There has been some speculation that a drug used to treat enlarged prostate and baldness in men — called finasteride (Propecia) — may be useful in women with hyperandrogenism symptoms, including hirsutism. The drug stops an enzyme called 5-alpha reductase, which converts testosterone to the more powerful dihydrotestosterone. Finasteride, however, can cause birth defects (indeed, pregnant women should not even handle crushed tablets).
If irregular and/or infrequent menstruation is a problem, birth control pills (typically incorporating estrogen and progestin) can probably get you on schedule again. During menstruation, the lining of the uterus is shed, providing protection against uterine cancer, so restoring regular periods (at least four per year) is essential. Some women may not want to take a daily medication, so a course of progestogen may be prescribed several times a year for women who are amenorrheic (absence of menstruation) to induce periods. Side effects of oral contraceptives include migraines, blood clots (especially among smokers), gallbladder disease and high blood pressure.
Infertility often is a consequence of PCOS. The first line of treatment if you have the syndrome and cannot conceive is usually an ovulation-stimulating drug called clomiphene citrate, which is sold under the brand name Clomid.
Until recently, a combination of injectable chorionic gonadotropin and gonadotropin was the next step for women who did not get pregnant using clomiphene. But this gonadotropin, in addition to being inconvenient and expensive, can lead to ovarian hyperstimulation syndrome, more common in women with PCOS, enlarged ovaries, escape of fluid into the abdomen, low blood volume and stroke.
Insulin-sensitizing drugs offer a new alternative for treating PCOS symptoms, particularly infertility, and are increasingly being prescribed if an initial course of clomiphene doesn’t result in pregnancy. These products were designed to treat Type II diabetes and are approved by the FDA for that. The class includes metformin (sold under the name Glucophage), pioglitazone (Actos) and rosiglitazone (Avandia). Clinical trials are under way that may ultimately lead to the FDA’s sanctioning them specifically for PCOS.
