The primary treatments for<unk>  include lifestyle changes and use of medications. Goals of treatment may be considered under four categories: * Lowering of insulin resistance levels * Restoration of fertility * Treatment of hirsutism or acne * Restoration of regular menstruation, and prevention of endometrial hyperplasia and endometrial cancer In each of these areas, there is considerable debate as to the optimal treatment. One of the major reasons for this is the lack of large-scale clinical trials comparing different treatments. Smaller trials tend to be less reliable and hence may produce conflicting results. General interventions that help to reduce weight or insulin resistance can be beneficial for all these aims, because they address what is believed to be the underlying cause. As<unk>  appears to cause significant emotional distress, appropriate support may be useful. Diet Where<unk>  is associated with overweight or obesity, successful weight loss is the most effective method of restoring normal ovulation/menstruation. The American Association of Clinical Endocrinologists guidelines recommend a goal of achieving 5 to 15% weight loss or more, which improves insulin resistance and all hormonal disorders. However, many women find it very difficult to achieve and sustain significant weight loss. Insulin-resistance itself can cause increased food cravings and lower energy levels which can make it difficult to lose weight on a regular weight-loss diet. A scientific review in 2013 found similar decrease in weight and body composition and improvements in pregnancy rate, menstrual regularity, ovulation, hyperandrogenism, insulin resistance, lipids, and quality of life to occur with weight loss independent of diet composition. Still, a low GI diet, in which a significant part of total carbohydrates are obtained from fruit, vegetables, and whole-grain sources, has resulted in greater menstrual regularity than a macronutrient-matched healthy diet. Vitamin D deficiency may play some role in the development of the metabolic<unk> , so treatment of any such deficiency is indicated. However, a systematic review of 2015 found no evidence that vitamin D supplementation reduced or mitigated metabolic and hormonal dysregulations in<unk> . As of 2012, interventions using dietary supplements to correct metabolic deficiencies in people with<unk>  had been tested in small, uncontrolled and nonrandomized clinical trials; the resulting data is insufficient to recommend their use. Medications Medications for<unk>  include oral contraceptives and metformin. The oral contraceptives increase sex hormone binding globulin production, which increases binding of free testosterone. This reduces the symptoms of hirsutism caused by high testosterone and regulates return to normal menstrual periods. Metformin is a medication commonly used in type 2 diabetes mellitus to reduce insulin resistance, and is used off label (in the UK, US, AU and EU) to treat insulin resistance seen in<unk> . In many cases, metformin also supports ovarian function and return to normal ovulation. Spironolactone can be used for its antiandrogenic effects, and the topical cream eflornithine can be used to reduce facial hair. A newer insulin resistance medication class, the thiazolidinediones (glitazones), have shown equivalent efficacy to metformin, but metformin has a more favorable side effect profile. The United Kingdom's National Institute for Health and Clinical Excellence recommended in 2004 that women with<unk>  and a body mass index above 25 be given metformin when other therapy has failed to produce results. Metformin may not be effective in every type of<unk> , and therefore there is some disagreement about whether it should be used as a general first line therapy. In addition to this, metformin is associated with several unpleasant side effects: including abdominal pain, metallic taste in the mouth, diarrhoea and vomiting. The use of statins in the management of underlying metabolic<unk>  remains unclear. It can be difficult to become pregnant with<unk>  because it causes irregular ovulation. Medications to induce fertility when trying to conceive include the ovulation inducer clomiphene or pulsatile leuprorelin. Metformin improves the efficacy of fertility treatment when used in combination with clomiphene. Evidence from randomised controlled trials suggests that in terms of live birth, metformin may be better than placebo, and metform plus clomiphene may be better than clomiphene alone, but that in both cases women may be more likely to experience gastrointestinal side effects with metformin. Metformin is thought to be safe to use during pregnancy (pregnancy category B in the US). A review in 2014 concluded that the use of metformin does not increase the risk of major birth defects in women treated with metformin during the first trimester. Liraglutide may reduce weight and waist circumference more than other medications. Infertility Not all women with<unk>  have difficulty becoming pregnant. But for some women with<unk> D may have difficulty getting pregnant since their body does not produce the hormones necessary for regular ovulation.