PCOS can affect your periods, ovulation, fertility, skin, hair growth, weight and long-term metabolic health. Because the condition affects people in different ways, there is no single treatment that is right for everyone. Your care should be based on your symptoms, health goals and whether you are planning a pregnancy.
Current PCOS care combines established options such as hormonal contraception and metformin with more recently available weight-management medicines for eligible patients and updated evidence on fertility treatment. Researchers are also studying new therapies, but not all are approved or recommended for routine use. The NHS now uses the name polyendocrine metabolic ovarian syndrome (PMOS), but PCOS remains widely recognised and is used throughout this article.
How Has PCOS Treatment Changed?
PCOS treatment has moved beyond focusing only on irregular periods, unwanted hair growth and fertility. Modern care also considers your metabolic health, emotional wellbeing, sleep, future pregnancy plans and your risk of developing conditions such as type 2 diabetes.
Your treatment should be tailored to your individual needs rather than following a single approach for everyone. Depending on your symptoms and goals, you may need support with regulating your periods, managing acne or excess hair growth, addressing metabolic or weight-related concerns, or planning for a future pregnancy.
UK Guidance
At the time of writing on 3 August 2026, NICE’s draft guideline on PMOS is open for consultation. The consultation is due to close on 11 August 2026, with final publication currently expected on 9 December 2026. Until the final guideline is published, care should be based on current UK medicine guidance, relevant local clinical pathways and the 2023 International Evidence-Based Guideline for PCOS.
Lifestyle Support Remains a Core Treatment
Healthy lifestyle habits remain a key part of PCOS management. Regular physical activity, balanced nutrition, good sleep and support for your emotional wellbeing may improve your overall health, even when they do not result in significant weight loss.
There is no single diet or exercise plan that works for everyone with PCOS. Your lifestyle plan should be tailored to your needs, preferences and daily routine, with realistic goals that take into account challenges such as poor sleep, low mood, joint pain or previous experiences with restrictive dieting.
Weight-Neutral Care Is Becoming More Important
Modern PCOS care places greater emphasis on reducing weight stigma. PCOS can affect people of all body sizes, and your symptoms should be assessed properly rather than being dismissed because you are slim or blamed entirely on your weight if you live in a larger body.
If weight loss is appropriate for your health and is one of your goals, modest and sustainable weight loss may improve certain metabolic measures and support more regular ovulation. At the same time, healthy habits may benefit your fitness, blood pressure, blood glucose and overall wellbeing, even without significant weight loss.
Combined Oral Contraceptive Pill
The combined oral contraceptive pill may be considered for irregular menstrual cycles and symptoms associated with higher androgen levels, such as acne or unwanted hair growth. It can make bleeding more predictable and may gradually improve acne and new coarse facial or body hair growth.
No single pill is suitable for everyone. Your clinician should consider your medical history, blood pressure, smoking status, migraines and risk factors for blood clots or cardiovascular disease before recommending a formulation.
How Metformin and the Pill Are Used Together
The combined contraceptive pill and metformin treat different aspects of PCOS. The pill is generally used to manage irregular periods, acne and unwanted hair growth, while metformin is more focused on improving insulin resistance and metabolic health.
Using both medicines together is not always necessary. Your clinician will recommend the most appropriate treatment based on your symptoms and health needs, and they should explain what each medicine is intended to achieve so you know what improvements to expect.
Progestogen Treatment and Womb-Lining Protection
If you have very infrequent periods, the lining of your womb may build up over time because it is not being shed regularly. Long gaps between periods may increase the risk of endometrial hyperplasia, in which the womb lining becomes abnormally thick. Long-standing untreated absent periods are also associated with an increased risk of endometrial cancer, although the overall likelihood for an individual remains low.
If the combined pill is unsuitable or you prefer not to use it, your clinician may discuss options such as a progestogen-only pill, a hormonal intrauterine system or scheduled courses of progestogen tablets. The most appropriate option depends on whether you also need contraception, your bleeding pattern and your medical history. Progestogen treatment may help protect the womb lining, although evidence specifically in PCOS is limited.
When May Metformin Be Considered?
Metformin may be considered for selected people with PCOS, particularly when metabolic concerns such as impaired glucose regulation or an increased risk of type 2 diabetes are present. It may improve certain glucose and metabolic measures and may support menstrual regularity in some patients, but responses vary.
Your clinician will consider your blood glucose results, wider metabolic risk, symptoms, other medicines and treatment goals before recommending metformin. It may also be considered for irregular menstrual cycles when the combined pill is unsuitable, unacceptable or poorly tolerated. Gastrointestinal side effects such as nausea, diarrhoea and abdominal discomfort can occur, particularly when treatment begins, and gradual dose increases may improve tolerance. Long-term use can be associated with low vitamin B12, so testing may be considered when symptoms or risk factors are present.
