Can PCOS Be Treated? Here’s What Works

This episode is a re‑air and the final (and longest) episode in my 3‑part PCOS series. If you haven’t listened to the first two episodes yet, I highly recommend starting there so this one makes even more sense.

In this episode, I focus on treatment — how we manage PCOS symptoms, support weight loss, and help with getting pregnant.

I briefly recap what PCOS really is: a hormonal mix‑up that affects ovulation and insulin resistance. That’s what leads to irregular, heavy, or absent periods, acne, excess facial or body hair, scalp hair thinning, weight gain, and fertility challenges.

Treatment depends on your goals.

If you’re not trying to get pregnant, I explain how combined hormonal birth control works by quieting the ovaries, lowering testosterone, improving acne, helping regulate bleeding, and sometimes even improving insulin resistance. (Keep in mind, it prevents new hair growth but won’t remove existing hair or scars.)

If you are trying to conceive, we talk about options like:

• Lifestyle changes and even modest weight loss (5–10%)
• Ovulation medications like clomiphene or letrozole
• Injectable fertility treatments with ultrasound monitoring

I also explain why AMH levels are often high in PCOS and why fertility success rates are generally very good with treatment.

A big part of this conversation is insulin resistance. I walk through medications like:

• Metformin — effective, affordable, generally safe (including in pregnancy), with manageable side effects
• GLP‑1 medications — more powerful for weight loss but expensive, weight often returns after stopping, and pregnancy safety is still unclear (so birth control is recommended while using them)

If you’ve been feeling overwhelmed by PCOS, this episode pulls everything together and walks through your real‑world options.

