8 - Approaches to lifestyle management in polycystic ovary syndrome

Summary

Introduction

Polycystic ovary syndrome (PCOS), one of the most common hyperandrogenic disorders, affects 4-7% of women. The definition of PCOS is currently based on the presence of hyperandrogenism (either clinical [hirsutism] and/or biochemical [increased testosterone blood levels]), chronic oligo-ovulation/anovulation and polycystic morphology of the ovaries at ultrasound, with the exclusion of other causes of hyperandrogenism such as adult-onset congenital adrenal hyperplasia, hyperprolactinaemia and androgensecreting neoplasms. Insulin resistance and associated hyperinsulinaemia are also now recognised as important pathogenetic factors in determining hyperandrogenaemia in most women with PCOS, particularly when obesity is present.

Although significant progress has been made towards the development of universally accepted diagnostic criteria for PCOS, the optimal treatment for women with PCOS has not yet been defined. In general, treatment should aim to improve:

1. ∎ the overall PCOS phenotype

2. ∎ hyperandrogenism and hyperandrogenaemia

3. ∎ menstrual abnormalities such as anovulation

4. ∎ infertility

5. ∎ obesity

6. ∎ insulin resistance and/or associated metabolic disturbances

7. ∎ cardiovascular risk factors.

Treatment should also aim to prevent long-term metabolic (such as type 2 diabetes), neoplastic (such as endometrial cancer) and cardiovascular diseases.

The available interventions include lifestyle modifications, administration of pharmaceutical agents (such as antiandrogens and estro-progestin compounds, clomifene citrate, insulin-sensitising agents, gonadotrophins and gonadotrophin-releasing hormone analogues), the use of laparoscopic ovarian diathermy and the application of assisted reproductive technology (ART).