PCOS Treatment (Irregular periods/ Infertility/ Acne)

Polycystic Ovary Syndrome (PCOS) is a hormonal condition that affects ovarian function and disrupts the normal pattern of ovulation. It is commonly associated with irregular or absent periods, excess androgen levels, and the appearance of multiple small follicles on the ovaries. Over time, these hormonal imbalances can lead to subfertility, acne, unwanted hair growth, and metabolic complications such as insulin resistance.

The treatment of PCOS depends on the specific symptoms and health priorities of the patient. For women with irregular periods, the focus is on restoring a regular menstrual cycle. For those trying to conceive, ovulation support becomes a central goal. Where acne or other androgen-related symptoms are prominent, treatment targets excess hormone production and its effects on the skin. In all cases, improving insulin sensitivity and reducing long-term risks is a key part of management.

There is no single approach that works for everyone. Treatment often includes a combination of hormonal medications, ovulation-inducing agents, insulin-sensitising drugs, lifestyle changes, and nutritional support.

What are the most common treatment options for PCOS?

The treatment for PCOS is tailored to your specific symptoms and personal health goals. Some women seek help for irregular or absent periods, while others are focused on improving fertility, treating acne, or managing long-term metabolic risks. The most effective approach is usually a combination of medical therapy, lifestyle changes, and targeted support to regulate hormones, restore ovulation, and improve overall health.

Here are the main treatment options used in managing PCOS:

Treatment Option	What It Does	When It's Used	What It Includes
Hormonal Therapy	Regulates periods, reduces androgens, improves acne and hair growth	For those not trying to conceive; helps manage menstrual irregularity and skin issues	Combined oral contraceptives (COCPs), progestin-only pills
Ovulation Induction	Stimulates ovulation to support pregnancy	For women trying to conceive	Letrozole (first-line), clomiphene citrate, gonadotropins
Insulin-Sensitising Agents	Improves the body’s response to insulin, supports cycle regulation	In cases with insulin resistance or irregular cycles	Metformin, sometimes used alongside ovulation-inducing drugs
Lifestyle Modification	Supports weight management, hormonal balance, and metabolic health	Recommended for all PCOS patients	Individualised diet plans, regular physical activity, sleep and stress support
Anti-Androgens	Lowers androgen levels, improves symptoms like acne and hirsutism	When excess hair growth or acne is a concern	Spironolactone (not suitable if trying to conceive)
Dermatological Treatment	Targets acne and skin symptoms directly	For persistent acne despite hormonal regulation	Topical retinoids, benzoyl peroxide, antibiotics, or dermatology referral

How do we treat irregular periods caused by PCOS?

Irregular or missed periods are one of the most common symptoms of PCOS, usually caused by disrupted or absent ovulation. This hormonal imbalance can lead to long cycles, skipped periods, or unpredictable bleeding. In addition to affecting fertility, prolonged cycle irregularity may increase the risk of endometrial thickening or abnormal uterine bleeding. The aim of treatment is to either restore regular ovulation or induce regular menstrual bleeding to protect the uterus and improve overall hormonal rhythm. Here are the common treatment options used: 

• Lifestyle modifications — including weight management, regular exercise, and dietary changes, can help restore hormonal balance and bring back spontaneous menstruation.

• Combined oral contraceptive pills — these help regulate menstrual cycles, reduce excess androgen levels, and protect the uterine lining in women who are not trying to conceive.

• Metformin — prescribed to improve insulin sensitivity, which may help restore more regular ovulation and periods in women with insulin resistance.

• Cyclical progestin therapy — used to trigger a period every one to three months in women who do not ovulate and are unable to take oestrogen-based medications.

• Ovulation-inducing medications — support natural cycle restoration in women trying to conceive by stimulating ovulation. Letrozole is often preferred.

• If clinically significant obesity is present and fertility is not desired weight-loss drugs can be considered (contraindicated when attempting to conceive).

Can PCOS-related acne be treated effectively?

Acne in PCOS is primarily driven by elevated androgen levels, which increase oil production in the skin and lead to blocked pores and inflammation. This type of acne often appears along the jawline, chin, and lower cheeks, and tends to persist despite over-the-counter skincare. 

Effective treatment focuses on reducing androgen levels, improving skin turnover, and addressing any underlying hormonal or metabolic imbalances contributing to breakouts.

• Hormonal contraceptives — help lower circulating androgens and reduce acne flare-ups in women who are not planning to conceive. Combined oral contraceptives are typically the first-line option for hormone-related skin issues.

• Anti-androgen medications — such as spironolactone may be used in selected cases to block the effects of androgens on the skin. These are only prescribed when appropriate and are not suitable during pregnancy.

• Topical treatments — including retinoids, benzoyl peroxide, or antibiotic creams, target clogged pores and surface bacteria. These are often used alongside hormonal therapy for best results.

• Dietary modifications — such as reducing high-glycaemic foods and dairy products, may help lower insulin spikes and reduce acne severity in some women.

• Dermatology referral — may be arranged if acne is severe, scarring, or unresponsive to hormonal and topical treatment alone. A combined care approach ensures both hormonal and skin-specific needs are addressed.

What fertility treatments are available for women with PCOS?

PCOS is one of the most common causes of anovulatory infertility. Although many women with PCOS face irregular ovulation or absent periods, most respond well to fertility treatment when it is appropriately planned. The goal is to support and monitor ovulation, improve egg quality, and time conception accurately. 

