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This could involve a mixture of lowering the dose

For symptomatic or persistent cysts , or those with concerning features on imaging, surgical intervention may be necessary: Laparoscopic cystectomy : Removal of the cyst whilst preserving the ovary (preferred for younger women) Oophorectomy : Removal of the affected ovary in cases of large, complex, or potentially malignant cysts In women with PCOS , treatment focuses on managing the underlying metabolic and hormonal dysfunction: Lifestyle modification : Weight loss of 510% can restore ovulatory function Metformin : First-line pharmacological treatment for insulin resistance in PCOS Ovulation induction : Letrozole (often used first-line though off-label) or clomifene citrate for women trying to conceive Anti-androgens : Such as co-cyprindiol for severe hirsutism and acne when other treatments have failed (note: co-cyprindiol carries an increased risk of venous thromboembolism) [1] Urgent referral to gynaecology is warranted if there is sudden, severe abdominal pain (suggesting rupture or torsion) or signs of internal bleeding

Studies have also proposed a role in ryanodine receptor modulation, interleukin-1 (IL-1) secretion and endoplasmic reticulum stress-mediated autophagy 7,12,13,14,15

These neuropathic symptoms can sometimes be misinterpreted as joint pain, particularly when affecting the hands, wrists, knees, or ankles

doi: 10.1152/ajpheart.00346.2019 180 TangTWChenH-CChenC-YYenCYLinC-JPrajnamitraRPet al

Homogentisic acid accumulation is relatively innocuous, causing urine to darken on exposure to air, but no life-threatening effects accompany the disease