Clinical Review Fortnightly Review

Polycystic ovarian syndrome: the metabolic syndrome comes to gynaecology

BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7154.329 (Published 01 August 1998) Cite this as: BMJ 1998;317:329
  1. Zoe E C Hopkinson, clinical research fellow (z.hopkinson@clinmed.gla.ac.uk)a,
  2. Naveed Sattar, specialist registrar in clinical biochemistryb,
  3. Richard Fleming, consultant grade biochemista,
  4. Ian A Greer, Muirhead professor of obstetrics and gynaecologya
  1. aUniversity Department of Obstetrics and Gynaecology, Glasgow Royal Infirmary University NHS Trust, Glasgow G31 2ER
  2. bUniversity Department of Clinical Biochemistry, Glasgow Royal Infirmary University NHS Trust
  1. Correspondence to: Dr Hopkinson

    Polycystic ovarian syndrome is the most common form of anovulatory infertility.1 Its association with menstrual disturbance and altered hormonal parameters leads many affected women of reproductive age to attend a gynaecology or infertility clinic. The aetiology of the condition is unknown, but recent evidence suggests that the principal underlying disorder is one of insulin resistance, with the resultant hyperinsulinaemia stimulating excess ovarian androgen production. Associated with the prevalent insulin resistance, these women exhibit a characteristic dyslipidaemia and a predisposition to non-insulin dependent diabetes and cardiovascular disease in later life. Thus, polycystic ovarian syndrome seems to have many of the hallmarks of the metabolic syndrome.24 This article focuses on the recent change in attitudes to polycystic ovarian syndrome arising from the link with insulin resistance—a concept that not only has major implications for the health of affected women but also offers a potential for new treatments.

    Summary points

    • It is evident that polycystic ovarian syndrome should no longer be considered a purely gynaecological disorder

    • Affected women seem to have subclinical insulin resistance and a form of the metabolic syndrome that manifests itself in early adult life with gynaecological symptoms

    • They may therefore gain particular benefit from early screening for cardiovascular risk factors, particularly glucose intolerance

    • Intervention with insulin sensitising agents, such as metformin, may play a major role in the future treatment of this condition, with the potential capacity to improve both endocrine and metabolic disturbances and reduce the risk of vascular disease

    • This approach may replace therapies used to treat individual components of polycystic ovarian syndrome such as hirsutism which may reflect a “downstream” feature of this complex metabolic syndrome

    Methods

    This article is derived from a review of recent publications in the relevant subjects of endocrinology, reproductive medicine, and gynaecology. In addition, we conducted a Medline search of …

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