Fertility Medications for PCOS (PMOS)
If you found your way here, I’m guessing you or someone you love is on a fertility journey and wondering about fertility medications for PCOS (PMOS). Maybe you’re curious about how these medications work, what their side effects are, or which medication might be the best fit for you.
I hope this blog gives you the information you’re looking for.
In this blog, we’ll cover the most common fertility medications for PCOS (PMOS), how they work, potential side effects, when they are typically used, and other lifestyle factors that can help support your fertility journey. My goal is that by the end, you’ll have a better understanding of the different medication options available and feel more prepared for your next conversation with your healthcare provider.
Understanding PMOS and Fertility
Before we talk about fertility medications, it is important to understand what PMOS actually is and why it can make conception more challenging.
PMOS, or Polyendocrine Metabolic Ovarian Syndrome, is the updated name for what many people still know as PCOS. Because many people still search for “PCOS,” you will often see the terms used interchangeably.
PMOS is diagnosed using the Rotterdam criteria. To receive a diagnosis, you must meet two out of the following three criteria:
Irregular menstrual cycles
A string of pearls appearance on a transvaginal ultrasound
Signs of elevated androgens, such as unwanted hair growth or facial acne
One of the biggest misconceptions is that PMOS is only an ovarian condition. It is not. PMOS is both an endocrine and metabolic condition, which means it affects much more than just the ovaries.
Women with PMOS often have too many eggs sitting inside their ovarian vault. That can send mixed signals to the brain, making it more difficult for the body to select one dominant follicle to mature and ovulate. Instead of ovulating regularly, ovulation may be delayed or may not happen at all.
Because ovulation is required for pregnancy to occur, delayed ovulation or anovulation can lead to very long menstrual cycles and make conception much more challenging.
How Fertility Medications Work
The goal of fertility medications is to give your body the extra little nudge it needs to ovulate in order to become pregnant.
For women with PMOS, ovulation does not always happen consistently on its own. Fertility medications are designed to encourage your body to ovulate so that pregnancy has the opportunity to occur.
There are several fertility medication options available for women with PMOS. The right medication is not one size fits all. These medications should be used strategically and selected based on the individual, their medical history, and their fertility goals.
Common Fertility Medications for PMOS
There are several fertility medications that may be used for women with PMOS. The right medication depends on the individual and should be selected strategically based on your medical history, symptoms, and fertility goals.
Some of the most common fertility medications include:
Letrozole (Femara)
Clomiphene citrate (Clomid)
Human chorionic gonadotropin (hCG), including Pregnyl and Ovidrel
Progesterone supplements
Metformin
GLP 1 medications
How These Fertility Medications Work
Each fertility medication works a little differently, but they all have the same overall goal: helping you achieve ovulation and, ultimately, pregnancy. Your healthcare provider will recommend the medication that best fits your individual situation.
Letrozole (Femara)
Letrozole was originally developed as a breast cancer treatment. It is an aromatase inhibitor that works by reducing estrogen levels, which can stimulate ovulation. It is increasingly used for ovulation induction, particularly in women with PMOS.
Clomiphene Citrate (Clomid)
Clomiphene citrate works by blocking estrogen receptors. This tricks the body into producing more follicle stimulating hormone (FSH) and luteinizing hormone (LH), which stimulates ovulation. It is commonly used to induce ovulation in individuals with irregular or absent menstrual cycles.
Human Chorionic Gonadotropin (hCG)
Human chorionic gonadotropin (hCG), including medications such as Pregnyl and Ovidrel, mimics the body’s natural LH surge. This helps trigger the final maturation of the egg and ovulation. It is often used alongside other fertility medications in timed cycles.
Progesterone Supplements
Progesterone prepares the uterine lining for implantation and supports early pregnancy. It may be prescribed after ovulation or following assisted reproductive procedures to support the luteal phase.
It is important to remember that when you are trying to conceive, progesterone should only be started after ovulation. Starting progesterone before ovulation can send mixed signals to the brain and may actually prevent ovulation from occurring. While progesterone is an important part of fertility treatment for some women, timing matters.
Metformin
Metformin helps support blood sugar stabilization. It may be used as part of a fertility treatment plan for some women with PMOS.
GLP 1 Medications
GLP 1 medications help support blood sugar regulation and reduce inflammation. They may be considered for some women with PMOS as part of an individualized fertility treatment plan.
Who Is a Good Candidate for Medication?
While we cannot prescribe fertility medications, it is important to have a conversation with your prescribing healthcare provider about whether they may be appropriate for you. As a pelvic floor physical therapist and a pharmacist, our role is to help you understand your options and advocate for the care you deserve.
Current guidelines recommend seeking a referral to a fertility specialist if you have been diagnosed with PMOS and have not conceived after six months of intentionally trying to become pregnant.
