Polycystic ovary syndrome: An overview

Polycystic ovary syndrome (PCOS) is a heterogeneous condition that represents a continuous spectrum from asymptomatic women with polycystic ovaries demonstrated on ultrasound through to those with the classic features of infertility, obesity and hyperandrogenaemia. It is now generally believed to be a metabolic and endocrine condition secondary to relative insulin resistance and compensatory hyperinsulinaemia. Hyperinsulinaemia is thought to cause abnormal ovarian androgen metabolism and altered ovarian gonadotrophin response resulting in anovulation, oligoamenorrhoea and features of hyperandrogenism. Logically, therapeutic strategies aimed at correcting the insulin resistance (weight loss and insulin sensitisers) would in theory make more sense than symptom relief. The potential increased risks of cardiovascular disease and non-insulin-dependent diabetes mellitus would also be obviated. In practice, however, several gaps exist in our current knowledge of the pathophysiology of PCOS with resulting challenges in strategies that aim primarily to correct insulin resistance. This article discusses the current understanding and management of polycystic ovary syndrome. Novel future research directions are suggested.