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Can 4th generation progesterone help me in PCOD/PMOS management?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

I have been dealing with PCOD/PMOS since nine years, and I have thick, coarse facial hair, particularly on my chin, as well as weight gain around my waist and hips. I also experience amenorrhea. I consulted a dermatologist, who is a relative, and she recommended I ask a gynecologist about trying a fourth generation progesterone medication.

Could this be an appropriate treatment?

Kindly help.

Thank you.
Answered by Dr. Ali Osman

Education:

MBBS

Professional Bio:

Dr. Ali Osman is a dedicated obstetrics and gynecology specialist committed to providing compassionate and comprehensive care for women at every stage of life. He has experience in managing a wide range of women’s health concerns, including pregnancy care, menstrual disorders, reproductive health, and gynecological conditions. Dr. Osman focuses on patient education, preventive care, and personalized treatment plans to ensure the best possible outcomes. Known for his supportive and professional approach, he strives to create a comfortable environment where patients feel heard, respected, and confident in their healthcare journey.      

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Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Polycystic ovary syndrome (PCOS/PMOS) is a common hormonal disorder that affects women of childbearing age. It impacts the ovaries, where eggs are stored, but can also affect other parts of the body. In some cases, if left untreated, PCOS/PMOS can lead to serious health complications.

PCOS/PMOS is often linked to issues with ovulation, where the ovaries do not release a mature egg. When ovulation does not occur, small fluid-filled sacs (cysts) can form in the ovaries. These cysts produce higher levels of androgens (male hormones), which can disrupt the menstrual cycle and cause symptoms like excess facial hair and weight gain.

Diagnosis (Rotterdam criteria):

  1. Oligomenorrhea (infrequent periods) or amenorrhea (absence of periods).

  2. Clinical or biochemical signs of hyperandrogenism (for example., excess hair growth, acne).

  3. Ultrasound showing more than 12 follicles in each ovary measuring greater than 22 mm.

Management:

Lifestyle changes: Weight loss and regular exercise are important.

Medications:

  1. Glucophage (Metformin) 500 mg twice a day for five days to help with insulin resistance.

  2. Diane-35 (oral contraceptive) one tablet at night for 21 days, then seven days off.

For excess facial hair: Laser hair removal or waxing are effective options.

Please consult your gynecologist for a personalized treatment plan.

I hope this helps answer your query.

Please let me know if I can assist you further.

Thank you.

Patient's Query

Hello doctor,

Thank you so much for your quick response.

I have been trying to lose weight and have successfully lost some, but my symptoms are still persisting. My previous gynecologist prescribed Syston NCR if my period did not come within 30 days. I have been exercising and making lifestyle changes, but the symptoms have not improved.

Can you prescribe a fourth-generation progesterone? I tried Diane-35 earlier, but it did not suit me due to estrogen dominance.

Thank you.

Answered by Dr. Ali Osman

Education:

MBBS

Professional Bio:

Dr. Ali Osman is a dedicated obstetrics and gynecology specialist committed to providing compassionate and comprehensive care for women at every stage of life. He has experience in managing a wide range of women’s health concerns, including pregnancy care, menstrual disorders, reproductive health, and gynecological conditions. Dr. Osman focuses on patient education, preventive care, and personalized treatment plans to ensure the best possible outcomes. Known for his supportive and professional approach, he strives to create a comfortable environment where patients feel heard, respected, and confident in their healthcare journey.      

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality

Hello,

Welcome back to icliniq.com.

Treatment Plan:

  1. Diet: Consult a dietitian for a personalized plan.

  2. Exercise & weight loss: Regular exercise and weight management are essential.

Medications:

  1. Metformin 500mg: Take twice a day for at least one year. It helps with weight loss and insulin resistance. It may cause mild GI disturbances.

  2. Yasmin (Ethinylestradiol 30mcg + Drospirenone 3mg): Start on the second day of your menstrual cycle, one tablet daily for 21 days, then seven days off. Continue for three months.

Hirsutism:

  1. Laser hair removal or bleaching.

  2. Eflornithine cream: Apply at night to reduce hair growth. Results may be seen in four weeks.

  3. Spironolactone 50mg: Take twice a day for at least two months.

PCOS: Lifestyle modification is the best approach, along with the medications above to manage symptoms.

Please feel free to reach out if you need further assistance.

Thank you.

Patient's Query

Hello doctor,

Thanks for your response.

Could you please share the prescription so I can order the medication online?

Thank you.

Answered by Dr. Ali Osman

Education:

MBBS

Professional Bio:

Dr. Ali Osman is a dedicated obstetrics and gynecology specialist committed to providing compassionate and comprehensive care for women at every stage of life. He has experience in managing a wide range of women’s health concerns, including pregnancy care, menstrual disorders, reproductive health, and gynecological conditions. Dr. Osman focuses on patient education, preventive care, and personalized treatment plans to ensure the best possible outcomes. Known for his supportive and professional approach, he strives to create a comfortable environment where patients feel heard, respected, and confident in their healthcare journey.      

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality

Hello,

Welcome back to icliniq.com.

I have already done.

Please feel free to reach out if you need further assistance.

Thank you.

Patient's Query

Hello doctor,

Thanks for responding Dr.

Answered by Dr. Ali Osman

Education:

MBBS

Professional Bio:

Dr. Ali Osman is a dedicated obstetrics and gynecology specialist committed to providing compassionate and comprehensive care for women at every stage of life. He has experience in managing a wide range of women’s health concerns, including pregnancy care, menstrual disorders, reproductive health, and gynecological conditions. Dr. Osman focuses on patient education, preventive care, and personalized treatment plans to ensure the best possible outcomes. Known for his supportive and professional approach, he strives to create a comfortable environment where patients feel heard, respected, and confident in their healthcare journey.      

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality

Hello,

Thank you.

Answered by Dr. Ali Osman
Medically reviewed by iCliniq medical review team
Published At February 22, 2025
Reviewed At May 29, 2026

Education:

MBBS

Professional Bio:

Dr. Ali Osman is a dedicated obstetrics and gynecology specialist committed to providing compassionate and comprehensive care for women at every stage of life. He has experience in managing a wide range of women’s health concerns, including pregnancy care, menstrual disorders, reproductive health, and gynecological conditions. Dr. Osman focuses on patient education, preventive care, and personalized treatment plans to ensure the best possible outcomes. Known for his supportive and professional approach, he strives to create a comfortable environment where patients feel heard, respected, and confident in their healthcare journey.      

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Ali Osman
Dr. Ali Osman

Obstetrics and Gynecology

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Education:

MBBS

Professional Bio:

Dr. Ali Osman is a dedicated obstetrics and gynecology specialist committed to providing compassionate and comprehensive care for women at every stage of life. He has experience in managing a wide range of women’s health concerns, including pregnancy care, menstrual disorders, reproductive health, and gynecological conditions. Dr. Osman focuses on patient education, preventive care, and personalized treatment plans to ensure the best possible outcomes. Known for his supportive and professional approach, he strives to create a comfortable environment where patients feel heard, respected, and confident in their healthcare journey.      

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality
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