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Treatment for PCOS
Insulin Resistance
Acne
Hirsutism
Hair Loss (Androgenic Alopecia)
Insulin Resistance
Prior to 1990s PCOS was treated
by separating out the symptoms and treating each individual one.
Research has led to scientists focusing on what may be the underlying
cause of PCOS, insulin resistance. Treatment of the underlying
cause therefore benefits all aspects of PCOS rather than the
specific targeting on each symptom.
Medications that lower insulin levels in the blood may be effective
in restoring menstruation and reducing some of the health risks
associated with PCOS. It can also lead to the reduction of testosterone,
thus diminishing many of the symptoms associated with excess
testosterone: hair growth on body, alopecia (hair loss on head),
acne, obesity and cardiovascular risk.
In Australia a drug called Metformin
(Glucophage®) is now being used to treat some women with
PCOS, and research is being conducted in many states. Metformin
improves both glucose tolerance and insulin sensitivity. It is
approved by the Australian federal drug authority as a treatment
for diabetes, however is not registered as a treatment for PCOS.
Even though its not listed as a treatment for PCOS many Drs who
have read the international research will often prescribe it
to patients with PCOS. It is hoped in the next few years after
more studies are conducted that Glucophage will be a registered
treatment for PCOS.
Metformin is prescribed under
the brand name Glucophage, it is available in 500mg, and 850mg
tablets. The therapeutic dose for PCOS has been found to be around
1500mg.
Approximately 30 % of patients
started on Glucophage will experience gastrointestinal symptoms
(diarrhoea, nausea, vomiting, abdominal bloating, flatulence,
and loss of appetite). These symptoms are usually temporary (1-4
weeks) and will disappear during continued therapy. It is advisable
for new patients to initiate therapy slowly to minimize the gastrointestinal
side effects.
You can get further information
about Metformin and Insulin Resistance from the following sites:
Dr Gluek's PCOS
Website
Dr Warren Kidson's
Article: Polycystic ovary syndrome: a new direction in treatment
Internationally there are a
wider range of insulin sensitising drugs available for PCOS.
They are Pioglitazone (ACTOSÒ), Rosiglitazone (AvandiaÒ)
and Rezulin (Troglitazone).
There are also studies into
a new drug called D-Chiro Inositol (INS-1), further information
is in their latest
press
release . Information about trials and further news about
INS-1 can be found at
Insmed's
website .
Acne
There are 3 main treatments
for women suffering from acne due to PCOS, Diane-35, Spironolactone
(Aldactone) and Roaccutane. Diane-35 is an oral contraceptive
pill with an anti-androgen, cypreterone acetate. The cypreterone
acetate helps reduce the testosterone and therefore helps control
acne and hirsutism of PCOS. The amount of cypreterone acetate
in Diane-35 is quite small and if not found to be adequate to
control the acne it can be prescribed by itself or other drugs
can be used such as Roaccutane or Spironolactone. Spironolactone works very
similarly to cypreterone acetate as it is also an anti androgen,
it can be used to treat acne and hirsutism caused by high testosterone.
Roaccutane is used for severe
cases of acne. It cannot be used by women who are trying to conceive
as it can cause defects to fetuses. It is usually taken for
4-7 months and then stopped once the acne is under control. Roaccutane
works by reducing sebum production and shrinking the sebaceous
glands. Treated skin is dry, inhibiting the growth of bacteria.
It can cause a number of side effects that can be unpleasant
(extremely dry skin, eczema, increased susceptibility to sunburn,
hair loss, fragile skin etc).
Hirsuitism
Hirsuitism is
excess body hair, such as on chins, chest and necks. This hair
is different from the hair that some women have on their upper
lip, chin, breasts, stomach or the fine "baby" hair
all over their body, tending to be longer and more coarse.
Hirsuitism is
caused by hair follicles that are overly sensitive to male hormones
(called androgens), or when there are abnormally high levels
of these hormones as is the case with PCOS. Treatment is usually
various types of antiandrogens which reduce the testosterone
levels which cause the male like hair growth.
Potential treatments:
- Cosmetic Treatments
- Laser - may
cause hyperpigmentation. Most suited to pale skinned, dark haired
women.
- Electrolysis
- can cause scarring.
- Waxing/creams
- Lifestyle
- Diet - exercise
to keep weight off, and low carbohydrate diets mean less excess
insulin is produced thus reducing the amount of androgens in
the body.
- Conventional
Doctors can prescribe medicine to decrease excess hair growth.
However, depending on the medicine, it will usually takes three
to six months to work and may only decrease the amount of new
hair growth. Existing hairs may have to be removed by electrolysis
or laser.
- Metformin increases
the effectiveness of insulin at the peripheral cell level, reduces
hyperinsulinemia, and reduces hyperandrogenemia in turn, thus
correcting this biochemical domino effect by correcting it at
the source. When insulin levels drop on Metformin, PCOS patients
lose weight, drop their blood pressure, and may lose the extra
body hair (caused by high testosterone).
- Spironolactone
(Aldactone) is a powerful anti-androgen reducing body hair growth
over time and is also used to treat alopeocia. It can only be
used by women who aren't trying to conceive a baby as it can
cause defects in a developing foetus.
- Cyproterone
is another anti-androgen available, considered as effective as spironalactone. It can cause weight gain and may cause depression.
- Oral contraceptives
(Dianette/Diane 35 etc) inhibit ovarian steroid production with
consequent reduced hair growth. They contain a small amount of
the anti-androgen Cyproterone Acetate in combination with the
normal pill hormones. Their use to treat the cosmetic consequences
of PCOS is questioned in research as oral contraceptives can
cause weight gain, which could aggravate the PCO at a later stage;
they have the potential to increase the number of ovarian cysts;
and there are concerns that oral contraceptives may result in
a deterioration in glucose tolerance.
- Herbal Remedies
Saw palmetto, licorice and peony can all be prescribed in tincture
forms. Both saw palmetto and licorice have been researched properly
and found to have anti-androgenic properties. Peony is a traditional
ingredient in Chinese herbal medicine (for menstruation problems)
Copyright © by POSAA All Right Reserved. Published on: 2005-03-11 (47427 reads) [ Go Back ] |
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