Transcript

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Welcome to Gyno Info, Frank Talk with Dr. Berkey, the podcast dedicated to teaching everyday women what they need to know about their body and how it works, to successfully deal with the healthcare system and communicate with their doctors. Each week, I'll provide you with new information and practical tips about gynecology and women's health care. I want to prepare you for your doctor's appointments by teaching you what to expect, what information your doctor will need to know from you, and what questions you will need and should ask her so you can be confident and make the most out of every visit. GyneInfo will give you the knowledge you need to take charge of your health and do this in a clear and frank way that you can understand without having a medical degree, one episode at a time. So now let's begin. Hello. Welcome back to Gyno Info, the podcast about women's health in normal, everyday language that normal, everyday people can understand. No special medical words and certainly no doctor speak. A special welcome to those who just discovered us and are listening for the first time. Please take a moment now and subscribe to GynoInfo. It will make it easier getting back to this episode in case you have to interrupt in the middle and would like to finish the podcast later on. The same episode might not show up in your feed anytime soon. Josh and I decided to slow down our GynoInfo podcast a little bit over the summer and run a new episode only every other week. Then my only sister died at the beginning of July, and as you can imagine, that sapped my strength a whole lot. Grieving is hard work and leaves you exhausted. And I'm not quite ready yet to research a lot of new topics for you right now. So this week we're going to rerun three episodes on PCOS polycystic ovary syndrome that we had produced last February. Each of these three episodes deals with a different problem caused by PCOS, from too much facial hair and acne to insulin resistance and not being able to lose weight to being unable to have children. The good news is that all these issues can nowadays be dealt with quite effectively, and women with PCOS can get better skin, lose weight, and have babies. I strongly suggest that you watch all three episodes and that you do it on YouTube so you can see all the interesting slides, including the one on how polycystic ovaries actually look like on an ultrasound. So here's the second run of my three PCOS episodes. Enjoy them, learn from them, and please share it around to all women who you know might be suffering from PMS. So here is the second run of my third PCOS episode. Enjoy it, learn from it, and please share it around to all women you know who might be suffering from PCOS. Hello, welcome back to GynoInfo, the podcast about women's health in normal, everyday language that normal, everyday people can understand. Today I'm going to talk about polycystic ovary syndrome, PCOS, how to treat the symptoms, and also especially how women with PCOS can lose weight and can get pregnant. It will be the last podcast on PCOS, but also the longest one. I tried very hard to avoid having to do a fourth one, but still manage to say all I think you should know about polycystic ovary syndrome. After all, as I said before, it is a problem that affects about one in ten women. It is a really important topic to talk about. First, just a quick reminder about what PCOS is. It is a mix-up, a disturbance in the normal functioning of the ovaries, whose main function is to produce eggs, and it is a mix-up with the various hormones that go along with that egg production. But it is also a mix-up in a different system in the body, the hormone system that deals with the sugars you eat and whether those get turned into energy or get turned into fat. The typical symptoms that make up polycystic ovary syndrome are irregular periods, often quite heavy, or sometimes no periods at all. And the same hormonal mix-up that causes the problems with the periods also causes the problems with getting pregnant that many women with PCOS suffer from. Another classic symptom is acne, often quite severe and upsetting, sometimes leaving deep scars. This is caused by abnormally high levels of male hormones of testosterone. Also caused by too much testosterone are loss of hair on the head and growth of too much thick and dark hair on face and body. Another problem with polycystic ovaries is the body does not process sugars correctly because of insulin resistance. This leads to severe weight gain. I have already posted two other episodes on PCOS. Episode 130 on the causes and symptoms, and episode 131 on how to make the diagnosis of polycystic ovaries and how insulin resistant that goes along with polycystic ovaries make it so incredibly hard to lose weight. I very much recommend that you take the time to watch those two episodes before you continue with the one today. It makes it much easier to understand what I'm about to explain. PCOS is at the same time very complicated, but also quite simple once you understand the different hormone systems that are mixed up in PCOS. I explained a lot of this in the other two episodes. Today I'm going to discuss what can be done about it, how to treat PCOS. So now let's assume that you studied and understand both episodes 130 and 131 and begin talking about the treatment of polycystic ovaries. The first and most important point that your healthcare provider will have to know is if you want to get pregnant or not, if you want to get pregnant right now, or if you want to get pregnant only later on. This is because the simplest way to treat polycystic ovaries, and its many different and often quite distressing symptoms, is to stop the ovaries, which are not working correctly, from working at all. In PCOS, the ovaries are swollen and stuffed with lots of little fluid-filled follicle sits, all about the same size, but none of them is able to actually become the ovulatory follicle, the follicle that makes the egg for this month. To understand all the words like ovulatory follicle that I have to use here and that I carefully explained when I first used them before, you really have to listen to the other two episodes, 130 and 131. I'm posting the same slide again here in this episode that explained the words, but to see these slides, you will just have to watch the podcast on YouTube. You can't just listen to it. All the spaces around and in between those many follicles are where the abnormally large amount of male testosterone is being made. If you stop the ovaries from doing anything at all, then the many little cysts shrivel up and go away. And when those cysts are gone, then there is much less space around and in between the cysts, and much less testosterone is being produced. When there is less testosterone, there is less acne in the skin, the dark hair in the face and on your body where you don't want it stops growing, and the hair on your head, where you do want it, stops falling out. In women, when there is less testosterone, insulin resistance usually improves too, and the body starts breaking down sugar into energy better and not turning sugars and starch in the diet into fat. Basically, what you do is telling the ovaries that they're doing it all wrong, that they're working much too hard, making too much of the wrong things, and that they should go and take a break and go for a long nap. And that you will call them back when you really need them. For instance, when you want to get pregnant. When the ovaries first wake up from their nap, they often function perfectly well. They make eggs every month, at least