What is the best way to treat polycystic ovary syndrome (PCOS)?
—Smitha Manoj, MD, Metuchen, N.J.

Women with PCOS suffer chronic anovulation and hyperandrogenism. Most PCOS patients are obese, and losing weight through dietary changes and exercise helps restore ovulatory cycles and decrease insulin resistance. If women with PCOS wish to conceive and do not lose weight, ovulation can usually be induced with clomiphene citrate, metformin, or a combination of these agents. If conception is not desired, use of an oral contraceptive containing an antiandrogenic progestin will decrease such androgenic effects as acne and hirsutism, restore regular cyclic bleeding, and reduce the risk of developing endometrial hyperplasia and adenocarcinoma of the endometrium. The risk of developing these endometrial changes is increased when ovulation does not occur because the proliferative effect of endogenous estrogen upon the endometrium is not opposed by progesterone.
—Daniel R. Mishell Jr, MD (118-4)