Polycystic ovary syndrome: metabolic consequences and long-term management

Young women with polycystic ovary syndrome (PCOS) present an increased risk for type II diabetes and cardiovascular diseases. The prevalence of altered glucose tolerance ranges between 20 and 35 % in patients while the prevalence of type II diabetes ranges between 2 and 8 % and seems related to body weight and ethnic group. Moving from the young fertile age to the 40s and the menopause the prevalence of type II diabetes continues to increase compared to the general female population and may reach 10-16 % of PCOS women. However, prevalence of altered glucose tolerance does not increase. Also cardiovascular risk is increased in a large part of young PCOS women but this risk tends to be normalized with age because of the reduction of ovarian androgen secretion and occurrence of ovulatory cycles in at least one third of PCOS women approaching menopause. It may explain the discrepancy between cardiovascular (CV) risk during young age and observed number of CV events. Long-term management should be directed to aggressively treat obesity and altered glucose tolerance. In non-obese patients with normal glucose tolerance it may be wise to wait until the age of 40 before deciding a long-term management of CV risk.