What’s the best treatment for PCOS?
Start with your main goal. There’s no cure, but lots can help. The first pick for irregular periods is a contraceptive pill. Trying for a baby needs a different one.
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What is the best treatment for PCOS?
There’s no cure for polycystic ovary syndrome (PCOS). But the NHS says treatments and lifestyle changes can help your symptoms.
Think of treatment as a toolbox, not one pill. Each symptom has its own tool. So the best treatment is the one that fits the problem bothering you most.
That’s why your goal comes first.
| Your main goal | Options to ask about | Who says |
|---|---|---|
| Regular periods | Combined pill, progestogen-only pill or a small device fitted in the womb (IUS). | NHS. The guideline puts the combined pill first. |
| Less face and body hair | Hair removal or laser, the combined pill, spironolactone or eflornithine (a prescription cream that slows hair growth). | NHS and guideline |
| Clearer skin | Skin creams or tablets for acne. | NHS |
| Weight and blood sugar | Healthy eating and exercise. Metformin may be considered if your BMI is 25 or more. Weight loss medicines. | NHS and guideline |
| Getting pregnant | Letrozole first, says the 2023 guideline. The NHS lists clomifene. | Guideline and NHS |
| Better mood | Talking therapy for depression or anxiety. | NHS |
Sources: NHS; International PCOS guideline 2023
Eating well and moving more are advised for everyone with PCOS. The 2023 international PCOS guideline says lifestyle changes should be recommended for everyone with PCOS.
The NHS now calls PCOS polyendocrine metabolic ovarian syndrome (PMOS). It’s the same condition with a new name.
Pick your top goal and take it to your GP.
Can you treat PCOS naturally?
Partly. Lifestyle is the one step advised for everyone with PCOS. The guideline says it helps even if your weight doesn’t change: there are benefits even without weight loss.
Lifestyle steps for everyone with PCOS
- Eat a healthy, balanced diet. No one type of diet has been shown to beat another.
- Adults: aim for at least 150 to 300 minutes of moderate activity a week, or 75 to 150 minutes of hard activity.
- Add muscle-strengthening exercise on 2 days a week that aren’t back to back.
- Spend less time sitting down.
- Try to lose weight if you’re overweight.
- Remove unwanted hair by shaving, waxing or creams, or with electrolysis or laser.
Sources: NHS; International PCOS guideline 2023
Want help to start? NHS Better Health has free tools to help you lose weight and get active.
What about inositol? The guideline says you could try it if you want to, as it seems to do little harm. But it found limited benefit for releasing an egg (ovulation), hair or weight.
For extra hair and belly fat, it prefers metformin, though metformin causes more stomach upsets. No inositol type or dose can be recommended yet, and quality can vary.
Tell your doctor if you take it. More in our inositol for PCOS guide.
Which medicines treat PCOS?
| Medicine | Used for | Know before you start |
|---|---|---|
| Combined pill | Irregular periods and extra hair | The guideline’s first medicine for both. It’s also contraception. |
| Metformin | Weight, blood sugar and tiredness | Considered if your BMI is 25 or more. Can upset your stomach and lower vitamin B12. |
| Spironolactone | Extra face and body hair | Used with contraception. Not usually recommended in pregnancy. |
| Weight loss medicines | Higher weight, alongside lifestyle changes | Includes semaglutide and liraglutide. Use contraception with those two if you could get pregnant. |
Sources: NHS; International PCOS guideline 2023; NHS: metformin; NHS: spironolactone
Most of these aren’t licensed for PCOS itself. The guideline says their use is based on evidence, but off-label. Your doctor should talk you through it.
On metformin? Feeling sick, diarrhoea and tummy pain are common. The NHS says most side effects should ease after a couple of weeks, but some can last longer.
Metformin and an active lifestyle work about as well as each other, the guideline says. So ask your GP whether metformin is worth adding to lifestyle changes.
Spironolactone blocks male-type hormones such as testosterone. The guideline says medicines like it could be considered if the pill or hair removal hasn’t helped enough after at least 6 months. The NHS says it can potentially affect a baby’s development.
Never stop or change a prescribed medicine without your prescriber. To see where your hormones stand, read about high testosterone in women.
PCOS treatment when you want a baby
Here’s the catch from the top. The combined pill stops pregnancy, so it’s no use when you’re trying. The guideline’s first pick changes to letrozole, a tablet that helps you release an egg.
The usual order of fertility treatment with PCOS
- 1
Get ready
Weight, smoking, alcohol, sleep and folate. A higher folate dose if your BMI is over 30.
- 2
Letrozole
First choice to help you release an egg, if nothing else affects your fertility.
- 3
Next options
Fertility hormones (gonadotrophins) or keyhole surgery on the ovaries.
- 4
IVF
Third choice, if other treatments to help you release an egg have failed.
Sources: International PCOS guideline 2023; NHS
The NHS page lists clomifene. The guideline prefers letrozole, for better ovulation, pregnancy and birth rates. Letrozole isn’t given if you could already be pregnant.
The surgery is called ovarian drilling. The NHS says it uses heat or laser on the ovaries and can sometimes increase the chance of getting pregnant.
Inositol for fertility is still experimental. Ask your GP which tests come first, and see our fertility blood test guide.
When to speak to a GP
Book an appointment if:
- You think you might have PCOS. The NHS says see a GP.
- Your symptoms are affecting your everyday life, work or relationships.
- You snore and wake up unrefreshed, or feel sleepy or tired in the day. The guideline says to check for sleep apnoea, where breathing stops and starts as you sleep.
- You feel low or anxious. The guideline says doctors should check everyone with PCOS for depression and anxiety.
- Your periods have stopped for a long time. Untreated, this is a risk factor for womb lining problems, though the overall chance of womb cancer is low.
Ask for a blood sugar check too. The guideline says to check it at diagnosis, then every 1 to 3 years depending on your risk.
The NHS says PCOS can sometimes increase the risk of type 2 diabetes, high blood pressure, heart disease, fatty liver disease and womb cancer. Regular check-ups can reduce that risk. See our PCOS blood test guide and insulin resistance test guide.