Condition

Polycystic Ovary Syndrome

PCOS - Hormonal disorder causing enlarged ovaries with cysts

65.8M
People Affected
40
Active Trials
1.2M
New Cases/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Lifestyle Modifications (Diet & Exercise)
85% Effectiveness• 95% Confidence• 95% Safety• 3 trials• 1M participants
HIGH EvidenceExcellent ValueDose: 30-60 minutes moderate exercise most days; balanced diet
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
95
DangerousModerateSafe

Time to Effect

3-6 months

Duration

lifetime

Response Rate

70%

Remission Rate

20%

Common Side Effects:

Muscle soreness: 15%
Increased hunger: 10%

Annual Cost of Care

Drug Cost

$0

Monitoring

$800

Side Effects

$0

Total Annual

$800

Cost-Effectiveness

EXCELLENT

QALYs Gained

1.2

0

Cost per Remission

$2,500

Cost per Responder

$714

Treatment Outcomes
Primary Outcomes
Body Weight90 kg
-7% (-6.3 kg)
Free Testosterone5 ng/dL
-20% (-1.0 ng/dL)
HOMA-IR3.5
-15% (-0.5 points)
Ferriman-Gallwey Score18/36
-25% (-4.5 points)
Secondary Benefits
Triglycerides150 mg/dL
-15% (-22.5 mg/dL)
PCOS Quality of Life Scale (PCOSQ)4.5/7
+12% (+0.5 points)
PHQ-9 Score15/27
-20% (-3.0 points)
Common Side Effects
Muscle soreness
+15%
Increased hunger
+10%
2
Combined Oral Contraceptives (COCs)
80% Effectiveness• 90% Confidence• 60% Safety• 1 trials• 5M participants
HIGH EvidenceGood ValueDose: standard low-dose combined pill daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

1-3 months

Duration

long-term

Response Rate

85%

Remission Rate

%

Number Needed to Treat (NNT)

2

Number Needed to Harm (NNH)

10000

Common Side Effects:

Nausea: 15%
Breast tenderness: 10%
Headache: 8%
Mood changes: 7%
Venous Thromboembolism (VTE): 0.01%

Annual Cost of Care

Drug Cost

$200

Monitoring

$75

Side Effects

$50

Total Annual

$325

Cost-Effectiveness

GOOD

QALYs Gained

0.1

Cost per Responder

$382

Treatment Outcomes
Primary Outcomes
Hirsutism Score18/36 points (Ferriman-Gallwey scale)
-30% (-5.4 points)
Free Testosterone50 pg/mL
-60% (-30 pg/mL)
Acne Severity3.0/5.0 (Investigator's Global Assessment scale)
-40% (-1.2 points)
Menstrual Cycle Frequency4 cycles/year (oligomenorrhea)
+200% (+8 cycles/year)
Secondary Benefits
PCOS Quality of Life Scale (PCOSQ) total score50/100 points (lower score indicates worse QoL)
+15% (+7.5 points)
Androstenedione250 ng/dL
-40% (-100 ng/dL)
Common Side Effects
Nausea
+15%
Breast tenderness
+10%
Headache
+8%

Clinical Trial Phases:

Phase 4
3
Metformin
75% Effectiveness• 90% Confidence• 65% Safety• 200 trials• 50K participants
HIGH EvidenceExcellent ValueDose: 1500-2000mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

3-6 months

Duration

long-term

Response Rate

60%

Remission Rate

10%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

10000

Common Side Effects:

Diarrhea: 25%
Nausea: 20%
Abdominal discomfort: 15%
Vitamin B12 deficiency: 8%
Lactic acidosis: 0.001%

Annual Cost of Care

Drug Cost

$75

Monitoring

$150

Side Effects

$50

Total Annual

$275

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.08

Cost per Remission

$2,750

Cost per Responder

$458

Treatment Outcomes
Primary Outcomes
Reduction in Inter-Menstrual Interval90 days
-33.3% (-30 days)
Hirsutism Score (Ferriman-Gallwey)18 points (scale 0-36)
-20% (-3.6 points)
Fasting Insulin20 µIU/mL
-25% (-5 µIU/mL)
Free Testosterone4.5 ng/dL
-20% (-0.9 ng/dL)
Secondary Benefits
Body Mass Index (BMI)32 kg/m²
-3% (-1.0 kg/m²)
Acne Severity Score3 (on a 0-4 scale)
-30% (-0.9 points)
HOMA-IR4.8
-20% (-1.0)
Common Side Effects
Diarrhea
+25%
Nausea
+20%
Abdominal discomfort
+15%

Clinical Trial Phases:

Phase 4
4
Letrozole (for Ovulation Induction)
70% Effectiveness• 85% Confidence• 60% Safety• 28 trials• 12K participants
HIGH EvidenceExcellent ValueDose: 2.5-7.5mg daily for 5 days per cycle
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

1-2 menstrual cycles

Duration

3-6 cycles

Response Rate

70%

Remission Rate

%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

30

Common Side Effects:

