When first-line options do not work or are not suitable, second-line medications may be considered, and this chapter explains them. It notes that some are not specifically licensed for PCOS but are supported by research. Letrozole, originally a breast cancer treatment, is described as an effective way to stimulate ovulation, particularly when clomiphene has not worked. The chapter also covers antiandrogens such as spironolactone, flutamide and finasteride, which block the effects of male hormones to reduce unwanted hair growth. Finally, it discusses anti-obesity medications such as GLP-1 receptor agonists, which are used only alongside lifestyle changes.