What is the initial treatment option for a 23-year-old woman desiring pregnancy with symptoms related to polycystic ovarian syndrome (PCOS)?

• A. Liraglutide (Victoza)
• B. Metformin (Glucophage)
• C. Spironolactone (Aldactone)
• D. Finasteride (Proscar)

Answer: (B)

The initial treatment option for a 23-year-old woman desiring pregnancy who is experiencing symptoms related to polycystic ovarian syndrome (PCOS) is metformin. This medication is often used due to its ability to improve insulin sensitivity, which is particularly beneficial in women with PCOS who often have insulin resistance. Metformin not only helps regulate menstrual cycles but also promotes ovulation, making it a suitable choice for women looking to conceive.

Additionally, metformin has been shown to have positive effects on weight management and metabolic abnormalities associated with PCOS, which are important considerations for fertility. Its safety profile during pregnancy further solidifies its role as a preferred first-line treatment for women desiring pregnancy.

Other medications mentioned, such as liraglutide, spironolactone, and finasteride, do not have the same role in managing PCOS in the context of fertility. Liraglutide is primarily used for weight loss and diabetes management rather than directly for fertility issues. Spironolactone is an anti-androgen used for managing hirsutism and is contraindicated in pregnancy. Finasteride is a 5-alpha reductase inhibitor used for conditions like benign prostatic hyperplasia and is also contraindicated in pregnancy due