Polycystic ovary syndrome and metabolic comorbidities: therapeutic options

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women and the most common cause of anovulatory infertility, affecting 5-10% of the population. Approximately 60-70% of PCOS patients are obese. Although it is well known that obesity is associated with insulin resistance, most studies have shown that impaired insulin sensitivity is present without obesity. Hyper-insulinemia associated with insulin resistance has been causally linked to all features of the syndrome, such as hyperandrogenism, reproductive disorders, acne, hirsutism and metabolic disturbances. PCOS patients often have an atherogenic lipid profile and increased incidence of cardiovascular risk factors and type 2 diabetes. It has been demonstrated that by reducing hyper-insulinemia, insulin-lowering agents might improve endocrine and reproductive abnormalities in PCOS patients, and have numerous beneficial effects on multiple cardiovascular risk factors in PCOS. Metformin is currently the preferred insulin-sensitizing drug for chronic treatment of PCOS and has been shown to improve the metabolic profile, menstrual cyclicity and fertility in women with PCOS, and is associated with weight loss. In this review the metabolic comorbidities of PCOS and their therapeutic options are discussed.