Based on what we know about PMOS and infertility, I also believe fertility medications should be part of the conversation early in your pregnancy planning journey. If ovulation is inconsistent or not happening at all, it may not make sense to spend months waiting before discussing treatment options with your provider.
Every person is different, which is why these decisions should always be individualized and made in partnership with your healthcare team.
Possible Side Effects and Risks
Like any medication, fertility medications come with potential side effects and risks. Not everyone experiences these, but it is important to understand what to expect and discuss any concerns with your prescribing healthcare provider.
Letrozole (Femara)
Possible side effects include hot flashes, headaches, fatigue, and dizziness.
Clomiphene Citrate (Clomid)
Possible side effects include hot flashes, mood swings, and bloating. In rare cases, Clomid may increase the risk of ovarian hyperstimulation syndrome (OHSS) or multiple pregnancies.
Human Chorionic Gonadotropin (hCG)
Possible side effects include mild injection site reactions. There is also a risk of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies.
Progesterone Supplements
Possible side effects include bloating, mood swings, headaches, and breast tenderness.
Metformin
Common side effects of metformin include nausea, diarrhea, upset stomach, cramping, gas/bloating, loss of appetite, metallic taste. Rare but potentially serious side effects include B12 deficiency.
GLP 1 Medications
Potential side effects include: nausea, vomiting, diarrhea, constipation, upset stomach, cramping, indigestion, heartburn, feeling full quickly, decreased appetite, belching, and bloating. Potentially serious side effects include: pancreatitis, gallstones, or cholecystitis, dehydration from nausea/vomiting, delayed stomach emptying (gastroparesis), low blood sugar.
Lifestyle Factors That Support Fertility
Fertility medications are just one piece of the puzzle. There are several lifestyle factors that can help support fertility and maximize the effectiveness of your treatment plan.
One of the most important things you can do is start tracking your menstrual cycle before beginning fertility medications. Understanding if and when you are ovulating allows you and your healthcare provider to time medications appropriately and maximize their effectiveness. This is especially important if you are taking progesterone, since using progesterone before ovulation can send your body mixed signals and may actually prevent ovulation from occurring.
Nutrition also plays an important role. We typically recommend an anti inflammatory or Mediterranean style diet because that is what has the strongest evidence for supporting fertility.
Strength training is especially beneficial for women with PMOS. Building muscle mass helps improve blood sugar stabilization, which is a key part of managing PMOS and supporting fertility.
Finally, do not overlook the basics. Prioritizing sleep, managing stress, and taking care of your overall health all play an important role in fertility. They may sound simple, but they truly matter.
When to Consider Other Fertility Treatments
Current guidelines recommend seeking a fertility workup or a referral to a reproductive endocrinologist after six months of trying to conceive if you have been diagnosed with PMOS, endometriosis, or are over the age of 35. If you are under the age of 35 and have no known fertility diagnosis, the recommendation is generally to seek further evaluation after one year of trying to conceive.
While those are the current guidelines, I believe fertility care should be individualized. Fertility is not one size fits all, and there is a biological clock. Your age, how many children you hope to have, and your overall family planning goals all matter when deciding how aggressive your timeline should be.
Be upfront with your healthcare providers about your goals. The more they understand your vision for your family, the better they can help you create a treatment plan that aligns with it.
It is also important to remember that in many states, you can schedule an appointment with a reproductive endocrinologist without a referral. And if reproductive endocrinology is not the right fit for you, there are other fertility treatment options that may align better with your goals and preferences.
Questions to Ask Your Healthcare Provider
If you are considering fertility medications for PMOS, here are a few questions to bring to your next appointment:
How do I know if I’m ovulating consistently?
Which fertility medication do you think is the best fit for me, and why?
How will we know if the medication is working?
When should I start progesterone?
Do I need additional fertility testing before starting medication?
Should my partner have a semen analysis?
At what point would you recommend seeing a reproductive endocrinologist?
Based on my family planning goals, does it make sense to take a more aggressive approach to treatment?
Ready for More Personalized Fertility Support?
If you’re on your fertility journey and are feeling frustrated with the current state of our healthcare system, we understand. We created The Cycle Script because so many women are told to “just keep trying” without receiving a thorough review of their cycle, lifestyle, medications, or overall health.
When you work with us, you’ll first complete our comprehensive intake forms. We carefully review everything you submit, and then a pharmacist and a pelvic floor physical therapist who is also a Pelvic Rehab Fertility Specialist work together to create your personalized action plan.
Your action plan includes individualized nutrition recommendations, a strength training and movement plan, a deeper look into your menstrual cycle and laboratory work, a medication review, a supplement review, and personalized recommendations based on your unique situation.
After you receive your action plan, you’ll also have two weeks of follow up with us. This gives you time to review everything, begin implementing your plan, and ask any questions that come up along the way.
You deserve answers, a plan, and a team that looks at the whole picture. We’d love to help you take the next step on your fertility journey.