The Pill, Metformin or Both?
| Treatment | Main role | Important consideration |
| Combined pill | Irregular bleeding, acne and unwanted hair | Not suitable with some clot, migraine or cardiovascular risks |
| Metformin | Selected glucose and metabolic outcomes | Gastrointestinal effects and possible low vitamin B12 |
| Both together | Selected patients with both hormonal and metabolic concerns | The additional clinical benefit may be limited in some lower-metabolic-risk patients |
| Neither | Preference for non-hormonal or alternative approaches | Symptom-specific or fertility-focused treatment may be appropriate |
GLP-1 and Dual GIP/GLP-1 Weight-Management Medicines
GLP-1 receptor agonists, such as liraglutide and semaglutide, and newer medicines such as tirzepatide may be offered if you meet the appropriate prescribing criteria for weight management. These medicines may reduce appetite and support clinically meaningful weight loss in eligible patients when they are prescribed as part of a supervised weight-management plan.
For some people with PCOS and higher weight, these medicines may improve weight and metabolic measures, and menstrual regularity or ovulation may also improve. They are not a cure for PCOS, and weight regain can occur after treatment stops. Nausea, vomiting, diarrhoea and constipation can occur. Severe, persistent abdominal pain that may spread to the back, especially with nausea or vomiting, requires urgent medical attention because it may indicate acute pancreatitis. These medicines should be prescribed alongside dietary, physical-activity and behavioural support.
GLP-1 Medicines and Pregnancy Safety
GLP-1 receptor agonists and dual GIP/GLP-1 medicines should not be used during pregnancy, while trying to conceive or while breastfeeding. Effective contraception is therefore important when pregnancy is possible.
Current UK advice recommends stopping semaglutide at least two months before trying to conceive and tirzepatide at least one month beforehand. Liraglutide should be stopped before trying to conceive. If you take tirzepatide with an oral contraceptive pill, use an additional barrier method or change to a non-oral contraceptive for four weeks after starting treatment and for four weeks after every dose increase. Confirm the instructions for your specific medicine with your prescriber.
Treatments for Acne
Acne related to PCOS may improve with hormonal treatment, although it often takes several months before you notice a difference. The combined contraceptive pill may be particularly helpful if you also want contraception or more regular periods.
Depending on the type and severity of your acne, your clinician may recommend standard treatments such as benzoyl peroxide, azelaic acid, topical retinoids or antibiotics. Topical retinoids and oral tetracyclines should not be used during pregnancy or when planning a pregnancy, and other acne medicines may also need to be changed, so discuss your pregnancy plans before starting or continuing treatment.
Treatments for Unwanted Hair Growth
The combined contraceptive pill may gradually reduce new coarse hair growth by lowering androgen activity, although treatment is generally assessed after at least six months because improvement in hair growth can take time. Existing hair does not disappear immediately, so many people combine medical treatment with cosmetic hair-removal methods.
You can choose temporary options such as shaving, waxing, threading or hair-removal creams, or consider laser and light-based treatments for longer-lasting hair reduction if you are a suitable candidate. If you have PCOS, you may need additional laser sessions or maintenance treatments, so choose an appropriately qualified practitioner who has experience selecting suitable laser or light settings for your skin and hair type.
Anti-Androgen Medicines
Anti-androgen medicines, such as spironolactone, may be considered for unwanted hair growth when the response remains inadequate after at least six months of the combined pill and/or cosmetic treatment. If the combined pill is unsuitable or poorly tolerated, an anti-androgen may still be considered alongside another effective form of contraception.
Effective contraception is essential because exposure during pregnancy may interfere with the genital development of a male foetus. Depending on the medicine and your medical history, your clinician may monitor blood pressure, kidney function or potassium levels and discuss the potential benefits and side effects before treatment.
Inositol and Other Supplements
Inositol supplements are often promoted to support insulin resistance, menstrual regularity and fertility in people with PCOS. Some studies suggest possible improvements in certain metabolic measures, but evidence for meaningful benefits in ovulation, unwanted hair growth or weight remains limited. No specific type, dose or combination can currently be recommended for everyone with PCOS.
Metformin has stronger evidence for selected metabolic indications. Inositol and other supplements should therefore not replace clinically indicated treatment for impaired glucose regulation, long gaps between periods or fertility problems. If you choose to take supplements, tell your clinician what you are using, especially if you are taking several products or planning a pregnancy.
Letrozole for PCOS-Related Infertility
The 2023 International Evidence-Based Guideline recommends letrozole as the first-line pharmacological treatment for anovulatory infertility related to PCOS when no other infertility factor has been identified. It works by encouraging a follicle to develop so that an egg can be released.
Pregnancy should be excluded before ovulation-induction treatment begins. You usually take letrozole for several days near the beginning of a treatment cycle, and your fertility team may use ultrasound scans or blood tests to monitor your response. Because it may be prescribed off-label for this purpose in the UK, your specialist should explain why it is recommended, along with the expected benefits and possible risks.
