The Polycystic Ovarian Syndrome (PCOS)

Abstract

Polycystic ovary syndrome (PCOS) is a complex and heterogeneous syndrome with an increased risk of cardiovascular morbidities and diabetes involving 6–8 % of women of reproductive age. Insulin resistance (IR) and hyperinsulinism have been known as pathogenetic mechanisms, present in 50–70 % of these women, whereas the metabolic syndrome (MS) prevalence is higher than in age and weight-matched controls. PCOS is defined by hyperandrogenism (clinical or biochemical), chronic anovulation, and/or polycystic ovaries, with the exclusion of adrenal, ovarian, and pituitary disorders. It is characterized by multiple metabolic aberrations, including IR and hyperinsulinemia, a high incidence of impaired glucose tolerance, visceral obesity, inflammation and endothelial dysfunction, hypertension, and dyslipidemia. These aberrations result in an increased risk for diabetes and clinical or subclinical cardiovascular disease. Even in the absence of obesity or MS, patients with PCOS may have IR and increased cardiovascular risks. Parenthetically, high insulin levels affect the hypothalamic–pituitary–ovarian axis function, as well as glucose utilization in peripheral tissues.