It depends on if you’re trying to conceive or not? If not trying to conceive birth control pills are often used, sometimes with anti-androgens like spironolactone as well to decrease acne/hair growth more than birth control pills alone. If trying to conceive we use insulin sensitizers like metformin, plus ovulation-inducing tablets – most commonly Clomid or letrozole. Sometimes low-dose shots or IVF (In Vitro Fertilization) is needed. Surgery for PCOS is no longer a good option.