Polycystic ovary syndrome and metabolic syndrome

There has been an upsurge in interest in polycystic ovary syndrome (PCOS) over the last 20–30 years, particularly since the revelation that insulin, by way of end-organ resistance and consequent hyperinsulinemia, has a significant role to play in its pathogenesis. Dramatic changes in lifestyle have led to the current epidemic of obesity in both developed and some developing countries and there are many who believe that this lies at the heart of the rapid rise in the prevalence of PCOS. This condition was previously considered relatively uncommon and predominantly the clinical realm of the gynecologist but it is now recognized as the most common endocrinopathy to affect women of reproductive age and has become a truly multidisciplinary concern owing to the potentially profound metabolic associations and implications for life-long health. There has been much speculation as to the outlook for women with PCOS in mid- and later-life because many develop features that are consistent with metabolic syndrome (MBS). MBS, by definition, is a collection of features that are strongly associated with a risk of cardiovascular disease and Type 2 diabetes. The inference is that there may be a substantial risk of increased morbidity and mortality for women with PCOS that could be prevented or at least moderated many years earlier. This review initially addresses the prevalence of MBS in women with PCOS and the current evidence as to the probable consequences of manifesting both conditions. The review then discusses current and potential therapeutic options for the different stages of a woman’s life.