PCOS MEDICATION AND SUPPLEMENTS
This week’s topic is one topic I could write 10 pages on, so this is going to be a short version of it. As we have learned over the last two weeks, PCOS impacts multiple organ systems with significant metabolic and reproductive manifestations. I truly believe treatment should be individualized based on the patient’s presentation as well as their desire for pregnancy.
At my practice, I treat PCOS patients who are at various stages of their life not just for fertility purposes. There are certain aspects of their treatment that are similar but each of my patients receives an individualized plan of care including a depth educational session during our first visit. Many if not all that I have seen recently have received little to no education on the disease, what “lifestyle” changes are or how to make them, and the long-term impact this disease has.
Today I am going to lightly touch on common medications and supplements used. I want to encourage you to have a conversation with your healthcare provider about what treatment is best for you. Find one who is familiar with PCOS and is able to provide you with a well-rounded plan of care moving forward.
Oral Brith Control: We know that PCOS causes hormonal imbalances. OBC pills increase estrogen, lower testosterone, and keep your female hormones more balanced. As the level of testosterone and other androgens declines, symptoms tend to improve. Progestin-only birth control is less likely to cause side effects than combination birth control.
What do we see happen when taking? Improvement in acne, hair growth to face, cycle regulation, and more. It is important to have a discussion with your healthcare provider if birth control is the right treatment for you.
Negative of using OBC: There is discussion being had around the impact that OBC is thought to have on PCOS. For some, they may not realize they have it until they come off of OBC. Also, there is discussion on this causing issues with glucose, lipids, insulin, inflammation, and coagulation parameters. One study showed that the pill causes a 30-40 percent reduction in insulin sensitivity and also stops exercise from improving insulin sensitivity. I am interested in seeing more research on this topic
Metformin: This medication makes the body more sensitive to insulin. In turn, it can help lower elevated blood glucose levels and androgen levels. When the body is able to better respond to the insulin it makes naturally, in turn, it decreases the amount of sugar the liver makes. Also, it decreases the amount of sugar the intestines absorb from food after eating. The side effects of this medication often lead to stopping use.
Myo-Inositol & D-Chiro: This is my favorite supplement to implement with PCOS. Myo- Inositol is found in foods such as cantaloupe, oats, bran, and citrus fruits. In women with PCOS, the mechanism needed to convert inositol into its bio-available inositol is not working as it should. The mechanism this supplement has is increasing insulin sensitivity. Do you see a theme with treatment?! Myo- Inositol is produced naturally by the body but women with PCOS, tend to have lower levels of myoinositol. The exact mechanism by which inositol improves ovulation and pregnancy outcomes is not fully understood but is likely linked to glucose and insulin levels.
N-acetyl cysteine (NAC): This supplement increases the cellular levels of antioxidants. NAC is thought to improve insulin receptor activity and improve insulin secretion in response to glucose. When there is a decreased level of circulating insulin, it can lead to a significant reduction in testosterone levels and free androgen.
One study showed NAC paired with l-arginine supplements restored ovulatory cycles. NAC is also thought to protect egg quality. In addition, women with PCOS have been shown to have higher levels of oxidative stress than women without PCOS.
Vitamin D: Vitamin D is my favorite supplement for not only fertility but also overall health. This supplement helps regulates more than 200 genes in our body.
Benefits for PCOS include insulin sensitivity, assist with the maturation of follicles, follicle-stimulating hormone sensitivity, and progesterone production.
One study demonstrated Vitamin D supplementation at high doses for a period of at least 12 weeks is thought to lead to improved glucose levels, insulin sensitivity, hyperlipidemia, and overall hormonal function in PCOS women.
I encourage you to have a conversation with your healthcare provider to determine what medications and supplements are best for you.
Also Read: The Ugly Truth About Diagnosing PCOS
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