Menstrual irregularity, heavy bleeding | First-line | | |
Lifestyle interventions | Diet and exercise aimed at weight reduction by 5%–10% or prevention of excess weight gain |
|
CHCs | Any form | |
Progestins | | |
Oral medroxyprogesterone | 5–10 mg for 5–10 d every 30–90 d | |
Oral norethindrone acetate | 5 mg daily for 7 d every 30–90 d or 5 mg daily for 3 wk on, 1 wk off | |
Oral drospirenone | 4 mg 24 d, 4 d placebo | |
Oral dienogest | 2 mg daily |
|
Levonorgestrel intrauterine device | 52 mg released over 5 yr |
|
Etonogestrel subdermal implant | 68 mg released over 3 yr |
|
Intramuscular medroxyprogesterone acetate | 150 mg intramuscularly every 3 mo | |
Alternative options | | |
Metformin | 1500–2000 mg daily in divided doses |
|
Inositol | Dosing varies 4 g of myo-inositol with a 40:1 ratio between myo-inositol and D-chiro-inositol daily (21) |
|
Acne, hirsutism or alopecia | First-line | | |
CHCs | Any form | |
Topical hirsutism treatment | 13.0% eflornithine |
|
Minoxidil (for alopecia) | 2% twice daily | |
Topical or oral acne treatments | According to general guidelines | |
External hair removal methods | Mechanical laser and light therapy | |
Alternative options | | |
Spironolactone | 50–100 mg twice daily |
Must be used with effective contraception given teratogenicity (i.e., CHCs or progestin-based contraception if CHCs are contraindicated) Do not use in combination with CHC containing dropirenone Requires monitoring with electrolytes 3 mo after starting and then annually and with dose adjustments
|
Finasteride | 5 mg daily |
|
Overweight or obesity | First-line | | |
| Lifestyle interventions | Diet and exercise aimed at weight reduction by 5%–10% or prevention of excess weight gain |
|
| Metformin | 1500–2000 mg daily in divided doses |
|
| Alternative options | | |
| Inositol | Dosing varies 4 g of MI with a 40:1 ratio between myo-inositol and D-chiro-inositol daily (21) | |
| Anti-obesity medications or surgery | |
|
Ovulation induction | First-line | | |
| Lifestyle interventions | Diet and exercise aimed at weight reduction by 5%–10% or prevention of excess weight gain |
|
| Metformin | 1500–2000 mg daily in divided doses |
|
| Letrozole | 2.5 mg–7.5 mg for 5 d |
Although considered first-line by many guidelines, still considered as off-label use in Canada If cycling regularly, start on day 2–5 If irregular cycles, can start randomly after negative home pregnancy test or medroxyprogesterone-induced withdrawal bleed Consider measuring serum progesterone level 3 wk after starting letrozole to confirm ovulation
|
| Alternative options | | |
| Inositol | Dosing varies; 4 g of myo-inositol with a 40:1 ratio between myo-inositol and D-chiro-inositol daily (21) | |
| Referral to gynecologist or reproductive endocrinologist and infertility specialist | | |