What should be considered if weight loss and oral contraceptive pills are not sufficient for PCOS?

In the management of polycystic ovary syndrome (PCOS), particularly when patients experience difficulties such as anovulation or insulin resistance, metformin is an important therapeutic option. When weight loss and the use of oral contraceptive pills do not achieve desired results—such as regulating menstrual cycles or improving metabolic parameters—metformin can help by targeting the underlying insulin resistance that is often associated with PCOS.

Metformin works by improving insulin sensitivity, which can lead to a reduction in insulin levels and may help normalize ovarian function. This can result in improved ovulation rates and regular menstrual cycles in women with PCOS who are seeking to conceive. Furthermore, metformin may assist in weight management, potentially aiding in weight loss, which can be beneficial for overall metabolism and hormonal regulation.

In contrast, other options might not directly address the insulin resistance or the hyperandrogenism often seen in PCOS. While Clomid therapy is useful for inducing ovulation, it is typically considered after metformin if it is indicated—especially in patients looking to conceive. Aromatase inhibitors may also be used in some fertility treatments, particularly in ovulation induction, but they are often employed in different scenarios compared to metformin. Thyroid hormone replacement would only be relevant