The simple idea (no memorising)
Ask first: what does she want right now?
*Goal A — she does not want pregnancy now. The aims are: regular cycles, protecting the womb lining* (remember: unopposed estrogen is risky), calming hair/acne, and reducing long‑term metabolic risk.
- Lifestyle (nourishing food, movement, sleep) is the foundation for nearly everyone.
- The combined oral contraceptive pill regulates cycles, protects the lining, and eases androgen symptoms.
- If hair is stubborn, an anti‑androgen can be added — always with reliable contraception, because these drugs can harm a developing male fetus. 🚩
*Goal B — she wants to conceive. Now the aim is to help ovulation happen.*
- Optimise lifestyle/weight first.
- Letrozole is the first‑line tablet to trigger ovulation (clomiphene is an alternative).
- If needed, escalate to injections or specialist fertility care.
The thread that never leaves
Whatever the goal, protect the lining. Long stretches with no periods mean long stretches of unopposed estrogen — so ensuring the lining sheds regularly (naturally or with medicine) is part of good PCOS care for the long run.
Why it matters
PCOS is lifelong, but very manageable. Framing care around the woman's current goal — and treating her as a whole person, not a lab result — is what makes her feel understood and in control.
Quick check ✅
- Which tablet is first‑line to help a woman with PCOS ovulate?
- Why must an anti‑androgen always be paired with contraception?
Remember this 🌟
Where we're going next → Another cause of pelvic pain hides tissue where it shouldn't be. Concept 19.