Editing Polycystic ovary syndrome (section)

=== Medications ===
Medications for PCOS include [[oral contraceptives]] and [[metformin]]. The oral contraceptives increase [[sex hormone binding globulin]] production, which increases the binding of free testosterone. This reduces the symptoms of [[hirsutism]] caused by high testosterone and regulates return to normal [[menstrual periods]].<ref name=emedicine_treatment /> [[Anti-androgens]] such as [[finasteride]], [[flutamide]], [[spironolactone]], and [[bicalutamide]] do not show advantages over oral contraceptives, but could be an option for people who do not tolerate them.<ref>{{cite journal | vauthors = Alesi S, Forslund M, Melin J, Romualdi D, Peña A, Tay CT, Witchel SF, Teede H, Mousa A | title = Efficacy and safety of anti-androgens in the management of polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials | journal = eClinicalMedicine | volume = 63 | pages = 102162 | date = September 2023 | pmid = 37583655 | pmc = 10424142 | doi = 10.1016/j.eclinm.2023.102162 }}</ref> [[Finasteride]] is the only oral medication for the treatment of [[Pattern hair loss|androgenic alopecia]], that is [[Food and Drug Administration|FDA]] approved.<ref name=":2" />

Metformin is a medication commonly used in [[type 2 diabetes mellitus]] to reduce insulin resistance and is used [[Off-label use|off label]] (in the UK, US, AU, and EU) to treat insulin resistance seen in PCOS. In many cases, metformin also supports ovarian function and a return to normal ovulation.<ref name=emedicine_treatment /><ref name=Lord>{{cite journal | vauthors = Lord JM, Flight IH, Norman RJ | title = Metformin in polycystic ovary syndrome: systematic review and meta-analysis | journal = BMJ | volume = 327 | issue = 7421 | pages = 951–3 | date = October 2003 | pmid = 14576245 | pmc = 259161 | doi = 10.1136/bmj.327.7421.951 }}</ref> A newer insulin resistance medication class, the [[thiazolidinedione]]s (glitazones), have shown equivalent efficacy to metformin, but metformin has a more favorable side effect profile.<ref>{{cite journal | vauthors = Li XJ, Yu YX, Liu CQ, Zhang W, Zhang HJ, Yan B, Wang LY, Yang SY, Zhang SH | title = Metformin vs thiazolidinediones for treatment of clinical, hormonal and metabolic characteristics of polycystic ovary syndrome: a meta-analysis | journal = Clinical Endocrinology | volume = 74 | issue = 3 | pages = 332–9 | date = March 2011 | pmid = 21050251 | doi = 10.1111/j.1365-2265.2010.03917.x | s2cid = 19620846 }}</ref><ref>{{cite journal | vauthors = Grover A, Yialamas MA | title = Metformin or thiazolidinedione therapy in PCOS? | journal = Nature Reviews. Endocrinology | volume = 7 | issue = 3 | pages = 128–9 | date = March 2011 | pmid = 21283123 | doi = 10.1038/nrendo.2011.16 | s2cid = 26162421 | id = {{Gale|A250471047}} }}</ref> The United Kingdom's [[National Institute for Health and Clinical Excellence]] recommended in 2004 that women with PCOS and a [[body mass index]] above 25 be given metformin when other therapy has failed to produce results.<ref name="NICE2004">{{NICE | 11 | Fertility: assessment and treatment for people with fertility problems | 2004}}</ref><ref>{{cite web | vauthors = Balen A |title=Metformin therapy for the management of infertility in women with polycystic ovary syndrome |website=Scientific Advisory Committee Opinion Paper 13 |publisher=Royal College of Obstetricians and Gynaecologists |date=December 2008 |url=http://www.rcog.org.uk/files/rcog-corp/uploaded-files/SAC13metformin-minorrevision.pdf |access-date=13 December 2009 |url-status=dead |archive-url=https://www.webcitation.org/5m73m3kuM?url=http://www.rcog.org.uk/files/rcog-corp/uploaded-files/SAC13metformin-minorrevision.pdf |archive-date=18 December 2009 }}</ref> Metformin may not be effective in every type of PCOS, and therefore there is some disagreement about whether it should be used as a general first-line therapy.