Diagnosis and management of polycystic ovary syndrome

PCOS is not just a disorder of oligoanovulation, infertility, and hirsutism. PCOS has serious medical consequences that may be reduced by early detection and treatment of PCOS and its associated metabolic and cardiovascular risk factors. The chronic treatment of women with PCOS includes reduction of insulin resistance through lifestyle modification with or without metformin. Improving insulin sensitivity in PCOS increases the frequency of ovulation and may decrease progression to type 2 diabetes and possibly cardiovascular disease. Some of the benefits of metformin therapy in PCOS include weight maintenance and sometimes weight loss, improved insulin sensitivity, and increased ovulation. In those symptomatic women who are not seeking pregnancy, OCPs and antiandrogens may be used to treat hyperandrogenic symptoms such as acne, hirsutism, and alopecia in PCOS. Oligoamenorrhea should be treated with OCPs to prevent endometrial hyperplasia, and subsequent endometrial carcinoma. As for women with PCOS who are seeking pregnancy, available treatments include metformin and clomiphene citrate in addition to lifestyle modification. Metformin alone may induce ovulation in some women with PCOS. If metformin or domiphene monotherapy fail to induce ovulation, the other agent may be added. Further studies are needed to investigate the long-term effects of metformin therapy on cardiovascular disease and diabetes in PCOS.