At The Metabolic Clinic, treatment options range from oral medications to recommending assisted reproductive techniques, depending on individual response and reproductive goals.

• Ovulation-inducing medications — are typically the first step. Letrozole is recommended for ovulation induction in women with PCOS due to its higher success rates. Clomiphene citrate may also be used in selected cases.

• Insulin-sensitising agents — such as metformin may be prescribed to improve ovulatory function, especially in women with insulin resistance. It can be used alone or in combination with ovulation-inducing drugs.

• Gonadotropin injections — are used when oral medications fail to trigger ovulation. These injections stimulate the ovaries directly and require careful ultrasound monitoring to reduce the risk of multiple pregnancies.

• Timed intercourse and ultrasound tracking — help identify the fertile window and ensure that ovulation induction is effective. Hormone blood tests may also be used to confirm ovulation.

• Intrauterine insemination (IUI) — may be offered when ovulation has been achieved but pregnancy has not occurred. Sperm is introduced directly into the uterus around the time of ovulation.

• In-vitro fertilisation (IVF) — is considered in cases where simpler treatments have failed or when there are additional fertility concerns. IVF success rates in women with PCOS are generally favourable when ovulation is well controlled.

• Lifestyle interventions — including weight loss, improved diet, and exercise, can significantly enhance ovulation and improve the chances of conception, particularly in women with higher BMI.

How does lifestyle and nutrition help manage PCOS symptoms?

Lifestyle and dietary changes are central to managing PCOS, especially in women with insulin resistance or weight-related concerns. Even in women with lean PCOS, nutrition and physical activity play a vital role in supporting hormonal balance, regulating ovulation, and improving skin and metabolic health. These changes are often the foundation upon which medical treatments are built, and in many cases, they improve treatment response and reduce long-term health risks.

• Balanced, low-glycaemic diet — helps stabilise blood sugar and reduce insulin spikes, which can worsen androgen production. A diet rich in whole grains, lean protein, healthy fats, and non-starchy vegetables is typically recommended.

• Weight management — even a modest weight loss of 5–10% in women with excess weight can significantly improve menstrual regularity, ovulation, and fertility outcomes.

• Regular physical activity — improves insulin sensitivity, supports weight control, and helps reduce circulating androgen levels. Both aerobic exercise and resistance training are beneficial.

• Consistent meal timing — can help regulate energy levels and hormonal signals, particularly in women with blood sugar fluctuations or cravings.

• Limiting processed foods and added sugars — reduces insulin resistance and may help with acne, fatigue, and weight control.

• Stress management — through techniques such as mindfulness, yoga, or breathing exercises may help regulate cortisol levels, which can influence hormonal and metabolic function.

• Sleep regulation — getting adequate, good-quality sleep supports metabolic health and helps maintain a regular hormonal rhythm.

These changes are not meant as a quick fix, but as long-term habits that improve symptoms, support hormonal function, and reduce the risk of conditions like type 2 diabetes and cardiovascular disease.

What happens during your first consultation with us?

Your first visit is focused on understanding your symptoms, health goals, and underlying hormonal patterns in detail. PCOS affects each woman differently, so this consultation is key to creating a treatment plan that is tailored to your needs, whether you are looking to regulate your cycle, improve fertility, manage acne, or address long-term metabolic risks.

• Detailed medical and menstrual history — our doctor will discuss your cycle patterns, symptoms such as acne or hair growth, fertility concerns, past diagnoses, and any previous treatments you’ve tried.

• Review of lifestyle and metabolic factors — including your current diet, physical activity levels, stress, sleep quality, and weight changes. These help us understand your hormonal environment beyond blood results.

• Physical examination (if required) — may include checking vital signs, BMI, and signs of androgen excess such as acne or hirsutism, depending on your symptoms and concerns.

• Targeted blood tests — hormonal and metabolic blood work is usually arranged to assess ovulatory function, androgen levels, insulin resistance, thyroid function, and other relevant markers.

• Pelvic ultrasound (if not already done) — helps assess the ovaries and endometrial lining, especially if your periods are absent or irregular.

• Personalised treatment planning — based on your symptoms, test results, and goals, we will discuss appropriate treatment options and next steps, whether that involves hormonal support, ovulation induction, nutrition planning, or a combination.

• Clear timeline and follow-up structure — so you know what to expect, how your progress will be monitored, and when to return for review. Regular follow-up is essential to track response and make any necessary adjustments.

Your first consultation is not just about diagnosis, it’s about building a roadmap for managing your PCOS with clarity and confidence.

Summary 

Polycystic Ovary Syndrome (PCOS) presents differently in every woman, which is why treatment must be carefully tailored to your symptoms, goals, and underlying hormonal patterns. Whether you are struggling with irregular periods, trying to conceive, or dealing with acne that hasn’t responded to standard care, there are effective, medically guided options to help you regain control. 

At The Metabolic Clinic, we combine hormonal therapy, ovulation support, insulin-sensitising treatment, nutrition, and lifestyle planning to address PCOS in a structured and targeted way. Our approach is not about managing symptoms in isolation, but about restoring hormonal balance, supporting long-term health, and helping you feel better in your body. If you are ready to take the next step in managing your PCOS, schedule a consultation with us to begin a personalised treatment plan that works for you.

Frequently Asked Questions (FAQs)