. Menstrual cycles coming at intervals of longer than 35 days.
  2. Androgenic features like hirsutism (excessive facial or body hair), acne, or alopecia (hair loss) and/or lab tests showing increased levels of androgens (male hormones).
  3. Polycystic ovaries on ultrasound.

Treatment will depend on the clinical problem with which the patient presents. For PCOS, treatment has to be individualized and tailored for each patient.

  • A teenager or adolescent may be bothered only about acne and hirsutism.
  • Obesity if present aggravates all features of PCOS hence weight reduction with diet, exercise and lifestyle changes has to be stressed.
  • Cosmetic measures may also be advised like waxing, bleaching. Or more permanent treatment like epilation, laser, or electrolysis.
  • Hormones like combined pills with cyproterone acetate with or without metformin are also used as first line drugs in treatment of hirsutism and acne.
  • Period irregularities and long intervals between periods may result in subfertility and require ovulation induction with ovulation inducing drugs but the most important advice would again be weight reduction by diet and exercise.

Even a reduction of 5% of weight may be enough in itself to correct the menstrual irregularity and help in conceiving and also increase the response to ovulation drugs.

Do many patients prefer metformin because it can cause weight loss as a side-effect?

Metformin is widely used in PCOS as its basic action as an insulin sensitising agent helps to reduce the insulin resistance. This improves hirsutism, acne and also may help to regularize the menstrual cycles.

Metformin is not a drug for weight reduction but it may help in women who are on a diet and exercise regimen for weight reduction.

How important is changing one’s lifestyle? What lifestyle changes do you usually recommended?

Lifestyle changes are the first line of management for all presentations of PCOS. They include diet and exercise regimens to reduce weight in PCOS patients who are overweight or obese.

Diet should be tailored according to requirement and individualized. A dietician may need to be consulted especially if weight reduction is needed.

Related Reading: 8 Dietary Guidelines for PCOS

What treatment is best for hair loss (thinning scalp hair) due to PCOS?

Hair loss is a problem for which a dermatologist will need to be consulted. Since the problem is male pattern of balding due to androgen hormone excess pills containing antiandrogens like cyproterone acetate may help. In severe cases hair transplant or wigs may be needed.

What treatment is apt for the skin changes such as darkening and acne?

Darkening of skin is due to high levels of insulin. Weight reduction by diet and exercise and metformin may help. A dermatologist consultation may be needed. Acne in PCOS may reduce with combined oral pills containing cyproterone acetate. Weight reduction will also help. A dermatologist consultation may be needed.

What percent of PCOS patients have trouble conceiving? What are the options for a patient facing trouble with conception or infertility?

A large percentage of women with PCOS may have infertility. The first line of treatment is weight loss by diet and exercise. Even a 5% reduction may help her conceive by making her cycles regular and restoring ovulation.

The next steps are:

  • Ovulation induction drugs like clomiphene with or without metformin, letrozole, and if these don't work then gonadotrophins.
  • Laparoscopic ovarian drilling.
  • IVF, if all else fails.

What are the common complications of PCOS?

Women with PCOS are at risk of developing Type 2 diabetes, hypertension, hyperlipidemias, and cardiovascular disease. Women who are overweight and obese and have PCOS are at greater risk. They would need help from a physician, endocrinologist or cardiologist if such problems develop.

Women with PCOS who conceive are at risk of gestational diabetes and should be screened for the same.

Delayed menstrual cycles also increase the risk of endometrial hyperplasia and (thickening of endometrial lining with heavy irregular periods) and endometrial cancer.

Women with periods coming at intervals longer than 3 months need to see a gynecologist and take progesterone to induce a withdrawal bleed.

Dr. Chandan Dubey is a consultant Obstetrician & Gynaecologist at Al Zahra Hospital, Sharjah, UAE. Her field of specialisation is gynaecological laparoscopic surgery.

