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The polycystic ovary syndrome: treatment with insulin sensitizing agents

Thepolycysticovarysyndrome(PCOS)ischaracterizedby chronic anovulation and hyperandrogenism, and affects an estimated 6±10% of women of reproductive age (i.e. approximately 3.5±5.0 million young women in the USA)[1]. It is the most common cause of female infertility in the USA, and is arguably the most common endocrinopathy affecting young women. Recently it has been appreciated that many, if not most, women with PCOS manifest a form of insulin resistance that is unique and intrinsic to the syndrome [2±4]. The insulin resistance is accompanied by a compensatory hyperinsulinaemia that allows the women to maintain normal glucose tolerance, at least while they are young. Many (50±80%) women with PCOS are also obese, and these women carry an additional burden of insulin resistance that is directly related to their excess adiposity. The insulin resistance of PCOS places affected women at higher risk for the development of glucose intolerance [5±8], hypertension [9±11], dyslipidaemia [9±11] and atherosclerosis [9±11]. Thus, in addition to the recognized problems of infertility and hirsutism, PCOS is also an important general health concern. It may, in fact, represent a major general health issue affecting young women today. For decades the treatment of PCOS has changed little. Standard therapy has been the administration of oral contraceptive pills with or without concurrent administration of an antiandrogen±the most common one being spironolactone. However, because of the recognition of insulin resistance and hyperinsulinaemia as prominent pathophysiologic features of PCOS, insulin sensitizing agents, such as metformin and troglitazone, have recently been proposed as novel therapies for the treatment of PCOS. The aim of this review is to discuss the evidence supporting the use of insulin sensitizing agents in PCOS.