Insulin-sensitisers in the treatment of polycystic ovary syndrome.
Polycystic ovary syndrome (PCOS) is a common endocrine condition with reproductive and metabolic implications. In the current setting there is an evolving, yet inadequate, understanding of the pathophysiology, long-term health implications and ideal therapies for women with PCOS. Insulin resistance, secondary to both genetic and lifestyle factors, is integrally involved in the pathogenesis, the metabolic and clinical features and the long-term sequelae of PCOS in a majority of patients. Therapeutic strategies targeting insulin resistance ameliorate clinical features and may reduce long-term sequelae of PCOS, including diabetes. The main benefit of improved insulin resistance is to improve fertility and potentially to improve clinical features of hyperandrogenism and lower androgen levels. Insulin sensitisers also have the potential to delay the development of diabetes and cardiovascular disease in PCOS. Lifestyle therapy is indicated as the first intervention; however, metformin as an insulin sensitising agent has a role in first-line medical therapy in women with PCOS. Further research is needed to define the role of insulin sensitisers in PCOS and to determine the long-term risks and benefits of these therapies.
Teede
Helena J
HJ
Jean Hailes Foundation, Monash Institute of Health Services Research, Monash Medical Centre, Level 1 Block E, Locked Bag 29 Clayton VIC 3168, Australia. helena.teede@med.monash.edu.au
Meyer
C
C
Norman
R J
RJ
D001835:Body Weight / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000517:prevention & control; D004032:Diet; D017277:Drug Approval; D015444:Exercise; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D007333:Insulin Resistance; D008597:Menstrual Cycle / Q000187:drug effects; D008687:Metformin / Q000494:pharmacology / Q000627:therapeutic use*; D009765:Obesity / Q000150:complications / Q000188:drug therapy; D010060:Ovulation / Q000187:drug effects; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D045162:Thiazolidinediones / Q000494:pharmacology / Q000627:therapeutic use
D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D008687:Metformin