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Treatment is aimed at goals, not at the condition

The question that makes any PCOS prescription make sense: what is this aimed at?

Lesson 3 of 5

13 min Text

What this lesson says

  • There are four separate goals and treatment for one is not treatment for another
  • A combined hormonal contraceptive addresses cycles and skin, and is also contraception
  • Anti-androgens require reliable contraception alongside them
  • Metformin is aimed at how the body handles insulin and is judged over months
  • Goals change over time, and so should the plan

This is general education. It is not advice about your own situation, and it does not replace seeing a clinician.

Written lesson.
  1. 1. There is no treatment for PCOS as a whole. There are treatments for specific goals, and confusion about which goal a prescription is aimed at is the commonest reason women feel their treatment is not working.
  2. 2. The four goals are: making cycles regular and protecting the lining of the womb; managing acne and unwanted hair; looking after metabolic health, including blood sugar and blood pressure; and, when it is wanted, helping ovulation in order to conceive.
  3. 3. A combined hormonal contraceptive is commonly used for the first two. It does not treat the underlying condition and it does not help you conceive — while you take it, you are also using contraception, which is the point of it. Anti-androgen medicines for skin and hair need reliable contraception alongside them, because they can harm a developing pregnancy; that is the first thing to settle before starting one, not a footnote.
  4. 4. Metformin is aimed at how the body handles insulin and glucose. It is judged over months rather than weeks, and it is not a weight-loss drug even though weight sometimes changes on it. Ovulation induction, for conceiving, is a separate thing again.
  5. 5. There is also a reason behind making cycles regular that is easy to miss: going many months without a bleed can leave the lining of the womb thickened over time, and inducing a regular bleed protects against that. If that is why something was prescribed, knowing it changes how seriously you take it.
  6. 6. So the single most useful question to take to your next appointment is: what is this aimed at, and how will we know whether it is working? Goals also change — the plan that suited you at twenty-two when cycles were the problem is not the plan for the year you want to conceive.

All lessons in this course

  1. 1 What PCOS is, and what the name gets wrong 10 min
  2. 2 How it is diagnosed, and what gets ruled out first 12 min
  3. 3 Treatment is aimed at goals, not at the condition 13 min Reading now
  4. 4 Lifestyle: what the evidence supports, and what it does not 12 min
  5. 5 Questions to take to your own clinician 8 min

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