New conception of polycystic ovary syndrome

The clinical features of polycystic ovary syndrome (PCOS) include hirsutism, acne, amenorrhea, anovulatory infertility and recurrent miscarriages. The endocrine features include elevated androgens and luteinizing hormone levels. The metabolic aspects of this syndrome include hyperinsulinemia, obesity, lipid abnormalities and an increased risk for type 2 diabetes mellitus. In PCOS, hyperinsulinemic insulin resistance plays a pathogenic role, that augments androgen production. Diagnostic criteria for PCOS are hyperandrogenism and ovulatory dysfunction with the exclusion of specific disorders, such as hyperprolactinemia, nonclassic congenital adrenal hyperplasia, Cushing's syndrome, androgen-secreting neoplasm and acromegaly. Therapeutic considerations focus on the management of menstrual irregularities and hyperandrogenemia. Insulin sensitizer treatment has been associated with a reduction in serum androgen and insulin concentration, and with an improvement of ovulation and fertility. Lifestyle modification with weight reduction has proven beneficial and pharmacological therapy with insulin-sensitizing agents has potential benefit in the treatment of the comorbidities in women with PCOS.