Clomifene, Metformin and Gonadotrophins
Clomifene citrate may be considered when letrozole is unavailable, unsuitable or has not resulted in ovulation or pregnancy. It can be used on its own or, in some cases, together with metformin. If you are having difficulty becoming pregnant, your clinician will also consider factors such as your age, the health of your fallopian tubes and your partner’s fertility.
If oral medicines do not lead to ovulation, you may be offered gonadotrophin injections. These treatments require careful ultrasound monitoring because they can stimulate several follicles, increasing the risks of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS).
Ovarian Drilling, IVF and In Vitro Maturation
Laparoscopic ovarian drilling is a keyhole operation that may help restore ovulation if you have not responded to oral fertility medicines, although it is used less often today because effective non-surgical treatments are available. If simpler treatments are unsuccessful or another fertility factor is present, you may be advised to consider IVF.
If you have PCOS, your fertility specialist will carefully plan treatment to reduce the risk of ovarian hyperstimulation syndrome, which can occur when the ovaries respond too strongly to fertility medication. In vitro maturation, where immature eggs are collected and matured in the laboratory, may avoid OHSS but can have a lower cumulative live-birth rate than stimulated IVF and is available only in selected specialist centres.
Metabolic Surgery
Metabolic, or bariatric, surgery may be considered if you have severe obesity and meet the general criteria for weight-loss surgery. Although it is not a treatment specifically for PCOS, significant weight loss after surgery may improve your metabolic health and help restore more regular ovulation.
If you are considering surgery, you will need long-term nutritional follow-up and lifelong changes to your eating habits. Fertility may return quickly, so effective contraception should be discussed before surgery. Even when pregnancy is desired, it should usually be delayed until your weight has stabilised, commonly for about one year, to reduce pregnancy and fetal-growth risks.
Mental Health and Sleep Treatments
PCOS can increase your likelihood of experiencing anxiety, depression, body image concerns and disordered eating. Modern PCOS care recognises that supporting your mental health is an important part of treatment, and you may benefit from talking therapy, psychological support or specialist eating disorder services if needed.
Your sleep also plays an important role in managing PCOS. If you snore, wake feeling unrefreshed or experience excessive daytime tiredness, your clinician may assess you for obstructive sleep apnoea. Treating sleep problems can improve your overall health and make it easier for you to manage other aspects of PCOS.
Which Emerging Treatments Are Being Studied?
Researchers are studying medicines that target insulin resistance, inflammation, liver health and reproductive hormone pathways, including SGLT2 inhibitors and other investigational therapies. Early studies may report changes in weight, glucose measures or menstrual patterns, but these findings do not establish routine PCOS treatment.
While early research is encouraging, many of these treatments are still experimental and are not yet recommended for routine PCOS care. You should be cautious of clinics or products that claim to cure PCOS, and you should always discuss new or experimental treatments with your clinician before deciding whether they are appropriate for you.
Myth vs Fact
| Myth | Fact |
| One treatment works for everyone with PCOS. | Treatment depends on your symptoms, metabolic health and pregnancy plans. |
| Medication can cure PCOS permanently. | Treatment manages symptoms and health risks, but there is currently no cure. |
| Everyone with PCOS needs to lose weight. | PCOS affects people of all body sizes, and healthy habits can provide benefits without weight loss. |
| Metformin is a weight-loss medicine for everyone with PCOS. | It is mainly considered for selected metabolic concerns and is not suitable for everyone. |
| GLP-1 medicines are specific PCOS treatments. | They may be prescribed under general weight-management criteria, not solely because you have PCOS. |
| Supplements are safer and more effective than prescribed treatment. | Evidence for supplements such as inositol remains limited, and they should not replace clinically indicated care. |
| Letrozole is suitable for every fertility problem. | It is mainly used when irregular ovulation is the identified fertility issue. |
Key Takeaways
- PCOS treatment should be tailored to your symptoms, metabolic health and pregnancy plans.
- Lifestyle, sleep and mental-health support remain important alongside medical treatment.
- The combined pill may help irregular periods, acne and unwanted hair growth.
- Metformin is mainly considered for selected metabolic concerns and is not suitable for everyone.
- GLP-1 and related weight-management medicines are not PCOS-specific cures and require pregnancy precautions.
- Anti-androgen medicines require effective contraception.
- Evidence for inositol remains limited, so supplements should not replace established treatment.
- Letrozole is generally recommended first-line when irregular ovulation is the main fertility problem.
- IVF and other specialist fertility treatments may be considered when simpler options are unsuccessful.
- Emerging treatments should not be used routinely until stronger evidence and guidance are available.
