Pathophysiology of polycystic ovary syndrome

The pathophysiology of polycystic ovarian syndrome (PCO) is the subject of many hypotheses and speculations. In particular, the possible intervention in the starting and the maintenance of this syndrome of hyperprolactinemia, androgen hypersecretion, decreased FSH secretion is discussed. A primary abnormality at the level of the GnRH generator responsible for an increase of GnRH pulses frequency and amplitude remains an attractive hypothesis, at least in pure PCO syndrome. However, the possibility that other factors may contribute to the maintenance of a vicious circle of anovulation cannot be neglected. Regarding the treatment of chronic anovulation and hirsutism currently observed in PCO syndrome, only agents acting at the hypothalamic level are efficient, namely: clomiphene citrate for inducing ovulation and antigonadotropic therapies for improvement of hirsutism. These different possibilities are discussed.