Patient's question:
I have had polycystic ovary syndrome for many years. In the past, I kept going to see a doctor, and my androgen levels dropped to normal, but my menstruation still didn't return. Over the past two years, I haven't seen a doctor again. Last year, my menstruation came naturally for the entire year, but the cycles were very short, only 15 days. However, starting from the first half of this year, it stopped coming again.Approximately since last year, I noticed that my body hair became very severe (even growing a beard on my chin this year), and my weight also increased significantly. Recently, I've even felt discomfort in my heart (a feeling of tightness and discomfort). Because I have hepatitis B, I am now afraid to take androgen-lowering medication (both Diane and diuretics can damage the liver).
Doctor's answer:
Hello, the main goal of PCOS treatment is to establish a normal ovulatory menstrual cycle, restore fertility, and eliminate hirsutism. Once a normal menstrual cycle is established, conception can occur, the ovaries no longer produce excessive androgens, and hirsutism also disappears. The methods to restore a normal menstrual cycle are as follows.（1）Clomiphene, also known as Clomiphene Citrate or Serophene. It is now widely recognized as the first-line treatment for PCOS. Clomiphene induces the release of GnRH from the hypothalamus, which in turn promotes the release of FSH from the pituitary gland, promoting normal follicular development. Elevated FSH levels are key to inducing ovulation in PCOS patients. Clomiphene treatment can induce ovulation in more than 80% of patients. The specific dosage is 50 mg once daily, starting from day 5 of the menstrual cycle, for 5 consecutive days. Ovulation typically occurs 7–10 days after starting the medication. If treatment is ineffective after 1–2 cycles, the dose can be increased to 100 mg daily for 5 days. During treatment, basal body temperature should be measured to observe for an ovulatory biphasic pattern.
（2）Ovarian wedge resection, which involves removing a wedge-shaped portion of the ovary. Before the introduction of clomiphene, the treatment for PCOS was ovarian wedge resection. The efficacy was significant. Most patients ovulated and became pregnant shortly after surgery. With the availability of clomiphene, ovarian wedge resection is rarely used today and is reserved only for patients who do not respond to medication.
（3）Traditional Chinese Medicine. The method of promoting blood circulation and tonifying the kidneys to induce ovulation has shown good results. Specific medications should be used under the guidance of a doctor.