Hot flashes: 25%
Headache: 15%
Fatigue: 10%
Dizziness: 7%
Multiple gestation: 5%

Annual Cost of Care

Drug Cost

$200

Monitoring

$750

Side Effects

$50

Total Annual

$1,000

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.8

Cost per Responder

$1,428

Treatment Outcomes
Primary Outcomes
Ovulation Rate per Treatment Cycle5% (spontaneous ovulation rate in anovulatory PCOS)
+1300% (+65 percentage points (e.g., from 5% to 70%))
Live Birth Rate per Patient (within 6 cycles)10% (untreated anovulatory PCOS over similar timeframes)
+200% (+20 percentage points (e.g., from 10% to 30%))
Clinical Pregnancy Rate per Patient (within 6 cycles)15% (untreated anovulatory PCOS over similar timeframes)
+200% (+30 percentage points (e.g., from 15% to 45%))
Serum Total Testosterone60 ng/dL (typical elevated value in PCOS)
-15% (-9 ng/dL)
Secondary Benefits
Ferriman-Gallwey Score (Hirsutism)15/36 (moderate hirsutism)
-10% (-1.5 points)
Endometrial Thickness (mid-cycle)5 mm (early proliferative phase)
+60% (+3 mm (e.g., from 5 mm to 8 mm))
PCOS Health-Related Quality of Life (PCOS-QoL) Score60/100 (lower QoL due to infertility/PCOS symptoms)
+15% (+9 points)
Common Side Effects
Hot flashes
+25%
Headache
+15%
Fatigue
+10%

Clinical Trial Phases:

Phase 4
5
Clomiphene Citrate (for Ovulation Induction)
65% Effectiveness• 85% Confidence• 60% Safety• 45 trials• 25K participants
HIGH EvidenceGood ValueDose: 50-150mg daily for 5 days per cycle
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

1-2 menstrual cycles

Duration

3-6 cycles

Response Rate

60%

Remission Rate

%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

15

Common Side Effects:

Hot flashes: 30%
Ovarian enlargement: 8%
Multiple gestation: 8%
Visual disturbances: 2%

Annual Cost of Care

Drug Cost

$100

Monitoring

$750

Side Effects

$50

Total Annual

$900

Cost-Effectiveness

GOOD

QALYs Gained

0.65

Cost per Responder

$1,500

Treatment Outcomes
Primary Outcomes
Ovulation Rate per Treatment Cycle5% (natural ovulation rate in untreated anovulatory PCOS women)
+1300% (+65 percentage points (from 5% to 70%))
Clinical Pregnancy Rate per Couple (cumulative over 3-6 cycles)2% (natural pregnancy rate in untreated anovulatory PCOS women)
+1150% (+23 percentage points (from 2% to 25%))
Live Birth Rate per Couple (cumulative over 3-6 cycles)1% (natural live birth rate in untreated anovulatory PCOS women)
+1700% (+17 percentage points (from 1% to 18%))
Secondary Benefits
Number of Menstrual Cycles per Year2 cycles/year (typical for oligomenorrhea/amenorrhea in PCOS)
+200% (+4 cycles/year (from 2 to 6 cycles))
PCOS Health-Related Quality of Life (PCOS-QOL scale, 0-100 points)50 points
+15% (+7.5 points)
Common Side Effects
Hot flashes
+30%
Ovarian enlargement
+8%
Multiple gestation
+8%

Clinical Trial Phases:

Phase 4
6
Spironolactone
60% Effectiveness• 80% Confidence• 65% Safety• 9 trials• 8K participants
MODERATE EvidenceGood ValueDose: 50-100mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
65
DangerousModerateSafe

Time to Effect

3-6 months

Duration

long-term

Response Rate

80%

Remission Rate

%

Number Needed to Treat (NNT)

3

Common Side Effects:

Menstrual irregularities: 15%
Dizziness: 8%
Breast tenderness: 7%
Hyperkalemia: 0.1%

Annual Cost of Care

Drug Cost

$75

Monitoring

$75

Side Effects

$20

Total Annual

$170

Cost-Effectiveness

GOOD

QALYs Gained

0.12

Cost per Responder

$212

Treatment Outcomes
Primary Outcomes
Hirsutism Score (modified Ferriman-Gallwey)18 (moderate-severe hirsutism on mFG scale 0-36)
-45% (-8.1 points)
Acne Severity Score (Global Acne Severity Score)7 (moderate acne on a 0-10 scale)
-50% (-3.5 points)
Serum Total Testosterone85 ng/dL
-30% (-25.5 ng/dL)
Serum Free Testosterone12 pg/mL
-35% (-4.2 pg/mL)
Secondary Benefits
Inter-menstrual Interval Length60 days (irregular)
-25% (-15 days)
Quality of Life (PCOS-specific QoL scale)50/100
+15% (+7.5 points)
Systolic Blood Pressure125 mmHg
-5% (-6 mmHg)
Common Side Effects
Menstrual irregularities
+15%
Dizziness
+8%
Breast tenderness
+7%

Clinical Trial Phases:

Phase 4