for a while, until they start getting mixed up again. And naturally, the time right after they wake up is the best time to try to get pregnant. One of the most effective and cheapest ways to tell the ovaries to stop working and take a nap is taking birth control pills or rings or patches that contain both estrogen and progesterone. It is the first-line treatment, the treatment of choice for women with polycystic ovaries who are not currently trying to get pregnant, who are not trying to get pregnant right now. When the brain notices that there is estrogen and progesterone in the system, those are the hormones of the birth control pills, it will stop telling the ovaries to work. The brain will stop sending out FSH, follicle stimulating hormones, and LH, luteinizing hormone, the two messenger hormones the brain uses to give orders to the ovaries. I explained this in last week's podcast in more detail. When the brain doesn't tell the ovaries to work, they stop working. They go and take a nap. Then they don't make eggs, they don't make hormones, no female hormones, and no extra male hormones. This is the reason why birth control pills are so good at controlling acne. They stop the production of too much acne producing male hormones of testosterone. And this is also the reason why women with PCOS that start taking the pill usually start losing weight. Less testosterone, male hormones, less insulin resistance, better breakdown of sugars into energy rather than turning sugars into fat. One last thing about hair and acne. Unfortunately, birth control pills, in fact, all treatments that lower male hormone productions by the ovaries only slow down growing of new extra hair. The dark hair in your face and forearms and chest and belly that you already have will not go away. At most, it will get less thick and grow slower, but it will need to be removed with special treatments such as laser treatments that I will discuss in another podcast. Also, while the acne will get much better, the acne scars will stay. This is why the treatment for polycystic ovaries, which often starts in teenagers, should be started early, before extra hair, before acne scars, and before extra weight has a chance to develop. Earm's control pills really are the first choice for treatment of polycystic ovaries in women who are not currently trying to get pregnant. Unless, of course, they have contraindications, reasons why they cannot take the pill, such as genetic blood clotting disorders or severe migraines with neurological symptoms. I have talked about the risks, but mostly also the benefits, good things that go along with taking birth control pills in several of my earlier podcasts. And if you're interested, you should just scroll through the list and find them. For women who do want to get pregnant, the treatment will be different, of course. But the principle is the same. First, you need to force the ovaries to shrink all the extra follicles that are so typical of polycystic ovary syndrome. Only after these extra follicles are shrunk, a dominant ovulatory follicle can develop and produce an egg. I explained all about ovulatory follicles and how they work in episodes 130. Pushing the ovaries to shrink all the extra many, many, many follicles so they can make eggs again to ovulate is done by fertility treatments with medications that are stronger and work faster than birth control pills. Though if money is an issue, it is perfectly reasonable and often quite effective to take birth control pills, let's say, for half a year and then see what happens. As I said before, when polycystic ovaries that have been suppressed for a while with birth control pills first wake up, they often work just fine for a few months. That is your best chance to get pregnant right after you stop the pill. Especially if you use those months on the pill to go on a strict low-carb diet and a major exercise program and manage to lose some weight. It really doesn't take that much weight loss to make a major difference. Losing just 5 to 10% of body weight will greatly improve your chances of getting pregnant. 5 to 10% would be about 10 to 15 pounds if you weigh around 170 pounds, or 4 to 8 kilos if you weigh 80 kilos. If you do go on the pills for six months, that is roughly 25 weeks, which would mean you would have to lose only about a pound every week or two, the more the better, of course. And with the pill improving your insulin resistance and helping you lose weight, this is certainly doable, especially if you really want to have a baby. And I said before, women with PCUS tend to lose weight on birth control pills. For overweight and obese women who want to get pregnant, weight loss, preferably through diet and lifestyle changes, is always a very important step in helping them to have a baby. Not the only step, but a very key step. Of course, many women with or without PCOS, especially in the US, start at much higher weights than 80 kilos and 170 pounds, more like 125 kilos and 275 pounds. For those women, the road will be harder and longer, but for them too, this situation is very far from hopeless. Especially now, when fertility treatments can be combined with medications that improve the body's response to insulin and lower insulin resistance, make it better. But these medications also work a whole lot better if they are combined with serious diet and lifestyle changes. But back to kicking the ovaries into making eggs. Two of the medications commonly used for that are clomethen and letrosol, which can be taken by mouth. Then you wait and see if after five days of either of these two medications, taken from the fifth to the ninth day of your cycle, the ovaries start up on their own and make an egg. To see if they did, you can measure progesterone in your blood, a hormone that is only produced after ovulation, if an egg was produced. If the ovaries do not kick in after those two medications and ovulate and make an egg, there is even stronger ammunition in the form of medications that have to be used as a shot available as a next step. These stronger medications are usually only prescribed at specialized fertility centers or doctors who are really specialized in fertility. The ovaries will need to be observed closely with regular ultrasound exams to see how the follicle cyst that is making the egg is growing, and then give it the sign that it should pop and release the egg, ovulate, at just the right time in the form of a specific hormone shot. It really goes beyond this podcast to go into the ins and outs of specialized fertility drugs and fertility treatments. Every woman should discuss that with her own gynecologist or fertility specialist, whether the cause of a problem getting pregnant is PCOS or something else. The main point I want to make here is that there are effective treatments available to help women with PCS become mothers. Always they involve a combination of lifestyle changes, such as diet and exercise to lose weight, which alone already improves insulin resistance, improves the functioning of the ovaries. But then you also most often need medications that help with this weight loss by treating insulin resistance specifically, plus also other medications that specifically push the ovaries into baking eggs. Having polycystic ovaries is something much more treatable than if you had ovaries that had no more follicles left by the time you're 30, such as in very early menopause or primary ovarian failure. One way of measuring how well your ovaries are going to be able to respond to fertility treatments is checking a hormone called AMH, anti-mularian hormone. You measure that in the blood. I talked about AMH in an