<ref name="pmid19697191">{{cite journal | vauthors = Leeman L, Acharya U | title = The use of metformin in the management of polycystic ovary syndrome and associated anovulatory infertility: the current evidence | journal = Journal of Obstetrics and Gynaecology | volume = 29 | issue = 6 | pages = 467–472 | date = August 2009 | pmid = 19697191 | doi = 10.1080/01443610902829414 | s2cid = 3339588 }}</ref> In addition to this, metformin is associated with several unpleasant side effects: including abdominal pain, metallic taste in the mouth, diarrhoea and vomiting.<ref>{{cite web |author=NICE |title=Metformin Hydrochloride |website=National Institute for Care Excellence |publisher=NICE |date=December 2018 |url=https://bnf.nice.org.uk/drug/metformin-hydrochloride.html#sideEffects |access-date=2 November 2017 |archive-date=10 June 2021 |archive-url=https://web.archive.org/web/20210610014142/https://www.nice.org.uk/bnf-uk-only#sideEffects |url-status=live }}</ref> Metformin is thought to be safe to use during pregnancy ([[pregnancy category]] B in the US).<ref>{{cite journal | vauthors = Feig DS, Moses RG | title = Metformin therapy during pregnancy: good for the goose and good for the gosling too? | journal = Diabetes Care | volume = 34 | issue = 10 | pages = 2329–30 | date = October 2011 | pmid = 21949224 | pmc = 3177745 | doi = 10.2337/dc11-1153 }}</ref> A review in 2014 concluded that the use of metformin does not increase the risk of major [[birth defect]]s in women treated with metformin during the first trimester.<ref name="CassinaDona2014">{{cite journal | vauthors = Cassina M, Donà M, Di Gianantonio E, Litta P, Clementi M | title = First-trimester exposure to metformin and risk of birth defects: a systematic review and meta-analysis | journal = Human Reproduction Update | volume = 20 | issue = 5 | pages = 656–669 | date = 1 September 2014 | pmid = 24861556 | doi = 10.1093/humupd/dmu022 | doi-access = free }}</ref> Liraglutide may reduce weight and waist circumference in people with PCOS more than other medications.<ref>{{cite journal | vauthors = Wang FF, Wu Y, Zhu YH, Ding T, Batterham RL, Qu F, Hardiman PJ | title = Pharmacologic therapy to induce weight loss in women who have obesity/overweight with polycystic ovary syndrome: a systematic review and network meta-analysis | journal = Obesity Reviews | volume = 19 | issue = 10 | pages = 1424–45 | date = October 2018 | pmid = 30066361 | doi = 10.1111/obr.12720 | s2cid = 51891552 | url = https://discovery.ucl.ac.uk/id/eprint/10050648/1/Hardiman_revised%20MS%5B23061%5D.pdf | access-date = 13 October 2021 | archive-date = 3 December 2021 | archive-url = https://web.archive.org/web/20211203131306/https://discovery.ucl.ac.uk/id/eprint/10050648/1/Hardiman_revised%20MS%5B23061%5D.pdf | url-status = live }}</ref> The use of [[statins]] in the management of underlying metabolic syndrome remains unclear.<ref name="Diagnosis and treatment of polycyst" />

It can be difficult to become pregnant with PCOS because it causes irregular [[ovulation]]. Medications to induce fertility when trying to conceive include the ovulation inducer [[clomiphene]] or pulsatile [[leuprorelin]]. Evidence from randomised controlled trials suggests that in terms of live birth, metformin may be better than placebo, and metformin plus clomiphene may be better than clomiphene alone, but that in both cases women may be more likely to experience gastrointestinal side effects with metformin.<ref>{{cite journal | vauthors = Sharpe A, Morley LC, Tang T, Norman RJ, Balen AH | title = Metformin for ovulation induction (excluding gonadotrophins) in women with polycystic ovary syndrome | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | pages = CD013505 | date = December 2019 | issue = 12 | pmid = 31845767 | pmc = 6915832 | doi = 10.1002/14651858.CD013505 }}</ref>