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There is no one-size-fits-all treatment for PCOS. What makes sense depends above all on one question: is there a current wish to have children or not? One thing, however, applies to everyone.
The basis for everyone. A healthy lifestyle is the most effective foundation. Even a modest weight loss of about 5 to 10 percent can clearly improve the cycle, ovulation and symptoms if you are overweight. Exercise and a balanced diet also help independently of weight.
Without a current wish to have children. Here the aim is to regulate the cycle, protect the lining of the womb and ease androgenic symptoms such as acne or excess hair. For this, above all the pill (combined hormonal preparations), if needed anti-androgenic medicines, and depending on the metabolic situation metformin come into question. More on this in the next section.
With a wish to have children. Here ovulation is the focus. Often weight optimisation alone helps. If that is not enough, ovulation can be stimulated with medication, today usually with the active substance letrozole as first choice (off-label in Germany), sometimes in combination with metformin. The pill is of course not an option here, since it prevents pregnancy. Fertility treatment belongs in specialist hands.
Many people ask this question, and the honest answer is: it depends on your goal. Metformin and the pill serve different purposes and are not a simple either-or.
| The pill (combined hormonal preparations) | Metformin | |
|---|---|---|
| Mainly for | regulates the cycle, protects the lining of the womb, eases androgenic symptoms (acne, excess hair) | acts on insulin resistance, can favourably influence metabolism and weight, sometimes more regular cycles |
| When trying to conceive | not suitable, as it prevents pregnancy | possible, sometimes used to support ovulation and metabolism (off-label in Germany) |
| Downsides and side effects | its own risks (for example thrombosis) and contraindications; does not act directly on insulin resistance | above all gastrointestinal symptoms at the start; not a contraceptive; does not act directly on skin and hair |
| Often sensible when | there is no wish to have children and androgenic symptoms are in the foreground | there is a clear insulin resistance or metabolic problems, often as an addition |
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In short: if there is no wish to have children and you are mainly bothered by your cycle, acne or excess hair, the pill is often the first choice, also because it protects the lining of the womb. If it is more about metabolism, insulin resistance or a wish to have children, metformin plays to its strengths. A combination is often sensible too. What suits you best you decide together with your doctor, depending on your goal, symptoms and metabolic situation.
Stay on track with your therapy.
Whether a daily pill or metformin: brite reminds you reliably to take it, helps you record your cycle and symptoms, and checks for interactions. So you can see what is changing and have everything ready for your appointment.
Get started for freeAn appointment at a gynaecology practice is sensible if your cycle is irregular or absent over a longer period, if signs of too many male hormones appear (excess hair, acne, hair loss) or if a wish to have children is not being fulfilled. An early work-up helps to ease symptoms and keep an eye on long-term risks.
Whether a daily tablet or the question of interactions: brite helps you support your treatment in everyday life and keep the overview.
The criteria by which PCOS is determined. At least two of three points must be met: a disturbed cycle, signs of too many male hormones and polycystic ovaries on ultrasound (or a raised AMH). Other causes must be excluded.
No. Two of the three criteria are enough. Besides, the “cysts” are not true cysts but immature follicles. Some women have PCOS without notable ovaries on ultrasound.
PCOS cannot be fully cured so far. But it can be treated well, and many symptoms improve clearly, for example through lifestyle, the right medication and targeted therapy.
Yes. PCOS is a common cause of an unfulfilled wish to have children, but many women do get pregnant, often after weight optimisation and, if needed, with medication to support ovulation.
It depends on the goal. The pill regulates the cycle and eases androgenic symptoms when there is no wish to have children. Metformin acts on insulin resistance and is compatible with a wish to have children. Sometimes they are combined.
Yes. Even a modest weight loss of about 5 to 10 percent can clearly improve the cycle, ovulation and symptoms if you are overweight. Exercise also helps independently of weight.
No. PCOS also affects slim women. Excess weight can intensify the symptoms, but it is not a precondition for the condition.
Above all an increased risk of type 2 diabetes and metabolic problems. With a cycle that is absent for a long time, the lining of the womb needs protection. Regular medical check-ups are therefore sensible.
