One option for PMOS treatments is to take a medication to target specific symptoms. It’s important to know that there are no drugs that the U.S. Food and Drug Administration has approved specifically for PMOS, she adds, meaning these options are prescribed off-label. Here are the ones you might talk about with your healthcare team:
Metformin (Fortamet)
Metformin is one of the main treatments to target insulin resistance if you have prediabetes or diabetes, including because of PMOS. The advice is controversial, but some physicians believe that PMOS always requires metformin, notes Dr. Dunaif. “There’s no reason to give every woman with PMOS metformin. It’s a good and safe drug, but there’s no point in taking it if you don’t need it,” she says. And it’s not a good way to reduce the male hormone symptoms, like excess hair growth, or as a first option for weight loss.
Spironolactone (Aldactone)
Spironolactone was originally developed as a blood pressure medication and diuretic for hormonal forms of high blood pressure (hypertension) and fluid retention. “Turns out, in high doses, it’s very good at blocking male hormones,” explains Dunaif. For that reason, it’s used to target excess hair growth, a symptom of PMOS that can be particularly embarrassing. This drug is sometimes prescribed in combination with hormonal birth control pills, which may also be used on their own (discussed below). Dunaif says these medications seem to work even better together.
Spironolactone is not safe in pregnancy, as it can cross the placenta and harm a fetus. Before prescribing this medication to a woman who is in her childbearing years, a doctor will explain this and make sure the patient is using reliable birth control.
Another note: “It takes about six months before the effect of these medications is seen on hair growth,” says David A. Ehrmann, MD, professor and director of the University of Chicago Center for PCOS in Illinois. This is because one hair growth cycle takes two to three months. “When patients don’t know that, they get frustrated when they don’t see results quickly,” he says. Talk to your doctor about what you can realistically expect and when.
Hormonal Birth Control Pills
Combination birth control pills — those with estrogen and progesterone or progestin — are frequently prescribed to women with PMOS who don’t want to get pregnant. If the main concern is irregular periods and the resulting potential health risks, this is a great option. “Birth control pills are very good for protecting the lining of the uterus in women who are chronically anovulatory,” says Dunaif.
A woman should shed this lining at least four times a year, says Dunaif. One option is to take progesterone (often called a “progesterone challenge”), though the resulting bleeding can be heavy for some women.
If a woman doesn’t want to take birth control pills, she has other options to introduce progesterone into their system, like a progesterone-releasing intrauterine device (IUD).
One complication with birth control pills is that they can make insulin resistance worse, something that would appear to be particularly harmful for women with PMOS. Insulin resistance is the hallmark of type 2 diabetes, and women with PMOS are already believed to be at a higher risk of this form of diabetes. “There’s no data to support that taking [birth control pills] increases the risk of diabetes,” says Dunaif. “This is a good therapeutic option for young women.”
Finasteride (Propecia)
Clomiphene (Clomid) or Letrozole (Femara)
With all of these options, it’s vital to emphasize that a woman will be making a choice about what’s most important to her in the moment. If a woman wants to get pregnant, she can’t also treat male hormone problems (such as excess hair growth, hair loss, or acne) simultaneously, as these are two conflicting goals. This scenario does have a bright spot: Once she does get pregnant, the high levels of estrogen in her system help suppress hair growth, notes Dunaif.
