Polycystic Ovarian Disease: Gynaecological and Metabolic Implications

Abstract

Polycystic ovarian syndrome (PCO) is common in women of reproductive age. This syndrome is characterized by a hyperestro-genic, hyperandrogenic state, and is associated with insulin resistance and compensatory hyperinsulinaemia. The most common presenting complaints of women with PCO are menstrual irregularities, hirsutism, acne and infertility. Regular bleeding can be achieved with the use of cyclic progestin or oral contraceptives. Hirsutism is most often improved by the use of anti-androgens in conjunction with oral contraceptives. Anovulatory infertility in women with PCO generally responds well to ovulation induction with clomiphene citrate. Those who are resistant to this treatment may benefit from anti-androgen therapy to normalize the intra-ovarian milieu or treatment with an insulin-sensitizing medication to correct the underlying metabolic derangement characterized by insulin resistance. Hyperinsulinaemia may play a role in the pathophysiology of menstrual irregularity, hyperandrogenism and infertility in PCO, and is an independent marker for future cardiovascular disease. Chronic anovulation predisposes women to abnormal endometrial proliferation and endometrial cancer. The management of women with PCO should not only be symptom-based, but must also include measures directed at preventing future gynaecological (hirsutism, endometrial cancer), metabolic (diabetes, dyslipidaemia) and cardiovascular (hypertension, coronary artery disease) concerns.