instruction: hi doctor I have been diagnosed with cos for more than years recently I have been doing yoga and doing intermittent fasting for the past months now I got my period twice in april and for may month it is spotting for the last days please help me
output: hi treatment of women with cos should begin with lifestyle measures for those who are obese a combination of weight loss and exercise may stimulate ovulation intermittent fasting is wonderful lifestyle what is your mode of intermittent fasting are you doing 16 or fast and feast have you tried 36 hours fasting please let me know also low carbohydrates diet with no sugary juices and no added sugar is very beneficial if the woman is not overweight or weight loss is ineffective then taking into account potential adverse effects ease and mode of use the woman mi and monitoring needed clomifene citrate or metformin or a combination of the above for women who are taking clomifene citrate I offer ultrasound monitoring during at least the first cycle of treatment to ensure that they are taking a dose that minimise the risk of multiple pregnancy women prescribed metformin may know side effects such as nausea vomiting and other gastrointestinal disturbances if woman known to be resistant to clomifene citrate we can go for laparoscopic ovarian drilling or combined treatment with clomifene citrate and metformin if not already offered as first line treatment or gonadotrophins so there are plenty of options available and you are not alone we can together make a plan for management please give me more details if you have done investigations ultrasound and harmony tests