earlier podcast on egg freezing. AMH is a measure for ovarian reserve, for how old the ovaries feel, how much fertility, how much eggs are left in them. With PCOS, the AMH level is unusually high, not low as in women with failing ovaries. PCOS ovaries can generally be made to work, and the success rate for fertility treatments is very high indeed. This is very hopeful. I want to use the rest of the time in this podcast to say a little bit more about weight gain, weight loss, and weight loss drugs in their relation to PCOS. These medications all work by fighting insulin resistance, by making the cells again respond better to insulin, making the cells open their doors wide, letting the sugar from the starches in your diet in and turn them into energy instead of fat. And because the actual needs fat to function, it will then start using up the extra fat stores in your belly and in the other places fat is stored, and you will start losing weight. There are two types of medications that push the body to again become more sensitive to insulin, medications that fight insulin resistance. The first is an old and tried and proven diabetes medication, a pill called metformin. It has been used for many years, and there are many studies showing that it often is quite effective, especially when taken together with clomophen and letrazol in pushing the ovaries into making eggs. Because its main action is to lower insulin resistance, it helps women lose weight. I use it quite successfully as a safe and effective poor woman's weight loss pill for women who develop insulin resistance as part of their midlife hormonal changes, not just in women with PCOS. A second way metformin helps with weight loss is through its main side effects: nauseousness, bloating, and diarrhea, all of which can be managed by starting the medication slowly in a low dose and gradually increase it to the dose you want to end up with. 1,000 milligrams of metformin twice a day. The side effects usually improve with time, and by then the women have already gotten used to eating smaller portions. It has also been shown that metformin is safe to be taken in pregnancy, which is important because many women will become pregnant while they are taking this medication. And so that it is safe in pregnancy, which has been shown over many years, is certainly a key point. Metformin is very cheap compared to the newer class of weight loss drugs called GLP1 agonists. These weight loss medications need to be taken as injections, as shots or jabs. One of the earliest of these medications on the market was semaglutide, sold under the name of Bagobi or Ozempic. There are now many more different brand names of these types of drugs that all work pretty much the same. They are more potent, they are stronger and more effective and work a lot faster than the older metformin. But their side effects are also much stronger. What they also have in common is that they are ungodly expensive. They have already made more money than the income of all countries for the companies that make them. And the other thing they have in common is that most people, once they stop them, gain most of their weight right back and have to start using them again, making even more money for the drug companies making them. Originally, these GLP1 agonists were designed for people with type 2 sugar diabetes. That is the form of diabetes that is not caused by not making enough insulin, but is caused by the body's resistance to that insulin. But these diabetes medications were soon being used simply to lose weight in zillions of people without diabetes. And before long, we found that overweight women with PCOS who lost large amounts of weight with these drugs, all of a sudden started ovulating and getting pregnant. Even those women who weren't actually trying to get pregnant and assumed that they could not get pregnant, they simply started ovulating again and having periods and got pregnant because they shed large amounts of weight. Now that's a little bit of a problem because not like with metformin, which we know to be safe in pregnancy from many, many years of experience using it, we don't know if these newer weight loss and insulin-resistant treatment drugs, the Vigovi types, are actually safe in pregnancy. There's some signs in animals that are pregnant that have been tested that they can cause major problems. So we just don't know yet. And all the companies that are making them recommend strongly that you use birth control while you're on these weight loss injections. We have long known that weight loss is one of the most important factors improving pregnancy chances in women with polycystic ovaries. This is how researchers actually finally figured out the vicious devil circle, the connection between weight, male hormones, insulin and insulin resistance. The whole thing is a bit a chicken and egg situation, forgive me this pun, but it is hard to know what came first, the too much weight or the polycystic ovaries making too many male hormones and causing insulin resistance. The fact is that all these things make each other worse. And anything that breaks any part of the vicious circle helps making the other parts better, whether it is weight loss or medications that make insulin resistance better, or stopping the mixed-up ovaries from working and producing the wrong hormones with birth control pills, or pushing the ovaries into ovulating again with fertility drugs. This brings me to the end of podcast three in this three-part series on polypsystic ovary syndrome on PCOS. I hope you found this force about PCOS interesting and useful. If you or any of your friends and relatives or coworkers live with PCOS, please let them know about this podcast. The more they know about PCOS, the better care they can usually negotiate for themselves. Their doctors will need to spend less time explaining what PCOS is and can spend more of their limited time discussing the best treatments for your situation. Please also take the time to subscribe to our podcast. The algorithm seems to like that and it makes it easier for more people to find us. And remember, you can send in any questions you might have or suggestions for future episode topics to questions at gynoinfo.net. Again, that's questions at gynoinfo.net. Goodbye and have a very safe week. Until next time, thank you for listening. And remember that you and your health are super important and deserve your full attention. Don't ever put off contacting your doctor because you're scared or embarrassed when something feels wrong about your body. Doctors are here to help you, not to judge you. And also, regular well-woman visits are always a good idea that you should make time for. You deserve it and you owe it to yourself, and you owe it to your body and your health. This podcast is part of Pride House Media, hosted by me, Dr. Berkey, produced and edited by Josh Rosenzweig. Original music composed by Nell Balaban. If you enjoyed this episode, please subscribe wherever you listen to podcasts. And while you're there, leave us a rating and a review. It really helps others discover the show. Stay connected and join the conversation by following me on Instagram and Facebook at gynoinfo and on LinkedIn at gyneoinfopodcast. Remember, any questions that I answer or information that I give you on this podcast are to be understood as information only, not treatment of your medical problems. While I'm a very knowledgeable gynecologist, I'm not your gynecologist who has talked to you and examined you personally and is therefore actually able to treat you. So please consult your own healthcare professional with any medical questions or concerns.