Polycystic Ovary Syndrome – An Endocrine and Metabolic Disorder Throughout Life

Journal für Reproduktionsmedizin und Endokrinologie - Journal of Reproductive Medicine and Endocrinology 2015; 12 (4): 222-226

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The etiology and pathogenesis of polycystic ovary syndrome (PCOS) is still a matter of controversies, but it is apparent that hyperinsulinism and insulin resistance (IR) are major determining factors in the development of ovarian hyperandrogenism and chronic anovulation. The consequences of the PCOS extend beyond the reproductive axis. Follow up studies have shown an increase in the incidence of type 2 diabetes mellitus and other elements of metabolic syndrome in PCOS and increased cardiovascular risk, too. It is possible that PCOS and type 2 diabetes mellitus are different clinical manifestations of the same IR syndrome, with their phenotypic differences. It is even more compound as PCOS is not a homogenous group of patients. It is reflected in the diagnostic criteria of PCOS by the Rotterdam PCOS Conference as the diagnostic criteria identify 4 phenotypes of PCOS. The PCOS phenotypes differ in the degree of hyperandrogenism, but differences in hyperinsulinism and obesity have not been studied yet. Management of PCOS depends on the principal goals of the patients (treatment of infertility, diminishing signs of hyperandrogensim, prevention of long term metabolic consequences), but the management should be individualized according to the phenotypes as well. The value of the insulin sensitizer therapy (e. g. metformin, myo-inositol), statins and/or lifestyle modification await further evaluation and it should be integrated in the spectrum of therapeutical options. A challenging task for the future is to assess the individul risk of PCOS patients according to phenotypes and to elaborate personal steps for prevention.