What is the mainstay pharmacologic therapy for PCOS to regulate menses and reduce androgen effects?

What is the mainstay pharmacologic therapy for PCOS to regulate menses and reduce androgen effects?

• A. Methotrexate.
• B. Combination oral contraceptives.
• C. Testosterone therapy.
• D. Estrogen alone.

Answer: (B)

Combined estrogen-progestin oral contraceptives are the mainstay for regulating menses and reducing androgen effects in PCOS. They work by suppressing ovarian androgen production, increasing sex hormone-binding globulin, and producing a regular withdrawal bleed, which improves cycle regularity and lowers the amount of free testosterone. This helps with common PCOS symptoms like acne and hirsutism while preventing endometrial hyperplasia. They’re favored for women who do not wish to conceive because they address both menstrual irregularity and androgenic symptoms without promoting ovulation. In contrast, methotrexate has no role in PCOS management, testosterone therapy would worsen androgen excess, and estrogen alone can stabilize some cycles but does not suppress ovarian androgen production and carries endometrial risks.

Combined estrogen-progestin oral contraceptives are the mainstay for regulating menses and reducing androgen effects in PCOS. They work by suppressing ovarian androgen production, increasing sex hormone-binding globulin, and producing a regular withdrawal bleed, which improves cycle regularity and lowers the amount of free testosterone. This helps with common PCOS symptoms like acne and hirsutism while preventing endometrial hyperplasia. They’re favored for women who do not wish to conceive because they address both menstrual irregularity and androgenic symptoms without promoting ovulation. In contrast, methotrexate has no role in PCOS management, testosterone therapy would worsen androgen excess, and estrogen alone can stabilize some cycles but does not suppress ovarian androgen production and carries endometrial risks.