<unk> D might also increase the risk of miscarriage or premature delivery. However, it is<unk> sible to have a normal pregnancy. Including medical care and a healthy lifestyle to follow. For those that do, anovulation or infrequent ovulation is a common cause and<unk>  is the main cause of anovulatory infertility. Other factors include changed levels of gonadotropins, hyperandrogenemia, and hyperinsulinemia. Like women without<unk> , women with<unk>  that are ovulating may be infertile due to other causes, such as tubal blockages due to a history of sexually transmitted diseases. For overweight anovulatory women with<unk> , weight loss and diet adjustments, especially to reduce the intake of simple carbohydrates, are associated with resumption of natural ovulation. Digital health interventions have been shown to be particularly effective in providing combined therapy to manage<unk>  through both lifestyle changes and medication. For those women that after weight loss still are anovulatory or for anovulatory lean women, then the medications letrozole and clomiphene citrate are the principal treatments used to promote ovulation. Previously, the anti-diabetes medication metformin was recommended treatment for anovulation, but it appears less effective than letrozole or clomiphene. For women not responsive to letrozole or clomiphene and diet and lifestyle modification, there are options available including assisted reproductive technology procedures such as controlled ovarian hyperstimulation with follicle-stimulating hormone (FSH) injections followed by in vitro fertilisation (IVF). Though surgery is not commonly performed, the<unk>  ovaries can be treated with a laparoscopic procedure called "ovarian drilling" (puncture of 4–10 small follicles with electrocautery, laser, or biopsy needles), which often results in either resumption of spontaneous ovulations or ovulations after adjuvant treatment with clomiphene or FSH. (Ovarian wedge resection is no longer used as much due to complications such as adhesions and the presence of frequently effective medications.) There are, however, concerns about the long-term effects of ovarian drilling on ovarian function. Mental Health Although women with<unk>  are far more likely to have depression than women without, the evidence for anti-depressant use in women with<unk>  remains inconclusive. However, the pathophysiology of depression and mental stress during<unk>  is linked to various changes including psychological changes such as high activity of pro-inflammatory markers and immune system during stress.<unk>  is associated with other mental health related conditions besides depression such as Anxiety, Bipolar disorder, and Obsessive–compulsive disorder. Hirsutism and acne When appropriate (e.g., in women of child-bearing age who require contraception), a standard contraceptive pill is frequently effective in reducing hirsutism. Progestogens such as norgestrel and levonorgestrel should be avoided due to their androgenic effects. Metformin combined with an oral contraceptive may be more effective than either metformin or the oral contraceptive on its own. Other medications with anti-androgen effects include flutamide, and spironolactone, which can give some improvement in hirsutism. Metformin can reduce hirsutism, perhaps by reducing insulin resistance, and is often used if there are other features such as insulin resistance, diabetes, or obesity that should also benefit from metformin. Eflornithine (Vaniqa) is a medication that is applied to the skin in cream form, and acts directly on the hair follicles to inhibit hair growth. It is usually applied to the face. 5-alpha reductase inhibitors (such as finasteride and dutasteride) may also be used; they work by blocking the conversion of testosterone to dihydrotestosterone (the latter of which responsible for most hair growth alterations and androgenic acne). Although these agents have shown significant efficacy in clinical trials (for oral contraceptives, in 60–100% of individuals), the reduction in hair growth may not be enough to eliminate the social embarrassment of hirsutism, or the inconvenience of plucking or shaving. Individuals vary in their response to different therapies. It is usually worth trying other medications if one does not work, but medications do not work well for all individuals. Menstrual irregularity If fertility is not the primary aim, then menstruation can usually be regulated with a contraceptive pill. The purpose of regulating menstruation, in essence, is for the woman's convenience, and perhaps her sense of well-being; there is no medical requirement for regular periods, as long as they occur sufficiently often. If a regular menstrual cycle is not desired, then therapy for an irregular cycle is not necessarily required. Most experts say that, if a menstrual bleed occurs at least every three months, then the endometrium (womb lining) is being shed sufficiently often to prevent an increased
Polycystic ovary syndrome
Hypothyroidism
Gonadotropin-resistant ovary syndrome
Hyperprolactinaemia
Functional hypothalamic amenorrhea
Congenital adrenal hyperplasia
Lactational amenorrhea
Metabolic syndrome