Medication or device	Description	Manifestations treated	FDA pregnancy category	Main adverse effects	Typical dosage	Cost*
Clomiphene†	Ovulation induction agent, selective estrogen receptor modulator	Infertility (first-line therapy)19	X	Multiple pregnancy or ovarian hyperstimulation, thromboembolism, visual disturbances	50 to 100 mg daily	$15 for 100 mg daily for 5 days
Eflornithine (Vaniqa)‡§	Inhibits hair growth	Mild hirsutism (second-line therapy)33	C	Mild skin irritation	13.9% cream applied to affected area twice daily	$78 (brand) for 1 30-g tube
Finasteride (Proscar)‡	5-alpha-reductase inhibitor	Hirsutism (weak recommendation because of inconsistent study results)32	X	Hypersensitivity reaction, decreased libido	5 mg daily	$10 (generic) and $273 (brand)
Flutamide‡	Nonsteroidal antiandrogen used mostly for prostate cancer	Hirsutism (safe and effective according to low- to very low-quality evidence) 32	D	Liver toxicity, thrombocytopenia, leukopenia, hot flashes	250 mg once or twice daily32	$32 for 250 mg daily
Hormonal contraceptives (e.g., pill, patch, vaginal ring)‡||	See article for details	Menstrual irregularities, hirsutism, acne (first-line therapy)19,30,32	X	Nausea, headache, spotting, thrombophlebitis, deep venous thrombosis	Varies	Varies
Letrozole (Femara)‡	Nonsteroidal competitive inhibitor of aromatase; inhibits conversion of adrenal androgens	Infertility (first-line therapy)19,29	C	Osteoporosis, thromboembolism, MI, hot flashes, arthralgias	2.5 to 7.5 mg daily for 5 days	$8 (generic) and $128 (brand) for 2.5 mg daily for 5 days
Levonorgestrel-releasing intrauterine system (Mirena)‡	Intrauterine device	Endometrial hyperplasia	X	Amenorrhea, nausea, vomiting; rare complications include the device becoming embedded in the myometrium and uterine perforation	5 years	$815 (not including cost of placement)
		Abnormal uterine bleeding (FDA approved)31
Metformin‡	Insulin-sensitizing agent	Insulin resistance (first-line therapy)	B	Gastrointestinal upset, lactic acidosis, increase in homocysteine levels	1,500 to 2,250 mg daily	$4 for 1,000 mg twice daily
		Menstrual irregularities (second-line therapy added to hormonal contraceptives)
		Hirsutism (third-line therapy added to hormonal contraceptives and spironolactone)19
Spironolactone‡	Antiandrogenic antimineralocorticoid	Hirsutism (second-line therapy added after 6 months of oral contraceptive therapy if not improved)32,33	C	Hyperkalemia, nausea, breast tenderness	50 mg daily to 100 to 200 mg daily	$15 for 100 mg daily
		Acne (second-line therapy)