PCOS care depends on what you want to change. Some people want regular periods. Others want help with acne or extra hair, or want to get pregnant. Your clinician can match options to your goals, your health and your plans for pregnancy.

femio provides health information for learning and planning. Nothing on this page is medical advice or an instruction to start, stop or change a medicine. Every option here is something to discuss with your clinician.

Options for irregular periods

The 2023 international PCOS guideline says a combined pill could be recommended for adults with PCOS who have irregular periods or extra hair. A combined pill is a hormone pill with two hormones. It is also a form of contraception, so clinicians talk that through as part of the choice. The NHS also lists other hormone options for periods, such as a progestogen-only pill or a hormone coil (IUS).

The World Health Organization (WHO) says combined pills can help regulate the menstrual cycle. They may also reduce acne or excess hair. WHO says treatment choices should be a shared decision between you and your clinician.

Tell your clinician if you are trying to get pregnant. This changes which options make sense.

Options for blood sugar and metabolic health

The guideline says metformin may be considered for some adults with PCOS, mainly for metabolic health. That means things like insulin resistance, blood sugar and blood fats. See the insulin resistance guide for what metformin is and its side effects.

Some people ask about weight medicines. The guideline says these may be considered alongside healthy habits. It says effective contraception is needed while taking them, if pregnancy is possible, because there is not enough safety data in pregnancy. Any weight goal is your choice, made with your clinician. See the lifestyle and weight guide.

Options when you want to get pregnant

Ovulation induction means using medicine to help the ovaries release an egg. The guideline describes these steps for people with PCOS who do not release eggs regularly and have no other fertility problem:

• Letrozole is the guideline's first-choice medicine for ovulation induction. The guideline notes that letrozole is still used "off-label" in many countries. This means it is not formally licensed for this use there. Availability depends on where you live.
• Clomifene (also spelled clomiphene) is an older tablet. The guideline prefers letrozole over clomifene. Clomifene may also be combined with metformin.
• Metformin alone could be used in some cases. The guideline prefers clomifene over metformin alone for this goal.
• Gonadotrophins are hormone medicines that help the ovaries release an egg, the NHS says. The guideline sees them as a second step if tablets have not worked.
• Keyhole ovarian surgery is another second step, for some people whose ovaries did not respond to clomifene. The NHS says it uses heat or a laser on part of the ovary, which may help eggs be released.
• IVF (in vitro fertilisation) is a third step if earlier options have not worked. In IVF, eggs are fertilised with sperm in a laboratory. The embryo is then placed in the womb (uterus), the NHS says. The guideline says putting back one embryo at a time lowers the chance of twins or more.

The NHS PCOS page names clomifene for fertility and does not mention letrozole. Guidance differs between countries and changes over time. Ask which guideline your clinic follows.

Before any ovulation medicine, the guideline says pregnancy should be ruled out. It also lists folate, a B vitamin, as part of planning a pregnancy. Some people need a higher amount, so ask your clinician what is right for you. The guideline also says a sugar drink test (OGTT) should be offered when you plan a pregnancy or fertility treatment. See PCOS and fertility for more.

Options for extra hair and acne

The guideline says the combined pill can be used for extra hair, and may be preferred over metformin for that goal.

If the pill or hair removal has not helped enough after at least six months, the guideline says anti-androgen medicines may be considered. Anti-androgens block some effects of "male-type" hormones. The NHS names spironolactone as one example. The guideline says anti-androgens are used together with effective contraception if pregnancy is possible.

Laser or light treatment may be considered for extra hair on the face, the guideline says. People with PCOS may need more sessions. The NHS also lists shaving, waxing, hair removal creams and electrolysis.

For acne, the NHS lists prescription creams or gels, and tablets such as antibiotics or the combined pill. A pharmacist can also advise on creams you can buy. Ask which option suits your skin and health.

Supplements and other choices

Inositol is a supplement. The guideline says it may be considered based on your own preferences and values. It has limited harm, but limited benefit for ovulation, extra hair or weight. The guideline cannot yet recommend a specific type or amount.

Do not start a supplement because of an online article. Talk to your clinician first, especially if you take other medicines.

When to see a doctor

If your periods are irregular or missing and you want to get pregnant, you do not need to wait a year. The American Society for Reproductive Medicine (ASRM) says fertility tests should start without delay for irregular cycles or missing periods. See when to seek fertility help.

Consider a clinical review if you have gone 3 months without a period. If your cycles were already irregular, guidance also defines 6 months without a period as needing a check. Seek advice sooner if pregnancy is possible or symptoms worry you.

Book a visit if acne, hair changes or mood affect your daily life, work or relationships. The NHS uses this same test for when to see a GP.

Ask for a review if a plan is not helping, if side effects worry you, or if you are trying to get pregnant without success.

Questions to ask your clinician

• Which goal should we focus on first?
• Which option fits that goal, and why?
• Is letrozole an option where I live?
• Which options would you suggest if I am not trying to get pregnant?
• What side effects should I watch for with each option?
• Do I need any tests before we start?
• When will we review how it is working?

What femio does and does not do. femio helps you record cycles, hair and skin changes, and questions for your clinician. femio does not recommend, choose or dose any medicine, and it does not treat PCOS. This page explains options a clinician may discuss. It is not a plan.