# PCOS treatments: what the 2023 guideline says > Cycles, skin and hair, mood, fertility and long-term health, in plain English. Category: Conditions · 6 min read · Written by the Splash team · Sources checked October 2026 URL: https://splash.care/learn/conditions/pcos-treatments ## Quick answer - Treatment is matched to what bothers you most: cycles, skin, hair, mood or fertility. - Healthy habits help whatever your weight. Weight stigma has no place in care. - Letrozole is the guideline’s first-choice tablet for ovulation, though practice varies. - Regular check-ups guard against diabetes, blood pressure and womb lining problems. There is no cure for [PMOS](https://splash.care/learn/glossary/pmos) ([PCOS](https://splash.care/learn/glossary/pcos)), but there is a lot you can do about each part of it. The 2023 International Evidence-based [PCOS](https://splash.care/learn/conditions/pcos) Guideline, written with people who have PCOS, is a good guide to what is recommended. Your care should depend on what bothers you most, so use this to ask questions rather than as a prescription. ## Everyday life - Healthy eating and regular movement benefit everyone with PCOS, whatever their weight, because they help insulin, mood and heart health. - The guideline found no single type or intensity of [exercise](https://splash.care/learn/period-care/exercise-on-period) that is better than another. Choose what you enjoy and can keep up. - It also calls for sensitive, non-judgemental care. Weight stigma is a real barrier. You are entitled to respectful support. ## Irregular periods and acne or hair - Combined pills, or [progestogen](https://splash.care/learn/glossary/progestogen), can regulate bleeding, protect the womb lining and reduce [acne](https://splash.care/learn/body-literacy/acne-skin) and unwanted hair. They do not cure PCOS, and signs can return when stopped. - For unwanted hair, medicines such as spironolactone or eflornithine cream (NHS), and hair removal methods like laser or electrolysis, can help. Some of these medicines are not suitable if you could become [pregnant](https://splash.care/learn/fertility-ttc/early-pregnancy-signs), so a [doctor](https://splash.care/learn/conditions/talk-to-your-doctor) will talk to you about it. - Metformin is a diabetes medicine that can help with metabolic features and cycles. The guideline says it has similar results to an active lifestyle approach, and is mostly considered when there are higher metabolic risks. It can upset the tummy at first. - Inositol is a supplement. The evidence is limited, so it is not recommended over medicines. Tell your clinician if you take it. ## Protecting the womb lining If you have fewer than 3 periods a year, the womb lining can thicken and, rarely, lead to womb cancer. The RCOG says progestogen (a short course every few months, a pill, or a hormonal coil) protects it. Overall the chance of womb cancer is low, and routine screening is not recommended. ## Mood, sleep and body image Depression, anxiety, body image distress and eating problems are more common with PCOS. The guideline recommends screening for depression and anxiety in everyone with PCOS, and checking for sleep apnoea (loud snoring plus waking unrefreshed). Talking therapies are effective. Treating the physical features can improve mood too. ## When you want to get pregnant - Not having regular periods does not mean you are not ovulating at all. Some people ovulate irregularly. - The 2023 guideline names letrozole as the first-choice tablet for triggering [ovulation](https://splash.care/learn/glossary/ovulation) in people with PCOS and no other fertility problem. It is used off-label in many countries, so what your clinic offers (letrozole or clomifene) may vary. - Metformin alone can help some, but is less effective. Gonadotrophin injections, keyhole ovarian drilling (NHS), IUI and IVF are other steps. - Take [folic acid](https://splash.care/learn/glossary/folic-acid) and have a pre-pregnancy health chat. PCOS raises the chance of [gestational diabetes](https://splash.care/learn/glossary/gestational-diabetes) and high blood pressure in pregnancy, so tell your midwife. ## Long-term health PCOS raises the chances of type 2 diabetes, high blood pressure, heart disease and fatty liver, as well as womb problems. Ask for blood pressure, weight, cholesterol and blood sugar checks at regular intervals. For many people PCOS is lifelong, so it is worth keeping up regular check-ups. **Myth:** You have to lose weight before anyone will treat your PCOS. **Fact:** Treatments for periods, skin, hair, mood and fertility do not have to wait. Healthy habits help whatever your size. Ask for the help you need. > **Splash says:** write down your top 2 goals (for example “regular periods” or “less acne”) before you see your doctor. Treatments differ depending on what matters most to you. ### When to see a doctor See a GP if you go 3 months or more without a period, you have heavy or prolonged bleeding, signs of low mood or anxiety that are affecting you, or rapidly worsening hair growth or deepening voice. Call 999 or NHS 111 for sudden severe pelvic pain, particularly if you might be pregnant. ## Sources 1. [2023 International Evidence-based Guideline for PCOS (Teede et al., Human Reproduction)](https://pmc.ncbi.nlm.nih.gov/articles/PMC10477934/) 2. [NHS: Polyendocrine metabolic ovarian syndrome (PMOS, formerly PCOS)](https://www.nhs.uk/conditions/polyendocrine-metabolic-ovarian-syndrome-pmos/) 3. [RCOG: PCOS and what it means for your long-term health](https://www.rcog.org.uk/for-the-public/browse-our-patient-information/polycystic-ovary-syndrome-pcos-what-it-means-for-your-long-term-health/) 4. [Verity (UK PCOS charity)](https://www.verity-pcos.org.uk/) This is general information, not medical advice. Splash can’t diagnose. If you’re worried, talk to a GP, pharmacist or sexual health clinic. In an emergency call 999 (UK) or 911 (US).