The menstrual dysfunction in PCOS is characterized by oligo- or amenorrhea
, and therefore, infrequent or absent ovulation.
Many women with PCOS do not ovulate regularly, and it may take these women longer to become pregnant. An infertility
evaluation is often recommended after 6 to 12 months of trying to become pregnant
The primary treatment for women who are unable to become pregnant and who have PCOS is weight loss
. Even a modest amount of weight loss may allow the woman to begin ovulating normally. In addition, weight loss can improve the effectiveness of other infertility treatments.
is an oral medication that stimulates the ovaries to release one or more eggs. It triggers ovulation in about 80 percent of women with PCOS, and about 50 percent of these women will become pregnant.
A few studies have shown that taking metformin
in addition to clomiphene increases the rate of ovulation; other studies have shown no additional benefit of adding metformin to clomiphene treatment. In addition, it is not clear if metformin is safe during pregnancy
(but metformin is FDA category B in pregnancy, which is generally interpreted as reasonably safe); women who take metformin before pregnancy are usually advised to stop it once they become pregnant.
If a woman does not ovulate or is unable to conceive with clomiphene, gonadotropin
therapy (FSH injections) may be recommended.