Although it remains easier to induce ovulation in patients with PCO syndrome than to help them achieve pregnancy, the prognosis for these patients has improved greatly. Alleviation of hirsutism is often the patient's major concern. Depilatory creams, waxes, and electrolysis can all be used to treat limited areas, but many patients seek hormone therapy. The drug should not be given to patients with diabetes or those prone to hyporeninemic hypoaldosteronism. Effective contraception must simultaneously be used by sexually active women to prevent potential harm to a male fetus because of androgen blockade.
Oral contraceptives are useful by themselves and in conjunction with spironolactone.
To varying degrees in different women, oral contraceptives suppress gonadotropins, reduce circulating androgens, increase androgen binding, and inhibit testosterone metabolism. One feature of PCO syndrome merits separate mention. Long intervals of anovulation such as those that occur in PCO syndrome can be a prelude to endometrial carcinoma. The link may be either continuous exposure of the endometrium to estrogen unopposed by progesterone or the particular carcinogenic role alleged for estrone, the estrogen that appears to be present in high levels in this disorder. Thus, it is important to induce regular shedding of the endometrium by judicious use of a synthetic progestin and to plan follow-up with regular physical examinations, Papanicolaou smears, and careful attention to any unexpected bleeding.