Changed
16/Sep/2019

Stories

  • "Stress And Hypertension Are The Biggest Enemies"
    Atul Garg*, 31 has been battling Type I Diabetes for last 8 years and has understood how important it is to lead a disciplined life to be able to keep the diabetes in check.  Please tell us a bit about your condition I am an insulin dependent Type 1 diabetic. I have been diagnosed with Type1 diabetes at the age of 23 What were the early symptoms? Feeling thirsty, frequent urination, weight loss, hunger, skin turning blackish, tiredness etc. Is there a history of diabetes (Type 1 or 2)…
  • Image of a heart with the text HYPERTENSION wrapped in a blood pressure monitor held by a physician
    Can I Exercise If I Have Hypertension?
    While exercise is one of the best ways to manage hypertension, there are are some precautions you must take while exercising if you have High Blood Pressure.   Exercise is the best way to lower blood pressure and is highly recommended by doctors for people with Hypertension (high blood pressure). Exercises help the heart pump blood more efficiently thereby decreasing the strain on the arteries and lowering the blood pressure. Exercising also aids in increasing energy levels and…
  • A person using a blood pressure monitor
    10 Travel Tips for Persons with Hypertension
    Millions of people with hypertension travel for holiday or work.  Whether you are a frequent traveler or an occasional traveler, it is important to follow certain guidelines to avoid potential complications, especially for airline travel.   1.   Get a check-up A regular check-up with your primary doctor along with vital tests should be ideally done before you book any holiday. Discuss any and all health concerns and make sure you are fit to travel. Update or take any…
  • A man sleeping with a CPAP machine attached to his face
    How I Fixed My Sleep Apnea Problem
    Rohan Kapoor*, 42 from Delhi has been dealing with Obstructive Sleep Apnea disorder for last fifteen years, and uses a CPAP machine to get undisturbed sleep. Please tell us a bit about your condition I have been living with Obstructive Sleep Apnea (OSA) since 2004, when it was diagnosed through a Sleep test. I use a CPAP machine to help me sleep and manage my condition fairly successfully because of the device. हिंदी में पढ़ें: मैंने अपनी स्लीप एपनिया समस्या को कैसे ठीक किया What were the…
  • Stock pic of a doctor in a white coat measuring the BP of a patient whose arm has a BP monitor band
    Less Than 10% Indians Have Blood Pressure Under Control
    In an interview with PatientsEngage,  Dr Dorairaj Prabhakaran, Vice President – Research and Policy, PHFI and one of the main authors of the study answers questions on the findngs and implications of population based study on Hypertension in India. The Silent Killer or Hypertension continues to strike us with an estimated 10.8% of all deaths, which equates to 9.4 million deaths each year worldwide1. These are the statistics from the study published by Nature’s Journal of Human…
  • Ragi Veg Tart - A Diabetes Friendly Recipe
    Most tarts are made from refined flour (maida) and often are loaded with sugar or cheese. Here is a recipe with a difference - good for everyone, especially people with diabetes contributed by Diabetes Awareness and You Serves:    4 Ingredients for Ragi Veg Tart Ragi (millet) flour:  100gm Wheat flour: 2 Tbsp Mix veg ( tricolour bellpepper, broccoli, Cabbage):  1 ⅟₂cup                      Green chilli :  1 pc Onion…
  • What Is Diabetes Distress And How to Handle It
    Managing your diabetes can seem like a never ending task that leaves you emotionally drained. Dr. Indu Elizabeth Mathew, Consultant, Department of Endocrinology, Ernakulam Medical Centre talks of the concept of Diabetes Distress and how it affects Type 1 and Type 2 patients and their family members and what they can do about it. Updated on 24 March 2019 with the Diabetes Distress Study Details What is Diabetes Distress? Are there different types of distress and worry that affect people with…
  • A bespectacled woman in a brown dress and white dupatta sitting on a sofa
    When New Age Medical Strides Saved My Mother
    Rehan Issa, son of Badar, recounts how the family took a bold decision to let his mother to be the first patient for a cutting-edge technique to cure her diseased heart valve. Read the build-up to the critical operation. It was November, 2017. My 83-year-old mother, Badar Issa, was going for a critical operation. Her heart valve was severely damaged and had to be replaced. Chances of survival were 50 per cent. The doctor had summoned all family members to be present for the operation. It could…
  • A doctor discussing a heart options with a patient
    New Heart Valve Procedures Safe for Seniors
    Dr. Snehil Mishra, Consultant Cardiologist, Hinduja Healthcare, gives us an overview of aortic stenosis predominantly a disease of the elderly and how TAVI has revolutionised treatment of heart valve disease. Stenosis of the aortic valve is a common type of valvular heart disease in the elderly. What is aortic valve stenosis? Aortic stenosis is a disease of one of the 4 major valves in the heart- the aortic valve. If the valve does not open fully, it will obstruct or restrict the flow of blood…
  • Pregnancy and Diabetes
    Dr Kanika Chaudhuri, practicing consultant Obstetrician and Gynaecologist, Singapore talks of the Risks of Gestational Diabetes and how to control diabetes before, during and after pregnancy As the age of childbirth goes up due to changing demographics, we are seeing more patients with pre-existing diabetes and the incidence of Gestational diabetes mellitus (diabetes developing in pregnant women) is also on the rise. Both these conditions need multi-disciplinary management to…