Treatment of the polycystic ovary syndrome with lifestyle intervention

Abstract

The polycystic ovary syndrome (PCOS) is a heterogeneous clinical entity defined as the association of hyperandrogenism with chronic anovulation in women without specific underlying disorders of the adrenal and pituitary glands. On the other hand, all features of the metabolic syndrome, particularly insulin resistance and associated hyperinsulinemia, are present in most women with PCOS. Insulin is a physiologic hormone regulating ovarian functions, specifically ovarian steroidogenesis. Hyperinsulinemia may therefore play a pivotal role in favoring the hyperandrogenic state and related clinical and metabolic alterations. In addition, as originally described by Stein and Leventhal (1), obesity is very common in women with PCOS, particularly the abdominal phenotype. There is consistent evidence that obese women with PCOS may be characterized by a different hormonal environment from that observed in their normal-weight counterparts. The main differences include more severe insulin resistance and hyperinsulinemia and a worsened hyperandrogenic state. Menstrual cyclicity and fertility rate are negatively affected by the presence of insulin resistance and hyperinsulinemia and may be further worsened in obese women with PCOS. Weight loss should represent the first-line approach in the treatment of these patients, because it significantly improves hormonal and metabolic abnormalities and may favor spontaneous ovulation and improve fertility rate in most of them. Individualized pharmacologic support aimed at favoring weight loss and maintenance and improving insulin resistance may play a complementary role in lifestyle interventional programs including dietary modifications and appropriate physical activity. Because of its proven effectiveness, this approach should therefore be widely extended in clinical practice. This, in fact, may ultimately be beneficial even in the prevention of diabetes type 2 and cardiovascular diseases, toward which women with PCOS appear to be susceptible.