ABSTRACT
Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder amongst women of reproductive age, which is characterized by reproductive and cardiometabolic disturbances with long-term health repercussions. Insulin resistance (IR), impaired glucose tolerance, type 2 diabetes mellitus (DM2), obesity and dyslipidemia occur more in women with PCOS than in age-comparable women without PCOS. Long term data regarding risks or benefits of medical intervention for metabolic dysfunction of PCOS are lacking. Therapies, such as oral contraceptives (OCPs) and anti-androgenic medications used to manage the reproductive manifestations of PCOS, may themselves be the cause of cardiometabolic perturbations. Hence, strategies regarding the management of reproductive issues in PCOS encompass a patient-specific tailored approach. Factors that influence the cardiometabolic side effects arising during treatment of the reproductive manifestations of PCOS (hirsutism/anovulation) are also discussed in this paper in order to build future strategies to minimize the overall cardiometabolic risk.
Subject(s)
Cardiovascular Diseases/prevention & control , Diabetes Mellitus, Type 2/prevention & control , Dyslipidemias/prevention & control , Healthy Lifestyle , Insulin Resistance , Obesity/prevention & control , Polycystic Ovary Syndrome/therapy , Adult , Androgen Antagonists/adverse effects , Androgen Antagonists/therapeutic use , Anovulation/etiology , Anovulation/prevention & control , Cardiovascular Diseases/chemically induced , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Combined Modality Therapy/adverse effects , Contraceptives, Oral/adverse effects , Contraceptives, Oral/therapeutic use , Diabetes Mellitus, Type 2/chemically induced , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/etiology , Disease Progression , Dyslipidemias/chemically induced , Dyslipidemias/epidemiology , Dyslipidemias/etiology , Female , Fertility Agents, Male/adverse effects , Fertility Agents, Male/therapeutic use , Humans , Obesity/chemically induced , Obesity/epidemiology , Obesity/etiology , Polycystic Ovary Syndrome/drug therapy , Polycystic Ovary Syndrome/metabolism , Polycystic Ovary Syndrome/physiopathology , Risk FactorsABSTRACT
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder amongst women of reproductive age. Although PCOS is diagnosed exclusively based on reproductive criteria, it is also a metabolic disorder. Insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, obesity, and dyslipidemia are more common in women with PCOS than in age-comparable women without PCOS. Many of the metabolic abnormalities that manifest in PCOS are worsened by the concurrent incidence of obesity. However, some of these metabolic perturbations occur even in lean women with PCOS and therefore are rightfully recognized as intrinsic to PCOS. The intrinsic factors that produce these metabolic disturbances are reviewed in this paper. The consequences of obesity and the other metabolic aberrations are also discussed. The metabolic perturbations in PCOS patients lead to chronic low-grade inflammation and to cardiovascular impairments that heighten the risk of having cardiovascular disease. Even though many studies have shown an elevation in surrogate biomarkers of cardiovascular disease in PCOS women, it is still not clear to what extent and magnitude the elevation precipitates more frequent and earlier events.
