**3.7. Symptomatic treatments**

**Anti-Androgens**: Spironolactone (Aldactone), Cyproterone acetate, Flutamide (Eulexin), Finasteride (Propecia, Proscar)

#### **Anti-Obesity Drugs**: Orlistat (Xenical), Sibutramine (Meridia)

**Metformin:** National Institute for Health and Clinical Excellence recommended in 2004 that women with PCOS and a body mass index above 25 be given metformin when other therapy has failed to produce results. Metformin treatment reduces hyperinsulinemia, LH levels, free testosterone concentrations, in overweight women with PCOs. Metformin improves menstrual cyclicity and increases the frequency of ovulation.

**Clomiphene citrate** (Clomid, Serophene) alone or in combination with weigh loss can be used to induce ovulation or with other, more aggressive, treatments for infertility. Including injection of gonadotropin hormones and assisted reproductive technologies may also be required in women who desire pregnancy and do not become pregnant on Clomid therapy (Gonadotropin injections, hCG , human chorionic gonadotropin, GnRH Lutrepulse).The primary indications for the use of CC is normogonadotropic normoprolactinemic anovulatory infertility i.e. PCOS. Approximately 70-80% of the women will ovulate half of which will conceive.
