Polycystic Ovary Syndrome

Endocrine Society Symposium
Wednesday June 16, 2004
3:45 – 5:45 PM

Reviewed by Joelle Escoffery, PhD

Polycystic ovary syndrome (PCOS) is a condition in which the ovaries are enlarged and develop fluid-filled cysts. It is the most common cause of annovulatory infertility. Increased risk of PCOS is correlated with central adiposity. PCOS is associated with hyperinsulinemia, reduced insulin sensitivity, and an increased risk for type 2 diabetes. Approximately 10% to 40% of obese young women with PCOS have impaired glucose tolerance or frank diabetes. In terms of treatment for PCOS, lifestyle change has been shown to be an effective strategy for the short-term improvement of reproductive and metabolic outcomes, and should be the first line of treatment.  With modest weight loss (ie, 5% of body weight), ovulation can be induced, and insulin sensitivity can be improved.  These results are consistent with the Diabetes Prevention Program (DPP), which demonstrated comparable metabolic effects with a modest weight loss.  In terms of pharmacologic therapy, metformin has also been shown to be effective for the short-term treatment of PCOS.  Specifically, metformin has been associated with the induction of ovulation and with the increased the likelihood of pregnancy. Further, metformin use confers an additional benefit to lifestyle treatment. Metformin may also be beneficial for the prevention of recurrent miscarriage and for the prevention of gestational diabetes, although randomized controlled trials in these areas need to be conducted to support the existing observational data. Finally, early intervention with metformin may be possible in order to reduce the incidence of PCOS among high risk teens. In addition to the metabolic and reproductive risks associated with PCOS, there is some evidence to suggest that PCOS is also associated with increased cardiovascular risk.  PCOS has been associated with increased rates of hypertension and dyslipidemia. Although the effect of PCOS on hypertension was attenuated after controlling for body mass index (BMI), the effect on dyslipidemia remained. PCOS has also been associated with a number of emerging risk factors for cardiovascular disease, such as small, dense LDL particles, increased PAI-1, platelet dysfunction, increased C-reactive protein, increased oxidative stress, and increased homocysteine levels. Although PCOS has been associated with increased intima-media thickness, decreased leg blood flow response, and increased coronary artery calcification, there is currently no good evidence to support the relationship between PCOS and cardiovascular mortality.