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The management of patients with polycystic ovary syndrome

Nature Reviews Endocrinology volume 10, pages 624–636 (2014)Cite this article

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This article has been updated

Key Points

  • Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women and the major cause of anovulatory infertility and hirsutism; patients have an increased risk of developing type 2 diabetes mellitus and cardiovascular disease

  • Lifestyle interventions such as weight loss and exercise remain the most effective means of regulating menses, preventing progression to type 2 diabetes mellitus and lowering cardiovascular risk

  • Anti-estrogens are the treatment of choice for induction of ovulation; metformin monotherapy might increase frequency of ovulation in patients with menstrual disturbances, but has no proven benefit over weight loss itself

  • Menstrual regulation in women who do not wish to conceive can be achieved by use of combined oral contraceptives or cyclical progestogens

  • If lifestyle interventions prove unsuccessful, metformin, whilst of debatable value for the treatment of infertility, has a clear role in the management of impaired glucose tolerance in women with PCOS

  • Currently, no evidence from large prospective studies supports the routine use of statins or insulin-sensitizing drugs other than metformin in young women with PCOS

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women. The syndrome is typified by its heterogeneous presentation, which includes hirsutism (a function of hypersecretion of ovarian androgens), menstrual irregularity and infertility (that is due to infrequent or absent ovulation). Furthermore, PCOS predisposes patients to metabolic dysfunction and an increased risk of type 2 diabetes mellitus (T2DM). The aetiology of the syndrome has a major genetic component. Obesity exacerbates the insulin resistance that is a feature of PCOS in many women and amplifies the clinical and biochemical abnormalities. In clinical practice, the choice of investigations to be done depends mainly on the presenting symptoms. The approach to management is likewise dependent on the presenting complaint. Symptoms of androgen excess (hirsutism, acne and alopecia) require cosmetic measures, suppression of ovarian androgen function and anti-androgen therapy, alone or in combination. Ovulation rate is improved by diet and lifestyle intervention in overweight individuals but induction of ovulation by, in the first instance, anti-estrogens is usually required. Monitoring of glucose is important in overweight women and/or those with a family history of T2DM. Metformin is indicated for women with impaired glucose tolerance but whether this drug is otherwise useful in women with PCOS remains debatable.

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Figure 1: Proposed pathogenesis of polycystic ovary syndrome.

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Article 18 October 2019

Selma Feldman Witchel, Helena J. Teede & Alexia S. Peña

Change history

  • 22 July 2014

    In the original version of this article published online the word 'anovulation' in Figure 1 was spelled incorrectly. This error has now been corrected in the HTML and PDF versions of the article.

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Acknowledgements

C.N.J. is supported by an Academy of Medical Sciences Starter Grant for Clinical Lecturers.

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  1. Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, DuCane Road, London, W12 0NN, UK

    Channa N. Jayasena

  2. Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, DuCane Road, London, W12 0NN, UK

    Stephen Franks

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Jayasena, C., Franks, S. The management of patients with polycystic ovary syndrome. Nat Rev Endocrinol 10, 624–636 (2014). https://doi.org/10.1038/nrendo.2014.102

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