Pediatric Polycystic Ovarian Syndrome Treatment & Management

  • Author: Robert J Ferry Jr, MD; Chief Editor: Stephen Kemp, MD, PhD   more...
 
Updated: Apr 27, 2010
 

Medical Care

Medical therapy in patients with polycystic ovarian syndrome (PCOS) is used to treat menstrual dysfunction, manifestations of hyperandrogenism, infertility,[6] and insulin resistance. The Endocrine Society published its clinical practice guideline in April 2008.[7]

First-line medical therapy usually consists of an oral contraceptive to suppress ovarian androgen production and induce regular menses. If symptoms such as hirsutism are not sufficiently alleviated, an androgen-blocking agent may be added (see Medications).

Metformin has been successfully used in clinical trials;[8] however, data are insufficient as yet to recommend this agent to all women with polycystic ovarian syndrome. One study concluded that the use of metformin throughout pregnancy was associated with a 9-fold decrease in gestational diabetes in women with polycystic ovarian syndrome.[9] A long-term study suggested that metformin continued to improve the metabolic profile of women with polycystic ovarian syndrome over a 36-month treatment course, particularly improving circulating high-density lipoprotein (HDL) cholesterol, diastolic blood pressure, and body mass index (BMI).[10]

If the patient has concomitant adrenal hyperandrogenism, treatment with low dose prednisone or dexamethasone may be considered.

Depot leuprolide acetate (Lupron) is effective in suppressing ovarian hormone production, which effectively induces menopause; therefore, this drug must be accompanied by hormone replacement therapy. This treatment approach has not gained widespread favor.

Several medications, including benzoyl peroxide, Retin-A, and topical and oral antibiotics, are effective for acne treatment.

If the patient develops type 2 diabetes mellitus, consider treatment with oral antihyperglycemic drugs, such as metformin. Clinical trials have recently shown that metformin can effectively reduce androgens, improve insulin sensitivity, and facilitate weight loss in patients with polycystic ovarian syndrome as early as adolescence.[11, 12]

The patient may desire mechanical removal of excess hair. Options include electrolysis, waxing, bleaching, tweezing, depilatories, shaving, and laser removal.

Clomiphene citrate is used to stimulate ovulation when fertility is desired. Other approaches use gonadotropin-releasing hormone (GnRH) analogues in combination with pulsatile luteinizing hormone (LH)-releasing hormone (LHRH) treatment.

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Surgical Care

Ovarian wedge resection was formerly considered an effective treatment for polycystic ovarian syndrome. Since the advent of hormonal therapies, this treatment is not often used but may be effective in alleviating ovarian dysfunction. Laparoscopic "ovarian drilling" is now performed.

If desired, clitoromegaly may be corrected with surgery.

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Consultations

Consultation with an endocrinologist is necessary for performing an adrenocorticotropic hormone (ACTH) stimulation test or for other causes of menstrual irregularity such as thyroid disease or pituitary adenoma.

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Diet

Nutritional counseling that addresses obesity and dyslipidemia is an important aspect of medical management. Weight loss may help to decrease insulin resistance and also may decrease adverse long-term cardiovascular effects.

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Activity

Discourage smoking because of increased risk of cardiovascular disease.

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Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Robert J Ferry Jr, MD  Chief, Division of Pediatric Endocrinology and Metabolism, Le Bonheur Children's Hospital; Professor, Department of Pediatrics, University of Tennessee Health Science Center at Memphis; St. Jude Children's Research Hospital, Memphis, TN; Brigade Surgeon, 36th Sustainment Brigade, U.S. Army; Adjunct Professor, Pediatric Surgery Department, King Saud University, Riyadh, Saudi Arabia

Robert J Ferry Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, Society for Pediatric Research, and Texas Pediatric Society

Disclosure: Nutropin Speakers Bureau Honoraria Speaking and teaching; Genotropin Speakers Bureau Honoraria Speaking and teaching; Eli Lilly & Co. Grant/research funds Independent contractor; MacroGenics, Inc. Grant/research funds Independent contractor; Ipsen, S.A. (formerly Tercica, Inc.) Grant/research funds Independent contractor; NovoNordisk SA Grant/research funds Independent contractor; Diamyd Independent contractor

Specialty Editor Board

Phyllis W Speiser, MD  Chief, Division of Pediatric Endocrinology, The Children's Hospital, North Shore LIJ Health System; Professor of Pediatrics, New York University School of Medicine

Phyllis W Speiser, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Lynne Lipton Levitsky, MD  Chief, Pediatric Endocrine Unit, Massachusetts General Hospital; Associate Professor of Pediatrics, Harvard Medical School

Lynne Lipton Levitsky, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Diabetes Association, American Pediatric Society, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Pfizer Grant/research funds P.I.; Tercica Grant/research funds PI, also occasional consultant

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD  Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital

Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

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Longitudinal transabdominal ultrasonogram of an ovary. This image reveals multiple peripheral follicles.
 
 
 
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