Table 1.

Commonly prescribed medications in PCOS.

Generic Name (Brand)/Ref	Mechanism of Action	Purpose of Therapy	Common Side Effects	Contraindications
COCs (estrogen and progestin)
Levonorgestrel/Ethinyl estradiol—LD and HD [100]	Inhibition of ovulation via negative feedback on the hypothalamus alters the regular pattern of gonadotropin secretion of FSH and LH from the anterior pituitary gland	Menstrual cyclicity, hirsutism, acne	Nausea and vomiting (especially at first), breast tenderness, breakthrough bleeding, weight gain, acne or darkening of facial skin, etc.	Oral contraceptives should not be used in women who currently have the following conditions: Thrombophlebitis or thromboembolic disorders A history of deep vein thrombophlebitis or thromboembolic disorders Cerebral vascular or coronary artery disease Known or suspected carcinoma of the breast Carcinoma of the endometrium or other known or suspected estrogen-dependent neoplasia Undiagnosed abnormal genital bleeding Cholestatic jaundice of pregnancy or jaundice with prior pill use Hepatic adenomas or carcinomas Known or suspected pregnancy
Desogestrel/Ethinyl estradiol (Marvelon®, Mircette®) [101]		Menstrual cyclicity	Depression, headache, migraine, mood changes, skin rash, urticaria, decreased or increased libido, weight gain or loss, abdominal pain, diarrhea, nausea and vomiting, breast hypertrophy and tenderness, vaginal discharge, hypersensitivity reactions, etc.
Cyproterone acetate/Ethinyl estradiol (Diane 35®) [102]		Menstrual cyclicity	Dysmenorrhea, breast tenderness, change in libido, headache, depression, nervousness, chloasma, varicosity, edema, dizziness
Drospirenone/Ethinyl estradiol (Yasmin®) [103]		Menstrual cyclicity, hirsutism, acne	PMS, headache or migraine, breast pain/tenderness/discomfort, nausea and vomiting, abdominal pain/tenderness/discomfort, mood changes
Drospirenone/Ethinyl estradiol (Yaz®) [104]		Menstrual cyclicity, hirsutism, acne	Headache or migraine, menstrual irregularities, nausea and vomiting, breast pain or tenderness, mood changes, fatigue, irritability, decreased libido, increased weight
Dienogest/estradiol valerate (Natazia®) [105]		Menstrual cyclicity, hirsutism, acne	Headaches, irregular uterine bleeding, breast tenderness, nausea and vomiting, acne, and increased weight
Chlormadinone acetate/Ethinyl estradiol (Belara®) [106]		Menstrual cyclicity, hirsutism, acne	Breast pain or tension, depressed state, loss of libido, migraine or headache
Progestins
Medroxyprogesterone acetate (Provera®) [107]	Inhibition of secretion of pituitary gonadotropins, Prevention of follicular maturation and ovulation	Menstrual cyclicity,	Amenorrhea, change in menstrual flow, hot flash, weight gain or weight loss, menstrual disease, abdominal pain, headache, nervousness	Undiagnosed abnormal genital bleeding Known, suspected, or history of cancer of the breast Known or suspected estrogen, progesterone dependent neoplasia Active deep vein thrombosis, pulmonary embolism, or a history of these conditions Active or recent arterial thromboembolic disease (e.g., stroke and myocardial infarction) Known liver dysfunction or disease Missed abortion As a diagnostic test for pregnancy Known hypersensitivity to the tablets Known or suspected pregnancy
Biguanides
Metformin (Glucophage®) [108]	↓hepatic glucose production ↓intestinal absorption, ↑insulin sensitivity	Impaired glucose tolerance, type II diabetes	Diarrhea, nausea and vomiting, flatulence, asthenia, indigestion, abdominal discomfort, headache	Severe renal impairment Known hypersensitivity to metformin hydrochloride Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma
Antiandrogens
Spironolactone (Aldactone®) [109]	Competitive antagonistic activity against aldosterone receptors causes potassium retention, sodium and water excretion	Hirsutism, acne	Gynecomastia	Hyperkalemia Addison’s disease Concomitant use of eplerenone
Finasteride (Propecia®) [110]	A competitive and specific inhibitor of Type II 5-alpha-reductase, an enzyme that converts the androgen testosterone into DHT	Hirsutism, acne	Decreased libido, erectile dysfunction, and ejaculation disorder	Pregnancy Hypersensitivity to any components of this product
Antiestrogens
Clomiphene citrate (Clomid®) [111]	Occupying ERs for a longer duration than estrogen, inhibiting normal estrogen negative feedback, which results in increased pulsatile GnRH secretion from the hypothalamus and pituitary gonadotropin release	Ovulation induction	Ovarian enlargement, vasomotor flushes, abdominal-pelvic discomfort/distention/bloating, nausea and vomiting, breast discomfort, blurred vision, lights/ floaters/waves/unspecified visual complaints, photophobia, diplopia, scotomata, phosphenes, headache, abnormal uterine bleeding, intermenstrual spotting, menorrhagia	Hypersensitivity to any components of this product Pregnancy Liver disease or a history of liver dysfunction Abnormal uterine bleeding of undetermined origin Ovarian cysts or enlargement not due to PCOS Uncontrolled thyroid or adrenal dysfunction In the presence of an organic intracranial lesion such as pituitary tumor
Aromatase inhibitors
Letrozole (Femara®) [112]	Nonsteroidal competitive inhibitor of the aromatase enzyme which catalyzes the conversion of androgens to estrogens	Ovulation induction	Hot flashes, arthralgia, flushing, asthenia, edema, arthralgia, headache, dizziness, hypercholesterolemia, sweating increased, bone pain	Women of premenopausal endocrine status, including pregnant women

Abbreviations: COC: Combined oral contraceptives; DHT: Dihydrotestosterone; ER: Estrogen receptor; FSH: Follicle-stimulating hormone; GnRH: Gonadotropin-releasing hormone; HD: High dose; IM: Intramuscular; LD: Low dose; LH: Luteinizing hormone; PCOS: Polycystic ovary syndrome; PMS: Premenstrual syndrome; Ref: Reference; XR: Extended-release.