Which drug is suitable for PCOS?

Pill and co

Particularly important in the treatment of skin problems is on the one hand to reduce the formation of male sex hormones (androgens) and on the other hand to inhibit the influence of these hormones on the hair follicle.

The contraceptive pill is typically used for patients who currently do not want to have children. These pills, also known as "micro pills," are low-dose and contain two different female hormones - estrogens and progestins. Most pills contain the artificially produced ethinyl estradiol, the progestogen content can vary. However, the first pills with natural estrogen are already available. Certain progestins inhibit the effects of male hormones in the body. Such gestagens are cyproterone acetate (CPA), chlormadinone acetate (CMA), dienogest (DNG) or drospirenone (DRSP). Pills with these gestagens are therefore preferred in the treatment of PCOS. In addition, every pill helps normalize the cycle and improve skin problems. Important: You need to be patient with this treatment. The acne will improve as quickly as possible, after 3 months of treatment. The stressful body hair only slowly improves after 9 months, the improvement in hair loss can sometimes be longer.

There are various options for taking the pill: 21 days of taking it and a 7-day break, or you can take the pill in a so-called "long cycle" for 3, 6, 9 or even up to 12 months without a break. There is no menstrual period here without the uterine lining growing. The skin problems improve a little faster in the "long cycle" and the iron deficiency that may be present is quickly compensated for due to the lack of bleeding. However, there is often intermenstrual bleeding, especially at the beginning of treatment. This long uninterrupted intake leads to a slightly higher hormone level in the body. An increased risk of breast cancer cannot be definitively ruled out.

In patients who do not need contraception, the drugs with natural estrogens in combination with the progestins that act against the male sex hormone should be preferred. Such drugs are known as hormone replacement therapy in the treatment of menopausal symptoms.

If this does not improve the skin problems, the dose of progestins such as CPA can be increased to 10, 50 or 100 mg per day for 10 to 15 days per month. After a sufficient improvement has been achieved, the dose should be reduced again.

Important to know:

  • You must not become pregnant under this therapy, as it can lead to malformations in the child!
  • Some other drugs, such as antibiotics, antiretroviral drugs in HIV treatment, or drugs for the treatment of seizures (epilepsy), can interact with the pill and make contraception unsafe and, for example, seizures occurring more frequently.
  • The pill works as long as you take it. Unfortunately, after stopping the treatment, the symptoms return quickly. The positive thing is that you can take the pill for years. So you should stop them if you want to get pregnant. Then talk to your doctor about your desire to have children as soon as possible.
  • The modern pills are generally low-dose and have little or no adverse effect on the metabolic peculiarities of PCOS. However, there are not many studies on this yet. Unfortunately, no improvement in the metabolic problems typical of PCOS is to be expected from the pill.
  • If you are already suffering from old-age sugar (diabetes mellitus type 2 or NIDDM - "non insulin dependent diabetes mellitus"), but have not yet damaged the blood vessels and have no additional risk factors (e.g. smoking, high blood pressure, burdened family history, etc.), you can take the "micro pill". Another possibility would be to only take antiandrogenic luteal hormones (progestins) and to use additional contraception, e.g. with an IUD or, if the child is trying to have children, by means of sterilization (possibly of the partner).
  • The pill lowers the risk of uterine cancer and normalizes menstrual cycles. The risk of developing ovarian cancer also decreases.
  • There may be a slightly increased water retention in the body while taking the pills. This smooths the skin and the wrinkles are easily “ironed”. Unfortunately, it can also mean that you gain up to 2 kg. If this becomes a problem for you, your doctor can help you by prescribing a pill that has a diuretic effect.
  • Clearly: if you take the pill, you have to stop smoking!
  • Your doctor must also know if you have other reasons against the pill, including: condition after a heart attack or stroke, breast cancer, disorders of lipid metabolism, vascular diseases, high blood pressure, high blood pressure in previous pregnancies, tendency to thrombosis (formation of blood clots), obesity and first time Occurrence or worsening of migraines while taking the pill.
  • If you take the pill as a PCOS patient, your blood pressure and blood sugar must be checked regularly.
  • Nobody knows yet whether the pill could have negative effects on your cardiovascular system.

Systemic therapy of skin problems can also be carried out with so-called “non-steroidal” antiandrogens, 5-α-reductase inhibitors or GnRH analogues. However, these preparations are not part of standard therapy and are not generally approved for these purposes. In exceptional cases, however, after a detailed consultation, your doctor can decide together with you to use these drugs (see information for doctors).

Non-hormonal therapy for acne

  • Benzoyl peroxide cream
  • Azelaic Acid 15% Gel, or Cream
  • Antibiotics such as clindamycin acne gel; Erythromycin solution or minocycline 50 mg tablets 2 x / d
  • Vitamin A Acid - Tretinoin Cream or Isotretinoin 10/20 mg Tablets. It is important to avoid pregnancy at all costs.
  • Laser treatment and cosmetic treatments for acne

(For further details see Info for Doctors)