Question for Betty.
 

I am 35 and was diagnosed with severe PCOS 10 years ago.  I have been on birth control pills for hormonal control since I was 12.  I don't have a period at all without them (once went almost 2 years without a period).  I am now looking for a long-term non-daily option for hormonal control and was considering the Mirena IUD.  Is this a good option?  Even with the normal BC pills I have trouble with weight loss and excess body and facial hair.

 
Betty's Answer.
 

 

Thank you for the great question, which involves multiple treatment options.  You may want to discuss these options for dealing with PCOS, Polycystic ovary syndrome, with your health care provider. Both the Mirena IUD and the Implanon implant, have progestin, but not estrogen.  This will not reduce the hirsuitism or acne, which some women may have.

In general, treatment for PCOS depends on a woman's goals.  The use of estrogen-progestin oral contraceptives is to decrease the androgen excess which may cause hirsutism (excessive hair) and acne.  Combined oral contraceptives are also used for endometrial protection: chronic anovulation seen in PCOS is associated with increased risk of endometrial hyperplasia (a build-up in the lining of the uterus), dysfunctional uterine bleeding (heavy or irregular bleeding) and possibly endometrial cancer (from the continual hyperplasia).

You also may want to discuss with your health care provider, further treatment for hirsuitism with spironolactone, an antiandrogen.

The approach to obesity management is the same as that for patients without PCOS, starting with lifestyle changes (diet and exercise).  Modest weight loss in women with PCOS may result in restoration of a normal ovulatory cycle. Any treatment that reduces insulin levels in both obese and lean women with PCOS may have beneficial effects.  These include a fall in ovarian androgen secretion and an improvement in cyclic pituitary-ovarian function, which may reduce hair growth and restore menstrual regularity.

Further information on this and other topics is available at, www.uptodate.com/patients

Be sure to make an appointment to discuss this information with your health care provider.