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What are the treatment choices for polycystic ovaries?

Q: I will be very grateful to you if you can let me know about the last choice of treatment for a patient with polycystic ovary disease who is 28 years old and has been treated for the last 7 years by all the medical choices including weight reduction and metformin therapy. Ovarian drilling was done a year back but still she has amenorrhoea for more than one year, hirsutism, obesity & billaterally large ovarian sizes with multiple peripheral small follicles. Can we repeat the drilling for her or try the old wedge resection to minimise the huge ovarian sizes and induce ovulation.

A:The treatment depends on the symptoms. If she has oligomenorrhoea, do a progesterone challenge test, if positive she can be put on oral contraceptive pills. If fertility is the issue, then of course ovulation induction is required which can be done with metformin, weight reduction programme and ovulating drugs - gonadotrophins etc. IVF is always the option. OCP always reduce the ovarian size in 3 months time.

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