Polycystic ovarian syndrome – prognosis and treatment outcomes

Abstract

Polycystic ovarian syndrome is the commonest endocrine disorder of reproductive-age women. It may have implications for women with regard to anovulatory infertility, insulin resistance and elevated androgens. Furthermore, patients are prone to health problems in later life, including diabetes and cardiovascular risk. This review provides an update of recent findings for the management of polycystic ovarian syndrome. Studies have been performed to determine the best first-line medication for ovulation induction in polycystic ovarian syndrome. Meta-analyses have been performed to determine whether metformin should be used as an adjunct in IVF in women with this syndrome and to determine whether metformin or the oral contraceptive pill should be used for symptom control. Adverse features of this syndrome can be improved by diet and exercise. Evidence for the longer-term use of metformin to protect against adverse cardiovascular outcomes, and for its pregnancy use to reduce gestational diabetes, preeclampsia, and fetal macrosomia is lacking, although evidence for a reduction in miscarriage in insulin-resistant patients is accumulating. Recent studies have sought to clarify the serious short-term clinical problems faced by women with polycystic ovarian syndrome; however, studies looking to the long term to address cardiovascular and diabetic conversion are still required.