Frequently Asked Questions
1. What is the latest treatment for PCOS?
There is no single latest treatment that works for everyone with PCOS. Treatment is now tailored to your individual symptoms and goals. Depending on your needs, this may include lifestyle support, hormonal contraception, metformin, newer weight-management medicines, fertility treatments or therapies for acne and unwanted hair growth.
2. Can PCOS be cured with medication?
No. There is currently no cure for PCOS, but treatment can help manage your symptoms and reduce the risk of long-term health complications. Your clinician will recommend a personalised treatment plan based on your symptoms, whether you are planning a pregnancy and your overall health.
3. Are GLP-1 weight-management medicines used to treat PCOS?
GLP-1 medicines and tirzepatide may be considered for people who meet general weight-management prescribing criteria. They are not a cure for PCOS and should not be used during pregnancy, while trying to conceive or while breastfeeding. Effective contraception and the medicine-specific washout period should be discussed with the prescriber.
4. What is the best fertility treatment for PCOS?
When anovulation is the main identified fertility factor, letrozole is recommended as the first medicine for ovulation induction. If it is unsuitable or unsuccessful, clomifene, gonadotrophins, ovarian drilling or IVF may be considered according to your individual fertility assessment.
5. Can lifestyle changes still help if you are taking medication for PCOS?
Yes. Healthy eating, regular physical activity, good-quality sleep and support for your mental wellbeing remain important parts of PCOS management. These measures can improve your overall health and work alongside medication to help manage your symptoms more effectively.
Final Thoughts: Personalised Treatment Can Help You Manage PCOS
PCOS affects everyone differently, which is why the most effective treatment plan is one that is tailored to your symptoms, health goals and future pregnancy plans. Whether you need support with irregular periods, weight management, fertility or metabolic health, early assessment and evidence-based care can make a meaningful difference. If you’re considering Polycystic Ovary Syndrome treatment in London, you can get in touch with us at Gynaecology Clinic London.
References:
- National Institute for Health and Care Excellence (2026) ‘Polyendocrine Metabolic Ovarian Syndrome (PMOS)’. NICE guideline in development GID-NG10436. Draft guidance published 1 July 2026; consultation closes 11 August 2026; expected publication 9 December 2026. Available at: https://www.nice.org.uk/guidance/indevelopment/gid-ng10436
- NHS (2026) ‘Polyendocrine metabolic ovarian syndrome (PMOS)’. Page last reviewed 30 June 2026. Available at: https://www.nhs.uk/conditions/polyendocrine-metabolic-ovarian-syndrome-pmos/
- National Institute for Health and Care Excellence (2025) ‘Polycystic ovary syndrome’, NICE Clinical Knowledge Summaries. Last revised March 2025. Available at: https://cks.nice.org.uk/topics/polycystic-ovary-syndrome/
- Teede, H.J. et al. (2023) ‘Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome’, The Journal of Clinical Endocrinology & Metabolism, 108(10), pp. 2447–2469. Available at: https://academic.oup.com/jcem/article/108/10/2447/7242360
- National Institute for Health and Care Excellence (2025, updated 2026) ‘Overweight and obesity management’. NICE guideline NG246. Published 14 January 2025; last updated 8 January 2026. Available at: https://www.nice.org.uk/guidance/ng246
- Medicines and Healthcare products Regulatory Agency (2025, updated 2026) ‘GLP-1 medicines for weight loss and diabetes: what you need to know’. Published 5 June 2025; updated 5 February 2026. Available at: https://www.gov.uk/government/publications/glp-1-medicines-for-weight-loss-and-diabetes-what-you-need-to-know/glp-1-medicines-for-weight-loss-and-diabetes-what-you-need-to-know
- National Institute for Health and Care Excellence (2024, updated 2025) ‘Tirzepatide for managing overweight and obesity’. Technology appraisal guidance TA1026. Published 23 December 2024; last updated 1 September 2025. Available at: https://www.nice.org.uk/guidance/ta1026
- Medicines and Healthcare products Regulatory Agency (2022) ‘Metformin and reduced vitamin B12 levels: new advice for monitoring patients at risk’. Published 20 June 2022. Available at: https://www.gov.uk/drug-safety-update/metformin-and-reduced-vitamin-b12-levels-new-advice-for-monitoring-patients-at-risk
- Fitz, V. et al. (2024) ‘Inositol for polycystic ovary syndrome: a systematic review and meta-analysis to inform the 2023 update of the international evidence-based PCOS guidelines’, The Journal of Clinical Endocrinology & Metabolism, 109(6), pp. 1630–1655. Available at: https://academic.oup.com/jcem/article/109/6/1630/7504796
- National Institute for Health and Care Excellence (2021, updated 2026) ‘Acne vulgaris: management’. NICE guideline NG198. Published 25 June 2021; last updated 30 April 2026. Available at: https://www.nice.org.uk/guidance/NG198